“In this country prevalence of CVD risk factors totally and specifically in women are neglected. No remarkable specific studies are conducted to evaluate this growing issue. General studies about the cardiovascular disease have been conducted in 1965, 1973 and 2008 which showed mixed data of cardiovascular disease prevalence in both rural and urban population of Pakistan generally and Karachi especially. During the literature review, I noticed no further remarkable studies have been undertaken. The migration of rural population to urban areas like Karachi has continued over the past decades. As Pakistan’s population are increasing rapidly and the same time increase in emerging lower-middle-class communities. Karachi, largest city and industrial hub of Pakistan, the population of Karachi has increased from 7 million in 1987 to well around 14.9 million as per the 2017 Census [2]. The aim of my study is to report the prevalence of CVD risk factors in women which is leading to many other problems in the selected community of district Malir, Karachi. Other objectives are to analyze the lifestyle in relationship to CVD risk factors in this community.

This study will uncover the risks factors causing cardiovascular disease and De-conditioning, to find out how health education on proper diet/nutrition, weight control, stress management, proper treatment and management of healthy lifestyle can reduce these risks. To determine if person’s lifestyle predispose to cardiovascular disease in women To assess the impact of a prolonged unhealthy diet on the cardiovascular health of women to assess the impact of uncontrolled blood pressure, high blood cholesterol and diabetes on the cardiovascular health of women. To assess if stress is a risk factor for cardiovascular disease among women. To produce awareness of life-threatening conditions of cardiovascular disease and how to manage with them in women of a developing country. To measure the existence of unrecognized risk factors of cardiovascular disease in the blue-collar worker.

Sample selection: I recruited a representative sample (n = 200; 100% participation rate) of adult (≥18 years) females residing in Malir district of Karachi, Sindh, Pakistan. Information related to the general condition and CVD risk factors were collected through a questionnaire, developed after discussions with cardiologists between January to March 2019.

Type of research: This is a Qualitative research study, employed a cross-sectional design, all ethical approvals were obtained; informed written consent was taken from participants individually.

Research Instruments: The study consent and questionnaires were written in English (Translator provided in case of other languages). The questionnaire was then pretested in a pilot study and finalized after necessary amendments. The questionnaire made simple due to the low literacy rates among the women of selected community, all questionnaires were conducted in English, Sindhi, Urdu or Pashto languages and interview-led by myself, The questionnaire interview collected information including demographic characteristics, General condition, lifestyle risk factors including, alcohol consumption, physical activity, type of food intake and cardiac health check-ups, Bodyweight and height measurements were completed with the participant wearing light clothing without shoes and standing motionless with weight and height scale (Seca703, Productnumber7031321993 SECA Hamburg, Germany). World Health Organization guidelines were used to classify underweight, normal or overweight and obese.

Research Execution: In the year 2019 between January and March, a total of 200 women were interviewed, the sample size of this study was based on the need to explore CVD risk factors among women of a developing country. I estimated a sample size of 200 to be adequate to address the primary research question and most of the other research questions. Out of the 200 eligible participants, 200 (100%) participated in the study.

Demographic: Overcrowding in the families are present, this study indicates approx. 1.5 families living together in a house, the structure of the population was an ethnic mixture mostly were recent migrants to Karachi from anterior Sindh, NWFP, and other provinces. The majority were Sindhis followed by Pathans, Punjabi and Baluchi community, while Mohajirs and others were very lass as compare to others, ethnic groups.

CVD risk factors prevalence: Women aged 40 and above are reported as a higher percentage of CVD risk factors 31%. 28% of participants were known cases of diabetes, while big number, 37% were known case of high blood pressure. While 38% were on prolonged medication use due to various diseases including raised blood pressure and diabetes. Family history of CVD risk factors was 39.5%, smoking was less famous due to cultural norms of the community, only 20% of the participants were smoking. Unhealthy food was another risk factors of CVD, almost 46 % of the population eating unhealthy food, it included unhygienic cooking oils, unhygienic meat, and meat products and roadside junk food. Level of obesity was higher, this research showed only 38% of the population of Malir district had healthy weight ( BMI <18.5 to 24.9 kg/m² ), while 31% were overweight ( BMI 25 to 29.9 kg/m² )and 22% had class one obesity ( BMI 30 to 34.9 kg/m² ), 04% were in class two obesity ( BMI 35 to 39.9 kg/m² ) and 1% were in class three obesity ( BMI >40 kg/m² ). Due to poor nutrition around 4% of women were underweight (BMI <18.5 kg/m²). Physical exercise is very rare for the women of Malir district, only 22% of women were doing physical exercise.

CVD risk factors knowledge: Responsiveness of prevalence of CVD was approximately 51% in all age women, most of the women agreed to question that CVD is a major problem for women in developing countries, majority 38% women think that CVD risk factors cannot be prevented. Education is another problem of this community, 62% of them have no education at all, while 38% were matriculated, 17% had graduate degrees and only 2% were with post-graduate education. Due to this lack of education, a lot of women thinks unlucky events are the cause of CVD risk factors or decondition, 62% women. Consulting with doctor and blood pressure management was not common in this community, only 41% women were visiting doctor. The question regarding smoking and CVD risk factors showed that less than 20% were smoking, and most of them were not sure of the linkage between smoking and CVD risk factors. The answer to the question about high blood pressure showed 37% were known a case of high blood pressure, 51% of women think raised blood pressure is a CVD risk factor, 42% of women replied yes to the question that fatty food can cause CVD risk factors.

