Academic journal article Perspectives in Public Health

A Conceptual Framework for Managing Modifiable Risk Factors for Cardiovascular Diseases in Fiji

Academic journal article Perspectives in Public Health

A Conceptual Framework for Managing Modifiable Risk Factors for Cardiovascular Diseases in Fiji

Article excerpt

INTRODUCTION

The Republic of Fiji, in concert with other developing Pacific Island nations, have seen a decrease in infectious diseases and a significant rise in the prevalence of noncommunicable diseases (NCDs), most notably cardiovascular disease (CVD).1 CVD has become the leading cause of death,1 with proportional mortality increasing from around 20% in the 1960s to over 45% today.2 Limited data are available comparing Fiji's two main ethnic groups (Indigenous- Fijian and Indo-Fijian), though at least one study has found higher CVD mortality rates among Indigenous-Fijian men compared to Indo-Fijian men; after accounting for all other measured risk factors, the relative risk (RR) for CVD mortality was lower among Indo- Fijian men (RR = 0.49, 95% confidence interval (CI): 0.30-0.82) but not women (RR = 0.58, 95% CI: 0.32-1.05).3 The same study also found deaths due to coronary heart disease (CHD) to be higher in urban compared to rural areas.

A cluster of modifiable cardio-metabolic risk factors precede CVD, including obesity, diabetes, high cholesterol and high blood pressure (see Table 1 for guidelines). In turn, modifiable lifestyle risk factors contribute to the development of this cluster of cardio-metabolic conditions (conceptualized in Figure 1). Modifiable lifestyle risk factors include, but are not limited to, physical inactivity, poor dietary choices, cigarette smoking and risky alcohol behavior. Multiple studies have revealed that modifiable risk factors are responsible for a large number of premature deaths due to CVD.17,18 A study by Danaei et al.17 reported that the single largest risk factor for cardiovascular mortality in the United States was high blood pressure, responsible for 45% of all cardiovascular deaths, followed by obesity, physical inactivity, high cholesterol and smoking. Notably, many of these metabolic and lifestyle risk factors are relatively simple to monitor and track (Table 1).

The aim of the current review is to look at cardio-metabolic (overweight-obesity, diabetes, high cholesterol and high blood pressure) and modifiable lifestyle (physical inactivity, poor nutrition, risky alcohol behavior and cigarette smoking) risk factors among Indigenous-Fijian and Indo- Fijian adults in the available literature. The discussion will focus on the causal relationship between modifiable lifestyle risk factors and cardio-metabolic conditions in the Fijian population. The review will finish with recommendations for future direction.

METHODS

Data sources

Electronic databases included PubMed, Medline and Google Scholar. All titles were exported to Endnote and checked for duplicates.

Study inclusion and exclusion criteria

National health surveys were identified where available. Electronic databases identified sources for filling missing data and to support data extracted from national health surveys. Articles were included if they were (1) published in a peer-reviewed English-language journal or government report; (2) controlled studies; (3) cited in health science, nursing or medical literature and (4) for the purpose of the primary end points (Tables 2 and 3), the largest sample studies published between 2002 and 2012. Articles were excluded if they did not meet these criteria. For the purpose of the primary end point, an electronic database search identified 59 articles, of which 4 met the inclusion criteria.

Data extraction and data synthesis

Search terms included Fijian, Indo-Fijian, Indigenous-Fijian, cardiovascular disease, heart disease, overweight, obesity, diabetes, cholesterol, blood pressure, hypertension, alcohol, physical activity, exercise, nutrition, cigarette smoking and tobacco. The most relevant data were identified, organized and synthesized.

RESULTS

Demographics

For the purpose of this review, the term Indigenous-Fijian (iTauki) refers to the original inhabitants of Fiji, who are a mixture of Polynesian and Melanesian descent. …

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