High prevalence of coronary risk factors among bank employees in India

Background: Bank employees are considered to have work situation bearing directly on the health status of individual. Materials and Methods: The employees were subjected to a detailed interview, examination and appropriate laboratory investigations. Data analysis was done using the SPSS 11.5. Results: About 50% of the population had presence of more than, one coronary risk factors. Conclusion: The prevalence of various risk factors for bank employees paralleled the prevalence rates in urban areas as per other studies and hence appropriate counseling and other interventional measures need to be instituted in this vulnerable population, to prevent cardiovascular disease.


INTRODUCTION
Cardiovascular diseases (CVDs) account for 29% of the cause of death, globally. [1]In 2005, there were 16.7 million deaths due to CVD and the fi gure is projected to rise to 19 million in 2020. [2]The working force of the population belong to 30-59 years age group.This age period is also witness to high incidence of coronary heart disease (CHD) in the population at large. [3]The work environment can enhance the CHD risk.There is a defi nite and direct link between work situation and health status. [4]The incidence of stroke and CHD is doubled in the age group of 53-60 years of age. [5]Death before retirement age is often attributed to CHD.CHD accounts for 45% premature male deaths and 18% in females.Work, with its antecedent stresses and strains increases the risk of CHD. [5]Factors that enhance CHD risk at work include; effort reward model, extremes of temperature, highly alert, vigilant job, decision-making, high responsibility, sudden shift from high risk to low risk job.Shift work, alone, has a propensity to cause CHD. [6]In fact, in the European work force, 18% of workers are on shift or overtime. [7]About 40% of the working population work in banking sector.Bank employees are certainly one group to be considered where the work situation would allude to their health status.Our study undertakes the coronary risk assessment in 300 blank employees, so as to quantify the risk and aid to bring out appropriate interventional measures.

MATERIALS AND METHODS
A cross-sectional study using 300 of a total of 1200 bank employees in and around Manipal town, were considered using a purposive sampling.The subjects were interviewed in detail for personal details, lifestyle, 7 item-questionnaire to check knowledge of coronary risk factors followed by complete examination (especially blood pressure [BP], height, weight, hip and waist measurement etc.) and laboratory investigations such as lipid profi le and oral glucose tolerance test (OGTT) were done.
Employment status was divided into three grades based on rank and qualifi cation.Knowledge about coronary risk factors was graded as adequate and inadequate.Body mass index (BMI) was used to assess obesity and waist to hip ratio was measured to assess truncal obesity.BP measurement was used along with history to calculate prevalence of hypertension; similarly OGTT was used along with history to fi nd the prevalence of diabetes and impaired glucose tolerance (IGT). [8]A detailed dietary history was taken using the 24 h dietary recall method.Total daily calorie intake as well as proportion of fat in daily diet was calculated.Data analysis was performed using SPSS Version11.