LifeStyle: Physical activity was very low among women of this community; Favourite activity is shopping, 1.7 times by women while walking stairs per day were done 6.1 times. The Activity monitoring showed inactive life-style of participants who were essentially home residents. 20% of women are currently smoking. The question, which is the most important factor in choosing food, the first choice was food which provides good taste, 45%. The next factor was food safety, 56% of women mistrusted restaurant food. The cost was not a significant factor in food selection, most of the women were not aware of the nutritional information of the food they were consuming. A most famous type of cosine was Veg & Non-veg, 62%, the vegetarian diet is not common in this community as only 16% were pure vegetarian. Eating outside of the home was 46%, backed food was used by 61%. Use of alcohol is not common due to religious restriction, only 6% women were consuming alcohol. Fast-food consumption, mostly from roadside food carts (Band kabab or local burger) were 46%.

Statistical Analysis

This study presented the results of awareness regarding cardiovascular disease were varied, mainstream seemed to know that CVD risk factor whenever happens was a major problem. The attentiveness regarding the consequence of many CVD risk factors and their role in the origin of cardiovascular disease was absent in the community at large. The awareness from meticulous knowledge is much less. The mix answers possibly due to the type of question, the question requiring to decide or strongly agree replies showed the noticeable disparity between the two choices. Most agreed because it is considered unwise to disagree with expert, but when the choice was to strongly agree which required opinion and prior knowledge the positive responses were significantly less. The prejudice of personal belief causing a major event such as Heart attack was noted when the incidence of CVD risk factors was attributed to luck. Few of replies showed apparent good information while others were dictated by folk bias and not true information so that a significant amount of participants believed that bad luck cause CVD risk factors. No alertness was apparent when we assessed the response to the question that CVD risk factors have no prevention, about half agreed with the proposal.

Chart Number: 1: CVD Risk factors

The responsiveness of CVD risk factors was present in the Malir district but the cultural bias was well-known in some of the participants and fact full knowledge in awareness was missing which is a precondition for motivation towards awareness of CVD risk factors. Life-styles such as overeating, Stress, and low physical exercise was prevalent, research showed one in three subjects was in the same status. Physical activity assessment showed, physical games were not famous in the community, which could be seemed as sedentary. Mainly walking stairs and shopping trips were famous as physical activity, participant’s activities were limited to the home and few visits to the market place. The low physical active lifestyle appears to be a factor [3], much education needs to be communicated to the groups so that they are aware of Heart friendly foods. As per recent reports, industrially developed countries (Asian) have already enlarged their fat intake and increased cholesterol so that in Singapore the fat usage in food has already conceded the 30% of total calories recommendation [1].

Chart Number 2: level of Obesity.

This study illustrates, in Malir district, the prevalence of CVD risk factors are evaluated with the questionnaire are 37% to 49%, which is very high. The similar situation was noted for High blood pressure which 37% for women of this particular community. The increasing trend of CVD risk factors in developing countries is widely reported [1, 4, 5]. Indian urban population’s life-style parallel to ours has also displayed increasing CVD risk factors [6,7]. Urbanization is a phenomenon in developing countries, which is a result of the industrialization and emerging urban communities such as Malir district, which are susceptible to developing danger of CVD risk factors. The cumulative prevalence of the cardiovascular disease in developing countries has been the result of changing lifestyles, acceptance of inactive urban living, whole new patterns of diet, for example, high consumption of red meat, oils, and Ghee. All this along with higher level of stress of city life [7,8], as this research showed 48% of the female population was suffering from various type of mental stress. The Indian prevalence rate of CVD risk factors has clearly increased over the previous ten years, many reports recommend that this surge is related to urbanization and increasing prevalence of risk factors [6,9]. The CVD risk factors in the developing countries are significantly high in an urban area as compared to rural ones [7,9]. If not prevented, the CVD risk factors would develop into unmanageable proportions and shall become a health-related disaster.

The increased CVD risk factors in the Malir district are a significance of the sedentary life-styles and no awareness to CVD risk factors and Heart related disease. Pakistan is in almost similar condition as compare to other developing countries such as India, Bangladesh and Sri Lanka. In Malir district, women’s participation in organized sports is almost absent, they were limited to house activities, congestion is present in the houses, most of the households were contained children. Physical activity is limited to shopping in open market (road side stalls) and mounting stairs. This research pleads the need for enlightening the advancement of physically active life-styles by providing infrastructures of such activities, for example, parks and gyms etc. The city needs to be planned in such a way so that enough infrastructures of parks, gyms and school play grounds are dispersed in the society with common accesses. The education in regards to CVD risk factors or cardiovascular disease and its anticipation should be provided in a manner so that every women can get access. To conclude, this study has shown that the prevalence of CVD risk factors in urban area likes of Malir district has increased over the past few years, awareness of CVD risk factors has not. Community of this study were physically inactive, CVD risk factors safety guidelines need to be advanced for whole nation and big data about CVD risk factors need to be generated. Serious efforts should be made or else this nation would end up with the bigger problems of cardiovascular disease and health, eg. A CVD Epidemic, a situation in which prevention will not be possible.

Many other aspects related to this study needs to be elucidated in the future

Special thanks to Professor Farry Bruce Jeffery for his guidance and unconditional support throughout the program. I am thankful to my family, specially my mother Mrs. Laila Rabnawaz for her lot of prayers, many thanks to BFCN & AHS College staff for being helpful, I am very thankful to all research Participant’s for their time and efforts.

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