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Bangladesh

Bangladeshi Heart Disease

  • A recent study from rural Bangladesh demonstrated a dramatic increase in cardiovascular diseases (CVD) from 1986–2006. The age-standardized CVD mortality rates increased by 30-fold (from 16 deaths per 100,000 to 483 deaths per 100,000) among males and 47-fold (from 7 deaths per 100,000 to 330 deaths per 100,000) in females.1 A 9-fold increase in non-communicable diseases (NCDs) were also observed.1
  • The prevalence and mortality from heart disease among Bangladeshis greatly exceeds that of Europids. As is true of other South Asians, the heart disease is premature in onset, clinically aggressive and angiographically extensive in Bangladeshis (see Malignant Heart Disease).2
  • A study in New York City showed that Bangladeshis had more extensive and severe heart disease with 53% having triple-vessel disease compared to 26% among whites. This occurred despite the fact that Bangladeshis were younger and had lower body mass index and smoking rates with no difference in other risk factors including diabetes compared to whites.2
  • In the INTERHEART Study, Bangladeshis had the highest prevalence of most risk factors compared to people in other South Asian countries.3
  • In the UK, Bangladeshis also have the highest CVD mortality─ higher than Pakistanis and Indians. CAD (coronary artery disease) mortality among Bangladeshis, compared to Europids, was 50% higher 20 years ago and has now increased to 100% higher. The death rates from stroke has also increased and is now three times higher than whites, despite similar access to health care.4
  • In the UK, the high CVD mortality rates is accompanied by a correspondingly high prevalence of traditional risk factors, particularly smoking in men (57%), triglycerides (180 mg/dL), high blood glucose levels (119 mg/dL), and the lowest levels of HDL or good cholesterol (38 mg/dL). The blood pressure, however, was the lowest. Shortness of height is associated with a higher risk of heart attack  and Bangladeshis were the shortest.5
  • Among South Asians in the UK, Bangladeshis were the most disadvantaged in terms of coronary risk factors and have the highest rate of smoking of all ethnic groups.6 They also had the highest rates of diabetes (27%), which was three to four times more common in Bangladeshis than in Europeans.7, 8
  • The prevalence of diabetes in Bangladesh ranges from 8% to 11% with lower rates in rural regions but is increasing in both regions.9-13 Diabetes occurs at a much lower BMI than observed in Europids.9 The prevalence of metabolic syndrome ranges from 38% to 66%.14 

Tobacco Use and Ruthless Misinformation

  • Bangladesh is one of 10 countries that make up two-thirds of the world population of smokers.15 Nearly 40% of the population (144 million) lives on less than a dollar a day. Yet, the country is a lucrative tobacco market, with annual sales of one billion dollars with many rural poor spending 5% of their income for tobacco according to WHO estimates.
  • Data from 2 surveys conducted in 1994 and 2008 showed that smoking declined from 41% in 1994 to 27% in 2008. However, the decline was lower among the poor and the rate remained the same for the female and illiterate.15
  • Low-income earners are more likely to smoke bidis ─ small unfiltered, hand rolled cigarettes that are cheaper than conventional cigarettes ─ than middle- and high-income earners. Those in the lowest income bracket spend the highest proportion of their daily income on tobacco ─ nearly 10%. The total national bidis spending is more than $1 million per day, or $401 million per year, which is 0.4% of the country’s gross domestic product. According to the latest WHO survey, 43% of the adult population and 28% of adult women now use tobacco.
  • The smoking rates among Bangladeshi women is substantially higher than Pakistani or Indian women and is likely to increase even further unless the aggressive, misleading advertisements bombarded at poor Bangladeshi women are immediately halted.15
  • Examples of such ruthless advertisements include: “smoking could make childbirth easier…If a lady smokes, her baby will be smaller and it will be easier to deliver, the labor will be less painful.”; ─”smoking makes you smarter and more manly.”; -”smokers are smarter, more energetic and better lovers than their non-smokers.”15
  • Tobacco advertising was banned in Bangladesh in 2005, so the advertisements are usually fly-posters that do not specify the company behind the message.15

Sources

1. Ahsan Karar Z., Alam N, Kim Streatfield P. Epidemiological transition in rural Bangladesh, 1986-2006. Glob Health Action. 2009;2.

2. Silbiger JJ, Ashtiani R, Attari M, et al. Atheroscerlotic heart disease in Bangladeshi immigrants: risk factors and angiographic findings. Int J Cardiol. Jan 29 2009.

3. Joshi P, Islam S, Pais P, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. Jama. Jan 17 2007;297(3):286-294.

4. www.heartstats.org. CHD Statistics. mortality. 2010. Accessed May 1,2010.

5. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2010.

6. Bhopal R, Unwin N, White M, et al. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ. 1999;319(7204):215-220.

7. McKeigue PM, Marmot MG, Syndercombe Court YD, Cottier DE, Rahman S, Riemersma RA. Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London. Br Heart J. 1988;60(5):390-396.

8.  Harding S, Rosato M, Teyhan A. Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups. Heart. Apr 2008;94(4):463-470.

9. Rahman MM, Rahim MA, Nahar Q. Prevalence and risk factors of type 2 diabetes in an urbanizing rural community of Bangladesh. Bangladesh Med Res Counc Bull. Aug 2007;33(2):48-54.

10. Sayeed MA, Mahtab H, Khanam PA, Latif ZA, Banu A, Khan AK. Prevalence of diabetes and impaired fasting glucose in urban population of Bangladesh. Bangladesh Med Res Counc Bull. Apr 2007;33(1):1-12.

11. Sayeed MA, Mahtab H, Khanam PA, Latif ZA, Banu A, Khan AK. Prevalence of diabetes and impaired fasting glucose in urban population of Bangladesh. Bangladesh Med Res Counc Bull. Apr 2007;33(1):1-12.

12. Hussain A, Rahim MA, Azad Khan AK, Ali SM, Vaaler S. Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh. Diabet Med. Jul 2005;22(7):931-936.

13. Rahim MA, Hussain A, Azad Khan AK, Sayeed MA, Keramat Ali SM, Vaaler S. Rising prevalence of type 2 diabetes in rural Bangladesh: a population based study. Diabetes Res Clin Pract. Aug 2007;77(2):300-305.

14. Rianon NJ, Rasu RS. Metabolic syndrome and its risk factors in Bangladeshi immigrant men in the USA. J Immigr Minor Health. Oct 2010;12(5):781-787.

15. Hanifi SA, Mahmood SS, Bhuiya A. Smoking Has Declined But Not for All: Findings From a Study in a Rural Area of Bangladesh. Asia Pac J Public Health. May 24 2010.

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