Abstract
The leading causes of death in the world are cardiovascular disease (CVD) and stroke according to the World Health Organization, as is also the case in India. There is also a high prevalence of major conventional risk factors in India, where 18.3%, 9.0% and 14.1% of adults are diagnosed with hypertension, diabetes and smoking, respectively. The aim of the present study was to look at the risk of CVD among doctors in our country using a validated tool developed by the National Health Service (NHS) in the UK, the QRISK3 calculator.
Methods
A cross-sectional study was conducted over a period of two months between 1 December 2017 to 31 January 2018 using a standardized questionnaire based on the QRISK3 score developed by the NHS in the UK. The QRISK3 calculator is an online, open source software which allows the user to input 22 parameters; it calculates the 10-year risk percentage of CVD and stroke, as well as the relative risk (RR) compared to age-, sex- and ethnicity-matched controls.
The questionnaire, was sent to doctors across the country using electronic and paper media. Inclusion criteria for administration of the questionnaire consisted of medical doctors who were willing to be included in the study and who were practising in a government or private medical institution. Exclusion criteria included alternative medicine practitioners (who are common in India). Private practitioners were not approached for the purpose of this study.
The questionnaire was administered in a print format directly to a few doctors and electronically via email to doctors in the database of the Indian Medical Association (IMA) as well as through the administrative offices of numerous medical institutions and professional societies all over the country. Confidentiality was ensured throughout.
The responses by each doctor were entered into the QRISK calculator and results calculated. Electronic submission was blocked unless all parameters were completed. The automatic calculator provides a 10-year CVD/stroke risk percentage and RR according to age-, sex- and ethnicity-matched controls from its database.
Results
We received 692 responses during the two months, after which the electronic link was deactivated and distribution of the paper questionnaire was discontinued. Of the responders, 487 (70%) were men. The average age of responders was 39 years with a standard deviation of 12. Their age distribution is shown in Figure 1. Rates of smoking, diabetes, hypertension and body mass index (BMI) are shown in Figures 2 and 3. Of the responders, 356 (51.4%) were unaware of their cholesterol levels, 61 (8.8%) were unaware of their blood pressure readings and 35 (5%) were unaware of their BMI.
Age distribution among responders. Smoking status among responders. Body mass index among responders.
RR distribution among age groups.
RR, relative risk.
RR distribution among BMI categories.
BMI, body mass index; RR, relative risk.
Discussion
The present study highlights that a doctor in India is more than twice as likely to develop CVD and stroke than the general population, despite easy access to healthcare facilities and first-hand knowledge. Many doctors are also unaware of their own blood pressure and cholesterol levels. This indicates that awareness does not automatically translate to correction of risk factors. Occupation-related stress could have led to higher incidence of blood pressure and obesity, consequently increasing the risk of CVD and stroke.
RR distribution among smoking categories.
RR, relative risk.
Footnotes
Acknowledgements
The authors thank the Kochi branch of the Indian Medical Association (IMA) for their support and administering the questionnaire. They also thank Stephen Hippisley-Cox and ClinRisk Ltd for allowing them the use of their software QRISK3 for the purpose of this study.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
