Prevalence of cardiovascular disease among Bangladeshi adult population: a systematic review and meta-analysis of the studies

Abstract

Background: Cardiovascular disease (CVD) is a group of conditions affecting the functioning of the heart or blood vessels and is one of the leading causes of death globally. Like other countries, CVD prevalence is also rising among the adults in Bangladesh. Epidemiological studies have shown not only a high CVD prevalence but also a significant increase in its prevalence in Bangladesh in the last few decades. To have a better understanding of the current CVD prevalence scenario, we conducted this systematic review and meta-analysis. Our objective was to assess the prevalence of CVD among the Bangladeshi adult population using evidence from the published scientific literature.

Methods: Electronic databases such as MEDLINE, Embase and PubMed were searched. We also manually checked the references of all relevant publications that describe the prevalence of CVD in Bangladeshi adults. To pool the CVD prevalence, we used random-effects meta-analysis. We assessed heterogeneity using both the formal tests and the subgroup analyses. We also assessed study quality and examined publication bias.

Results: We retrieved 755 potentially relevant papers through searches of electronic and gray literature, of which only 13 met inclusion criteria after the screening and were included in this review. Of the studies that met inclusion criteria, three were carried out in rural populations, five in both urban and rural populations and two in strictly urban populations. Male and female participation in the studies was almost equal. The weighted pooled prevalence of CVD was 5.0%, regardless of the types of CVD, gender and geographical location of the study participants. There was also a high heterogeneity in the observed CVD prevalence. Weighted pooled prevalence of overall CVD in the Bangladeshi population was higher in urban areas (8%) compared to rural areas (2%). However, no such difference was observed in terms of gender (3% for both males and females). The highest reported prevalence (21%) was for heart disease, while the lowest reported prevalence (1%) was for stroke. Sources of heterogeneity were often unexplained. The criteria used to assess study quality were fulfilled by only a few studies, and adequate sample size criteria was missed by almost all of them. In addition, there was evidence of small-study effects.

Conclusion: A high CVD prevalence along with an upward trend was observed in Bangladeshi adults. Proper strategies are required for primary prevention of CVD so that a further increase can be alleviated and the morbidity and mortality associated with it can be reduced.

Keywords: Bangladesh; cardiovascular disease; prevalence; systematic review.

Figure 1

PRISMA diagram for systematic review of studies that evaluated the prevalence of CVD in the Bangladeshi population. Abbreviation: CVD, cardiovascular disease; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Forest plot of prevalence, with 95% CIs of CVD in Bangladeshi population. Notes: ^aExtrapolated prevalence was reported. ^bStudy participants are UGC employees. Abbreviations: CVD, cardiovascular disease; UGC, University Grants Commission; ES, effect size; H, health system and infectious disease site; W, woman abuse tracking in clinic and hospital site; M, Matlab site; IHD, ischemic heart disease; CHD, coronary heart disease.

Figure 3

Forest plot of prevalence, with 95% CIs of CVD in Bangladeshi population, stratified according to the gender of study participants. Abbreviations: CVD, cardiovascular disease; ES, effect size.

Figure 4

Forest plot of prevalence, with 95% CIs of CVD in Bangladeshi population, stratified according to the geographical region of study participants. Notes: ^aExtrapolated prevalence was reported. ^bStudy participants are UGC employees. ^cMost study participants are from urban areas and so were treated as urban residents in the analysis. Abbreviations: CVD, cardiovascular disease; UGC, University Grants Commission; ES, effect size; IHD, ischemic heart disease; CHD, coronary heart disease.

Figure 5

Forest plot of prevalence, with 95% CIs of CVD in Bangladeshi population, stratified according to the type of CVD reported. Notes: ^aExtrapolated prevalence was reported. ^bStudy participants are UGC employees. Abbreviations: CVD, cardiovascular disease; UGC, University Grants Commission; ES, effect size; CHD, coronary heart disease; H, health system and infectious disease site; W, woman abuse tracking in clinic and hospital site; M, Matlab site.

Figure 6

(A) Prevalence of CVD in Bangladesh over the time and (B) prevalence of CVD in Bangladesh over the time (stratified by the CVD type). Abbreviations: CVD, cardiovascular disease; CHD, coronary heart disease.

Figure 7

Funnel plot for the publication bias of the studies that evaluated the prevalence of CVD in Bangladeshi population. Abbreviations: CVD, cardiovascular disease; SE, standard error.