Conventional risk factors and acute coronary syndrome during a period of socioeconomic transition: population-based case-control study in Tirana, Albania.
OBJECTIVE
To assess the association between conventional risk factors and acute coronary syndrome in Albania, a transitional country in Southeast Europe.


METHODS
A population-based case-control study was conducted in Tirana in 2003-2006. A total of 467 consecutive patients with nonfatal acute coronary syndrome were recruited. There were 370 men with mean+/-standard deviation (SD) age of 59.1+/-8.7 years and 97 women with mean+/-SD age of 63.3+/-7.1 years. The control group comprised a population-representative sample of Tirana residents. In the control group, there were 469 men with mean+/-SD age of 53.1+/-10.4 years and 268 women aged 54.0+/-10.9 years. A structured questionnaire on demographic, socioeconomic, psychosocial factors, and health behaviors was administered. Physical measurements included anthropometrics and blood pressure. Venous blood and adipose tissue aspirations from the gluteal region were frozen-stored for future analysis. Multivariable-adjusted logistic regression was used to assess the independent associations of conventional risk factors with acute coronary syndrome.


RESULTS
Upon adjustment for covariates, family history of coronary heart disease was found to be a strong predictor of acute coronary syndrome in both men (odds ratio [OR], 3.70; 95% confidence interval [CI], 2.58-5.30) and women (OR, 4.53; 2.40-8.57). Waist-to-hip ratio in men (OR, 4.03; 2.83-5.73) and obesity in women (OR, 3.31; 1.54-7.14) were strongly associated with acute coronary syndrome. In men, but not in women, there was a significant association with hypertension and current smoking (P=0.011 and P<0.001, respectively). Diabetes was not significantly independently associated in either sex.


CONCLUSIONS
Classical risk factors predicted coronary heart disease in Albania, similarly as in the rest of the world, although associations with family history and anthropometric indices were stronger. These findings are resulting largely from the heterogeneous adoption of lifestyles conducive to increased coronary risk in transitional countries, and they point to the urgent need for targeted public health interventions.
Burazeri
Genc
G
Department of Public Health, Faculty of Medicine, Tirana, Albania. gburazeri@yahoo.com
Goda
Artan
A
Sulo
Gerhard
G
Stefa
Jonida
J
Roshi
Enver
E
Kark
Jeremy D
JD
D000208:Acute Disease; D017677:Age Distribution; D000415:Albania / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000235:genetics; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D012922:Social Change; D012959:Socioeconomic Factors