RESULTS AND DISCUSSION
Of the total 300 subjects, 37% of men belonged to the age group 45-49 years.More than 35% of subjects belonged to the Grade II of employment status.63% were graduates from the sample and 55% belongs to the middle socioeconomic status.Only 39.6% of the sample had correct knowledge about the ill effects of smoking, whereas 39% know that high fat diet is harmful to the heart.Nearly 32% men had poor knowledge of coronary risk factors and 60% of Grade II employees had adequate knowledge of coronary risk factors [Table 1].There is no signifi cant difference in the knowledge of risk factors with respect to educational qualifi cations.This could be attributed to the fact that the media and mass communications have effectively brought the message to the masses. [9]dentary habits were seen in 33% of the subjects, obesity in 4.3%, but truncal obesity in 12.7% of the volunteers.Family history of diabetes is 3.6%, while heart disease is 18.6%.In a study conducted in Trivandrum by Joseph et al. in the year 2000 reported a prevalence of obesity (BMI ≥ 30) 2.3% among man and 9.2% among women. [10]Enas et al. in 1996 observed among Asian Indian physicians, prevalence of obesity among 6.7%. [11]Gupta et al. reported in 1995, 11% of 2212 subjects had truncal obesity. [12]he prevalence of smoking was 16%, in our study; Chadha et  al. 1990 in their study at urban Delhi reported a prevalence of smoking in 36.7% in males over the age of 24 years. [13]Prevalence of alcohol consumption was 10% in the bank employees, whereas Joseph et al. reported 34.4% in Trivandrum city.More than 6% of the subjects consumed >30% of their calories as fats.59% of the subjects reported the use of saturated oil as the cooking medium in their home that is, coconut oil, pam oil or ghee.42% of the bank employees had hypertension.Gupta et al. in 2002 reported from Rajasthan, a prevalence of hypertension among 38.6%, between the ages 30 and 59 years. [14]e high prevalence of hypertension among the bank employers in Manipal is conjectured to be due to occupational stress, sedentary lifestyle, dyslipidemias and the use of saturated fats.Dietary patterns of high salt intake and consumption of saturated fats cannot be ruled out.Use of fi nely grated coconut led to show much dyslipidemia when compared to oils hence, the authors opine that fi nally grated coconut may also play an important role.
Of the 300 bank employees examined, only 212 (70.6%) reported for the investigations viz.Lipid profi le and 196 nondiabetic subjects were subjected to the OGTT.The profi le of nonrespondents to respondents was not much variable and it hence it can be assumed that the study sample would not make a difference in the overall prevalence of risk factors in the study.
Hypercholestrolemia was observed in 50.7% of subjects.Elevated low density lipoprotein was seen in 43.8% low high density lipoprotein we seen in 20.2% hypertriglyceridemia was seen in 35.8% Kutty et al. reported that a prevalence of hypercholestrolemia in 70% of the population in Trivandrum city. [15]Gupta et al. in 1997 reported 21% of urban Rajasthan has compared with rural. [16]opinath et al. in 1990 reported in Delhi in 376 asymptomatic CVD patients, of which 34.9% had hypercholesterolemia. [17] Reddy KS in 1997 in Delhi showed hypercholesterolemia in 36.8% of males in urban areas. [18]Among the bank employees, 11.7% had self-reported diabetes and 8% was diagnosed as diabetes only after OGTT.Kutty et al. in 2000 reported an overall crude prevalence of diabetics to be 60.8% in the 30-50 age group in Trivandrum. [19]upta et al. [20] in 1994 reported from Jaipur in 12.27% diabetes in the 30-59 years age group.Ramachandra et al. showed in 1992 diabetes prevalence in those over 20 years of age to be 8.2% urban in contrast to 2.4% in rural areas, while impaired glucose tolerance test was 8.7% in urban end 7.8 in rural areas.Dowse et al. 1990 in their study reported an age adjusted prevalence of IGT of 16.2% in adult Indian males. [13]e most frequent risk factor in this study was dyslipidemias, diabetes, less physical activity and truncal obesity.Kamlaker et al. in their study at NIRD, Hyderabad found that at least 1 risk factor in was seen in 26%, 2 risk factors in 5.8%, while 14.5% had at least 3 or more risk factors.The study undertaken shows there are high prevalence of risk factors in bank employees.Hence, appropriate interventional measures are needed to halt the evolution of CHD in bank employees.To this end, regular health checks, health education, leisure time activity, reduce radiation, bailout stress, use of ergonomic chairs etc., Kutty et al. 2000 reported and overall crude prevalence of diabetics to be 60.8% in the 39-59 age group in Trivandrum. [15]upta et al. 2002 reported from Jaipur diabetics in 12.27% separately, in the 30-59 age group [Table 2 and 3].
Ramachandra et al. in 1992 reported in their study at Madras a high prevalence of diabetics.The bank employees in contrast to other sectors of workforce have to contend with a stressful, sedentary lifestyle that accelerates their risk of developing CHD. [17]Stable domestic economics further compound their risk for CHD by reduced physical activity and use of saturated fats.3][24][25][26]

CONCLUSION
Cardiovascular disease occurs due to work environment as seen in the statistical fi gures of WHO, where the contributory factors are the heavy stress, demand-output, shift and over time work etc. Urbanization itself contributes to CHD. [27][28][29] Diabetes mellitus is on the rise and is set to be a "CVD."Pollution as bearing upon the individual risk of developing CHD, environmental infl uences and genetic factors play a role in evolution of CHD in an individual.Thus the multi factorial causation of CHD is further compounded by the vagaries of one's employment.Hence, our study stands to defi ne into the South Indian region, the humble statistics that has been worked out by many studies.Similar studies would pave a formidable database to propound any theories in the offi ng.The bank employees form a large sector in the working population.Moreover, there may be preponderance to CHD, in synchrony with all other risk factors affecting the population at large.The prevalence of 2-3 risk factors was quite common and dyslipidemia is the least common denominator for CHD.These fi ndings are in tandem with other studies, conducted in the general population.The section of 30-59 years of the working populace has 40% working as bank employees or related fi elds.% Gupta and Gupta [9] % Singapore Indians [29] 5 IBM Corporation.International Journal of Medicine and Public Health | Oct-Dec 2014 | Vol 4 | Issue 4

Table 1 : Presence of modifi able risk factors of CHD among bank employees
CHD = Coronary heart disease