SYNERGISTIC IMPACT OF OBESITY AND DIABETES ON CARDIOVASCULAR RISK IN PAKISTAN: A SYNDEMIC PERSPECTIVE

Abstract

CVD or Cardiovascular Disease affects developing countries such as Pakistan at a very high rate, due to the co-occurrence of obesity and diabetes, both of which contribute greatly towards increased incidence of cardiovascular disease through syndeic interactions. The study looks at how the combination of obesity and diabetes will affect an individual’s risk of developing cardiovascular disease based on how socioeconomic class and lifestyle affect an individual from Pakistan. We used a cross-section analysis design with data taken from 400 patients aged 18 years and over from both urban and semi-urban health care facilities. The information collected was sociodemographic, clinical and biochemical. Cardiovascular disease risk was defined using existing and validated cardiovascular score systems. Multivariate logistic regression analysis was performed to look at an independent analysis of each individual’s risk factors (obesity, diabetes) and then to look at an interaction effect between the two risk factors on an individual’s risk of developing cardiovascular disease. The average age of participants was 44.2 years (+/- 12.6 years). Prevalence rates in the study for obesity (40%) and diabetes (35%) were significant. The results indicated that there was a significant association between combined obesity/diabetes increased CVD risk based on the chi-square analysis (x2-45.62, P<0.001) and the following adjusted odds ratios; obesity (OR=1.92), diabetes (OR=2.58) and the combination of both risk factors (OR=3.82) indicating a clear synergy. There is also a significant association between a sedentary lifestyle (OR=2.20) and low socioeconomic status (OR=2.10) on increasing an individual’s risk of developing cardiovascular disease. The study provides empirical proof of the syndemic interaction between obesity and diabetes that contributes to the increased risks of developing cardiovascular disease in Pakistan. The results highlight the need for public health initiatives and services to provide integrated strategies in order to address both the biological as well as socioeconomic factors affecting the growing incidence of cardiovascular disease.