Major NCDs, such as CVD, diabetes, cancer and COPD, are in increasing prevalence. Similar to other low- and middle-income countries, Nepal is facing a triple burden of diseases: communicable diseases, re-emerging diseases and an escalation of NCDs. The burden of CVD is also increasingly affecting developing countries such as Nepal. In a large multi-ethnic population, 9 the OR of AMI for smokers was 2.95, which was higher than that of non-smokers. The risk associated with former smokers decreased to 1.87 times within 3 years after quitting smoking (95% CI: 1.55–2.24) however, there are still residual risks in the 20 years after smoking cessation (1.22, 1.09–1.37). Smokers have an increased risk of non-fatal myocardial infarction compared with non-smokers (odd ratio (OR): 2.95, 95% confidence interval (CI): 2.77–3.14, p < 0.0001), and their risk increased by 5.6% per cigarette. 8 The INTERHEART study 4 was a case–control study conducted in 520 countries (Africa, Asia, Australia, the Middle East, and North and South America) which showed that smoking was one of the most important causes of global AMI, especially in men. 6 However, a number of studies have shown that smoking cessation significantly reduces CVD prevalence. Despite this improvement, smoking prevalence remains high in many of these countries, and no substantial effort has been made in low-income countries to reduce this prevalence. 7 In high-income countries, along with the decreasing prevalence of smoking, a decline in CAD, due to the decline in important risk factors, has been observed over the past few decades. 6 Smoking and passive smoking have been identified as variable risk factors for acute myocardial infarction (AMI) and CAD. 5 In addition, 29% of deaths from coronary heart disease can be attributed to tobacco. Tobacco use is the leading cause of death worldwide, killing 5 million people each year and accounting for 12% of all deaths. 3, 4 Most studies on the risk factors of coronary artery disease (CAD) have been reported from research carried out in Europe and North America, and sufficient information regarding the relative contribution of these risk factors in south Asian communities is still lacking. 1 Of these, age, sex, smoking, obesity, dyslipidaemia, physical inactivity, hypertension and diabetes mellitus are established risk factors for CVD. 2 Tobacco use, unhealthy diet, lack of physical activity, and harmful alcohol use, are four key modifiable behavioural risk factors which contribute the most to the development of NCDs. 1 Each year, 15 million people between the ages of 30 and 69 years die from a NCD, and over 80% of these “premature” deaths occur in low- and middle-income countries, demonstrating an important public health challenge. In conclusion, smoking was found to increase the risk of CAD in the Nepalese population.Ĭardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD) and diabetes have been identified by the World Health Organization (WHO) as the four major non-communicable diseases (NCDs) worldwide. After adjusting for the covariates, current smokers and ex-smokers had an increased risk of CAD (OR: 6.64, 95% CI: 3.64–12.12, p < 0.00001 OR: 1.89, 95% CI: 1.08–3.31, p < 0.012, respectively) compared with non-smokers. However, further adjustment for behavioural risk factors (alcohol use and physical activity) showed that the risk was attenuated by 59% in current smokers. In the subsequent multivariate analysis, adjustment for socio-demographic, cardio-metabolic and psychosocial risk factors showed a steady increase in risk. From stratified socio-demographic, cardio-metabolic, behavioural and psychosocial risk factor analysis, smoking was found to be associated with CAD in almost all subgroups. ![]() ![]() Bivariate analysis showed that the risk of developing CAD in ex-smokers and current smokers was higher (odds ratio (OR): 1.81 (confidence interval (CI): 1.21–2.7) and OR: 5.2 (CI: 3.4–7.97)), with p-values less than 0.004 and <0.00001, respectively, compared to the risk in never smokers. A hospital-based age- and sex-matched case–control study was carried out with a total of 612 respondents. ![]() This study aims to determine the magnitude of smoking as a risk factor for CAD in the Nepalese population. ![]() Among them, smoking is one of the most prominent and modifiable risk factors. There are well-known traditional risk factors for coronary artery disease (CAD).
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