Conventional risk factors and acute coronary syndrome during a period of socioeconomic transition: population-based case-control study in Tirana, Albania

Aim

To assess the association between conventional risk factors and acute coronary syndrome in Albania, a transitional country in Southeast Europe.

Methods

A population-based case-control study was conducted in Tirana in 2003-2006. A total of 467 consecutive patients with nonfatal acute coronary syndrome were recruited. There were 370 men with mean ± standard deviation (SD) age of 59.1 ± 8.7 years and 97 women with mean±SD age of 63.3 ± 7.1 years. The control group comprised a population-representative sample of Tirana residents. In the control group, there were 469 men with mean±SD age of 53.1 ± 10.4 years and 268 women aged 54.0 ± 10.9 years. A structured questionnaire on demographic, socioeconomic, psychosocial factors, and health behaviors was administered. Physical measurements included anthropometrics and blood pressure. Venous blood and adipose tissue aspirations from the gluteal region were frozen-stored for future analysis. Multivariable-adjusted logistic regression was used to assess the independent associations of conventional risk factors with acute coronary syndrome.

Results

Upon adjustment for covariates, family history of coronary heart disease was found to be a strong predictor of acute coronary syndrome in both men (odds ratio [OR], 3.70; 95% confidence interval [CI], 2.58-5.30) and women (OR, 4.53; 2.40-8.57). Waist-to-hip ratio in men (OR, 4.03; 2.83-5.73) and obesity in women (OR, 3.31; 1.54-7.14) were strongly associated with acute coronary syndrome. In men, but not in women, there was a significant association with hypertension and current smoking (P = 0.011 and P<0.001, respectively). Diabetes was not significantly independently associated in either sex.

Conclusion

Classical risk factors predicted coronary heart disease in Albania, similarly as in the rest of the world, although associations with family history and anthropometric indices were stronger. These findings are resulting largely from the heterogeneous adoption of lifestyles conducive to increased coronary risk in transitional countries, and they point to the urgent need for targeted public health interventions.The relationship between coronary heart disease and risk factors such as smoking, high blood pressure, diabetes, obesity, and distribution of body fat is well established in developed countries (1-4). However, data on conventional risk factors, their patterns, determinants, and associations with coronary heart disease are scarce for the transitional countries of South East Europe. Unique among former communist countries in Southeast Europe, Albania was under Stalinist communist regime, and following the breakdown of this rigid government in 1990, it experienced a major social, cultural, and economic upheaval (5). Over the past 15 years changes in life-style (diet, tobacco, alcohol consumption, and physical exercise) have taken place, particularly in urban settings (6-8). The available evidence suggests an increase in alcohol intake, particularly among men (6). Smoking appears to have increased too, although smuggling makes it very difficult to validly estimate cigarette consumption in Albania (7). In 2001, the lifetime prevalence of smoking in Tirana was 61% in men and 24% in women (8). Furthermore, in 2001, 49% of men and 58% of women in Tirana reported largely sedentary leisure time activities such as reading and watching television (9). Although there is little information about cardiovascular disease occurrence in Albania, available data suggest that cardiovascular disease mortality may have increased over the past few years (10,11), and that cardiovascular disease morbidity (based on hospital admission counts) in both Tirana and the whole country has been increasing continually in the last decade (10).In this context, we undertook a population-based case-control study of coronary heart disease in Tirana between June 2003 and January 2006. Here, we report on the association of selected conventional risk factors such as smoking, anthropometric indices, hypertension, diabetes, and family history of coronary heart disease with acute coronary syndrome.