Chad is world leader in chest pain

NEW YORK (Reuters Health) - A new survey of chest pain reports worldwide finds that the most afflicted country is the African nation of Chad, where 24 percent of the population has chest pain.

The study, which included 52 countries, also showed that the fatter you are, the more likely you are to develop chest pain, or angina pectoris.

Angina shares the same risk factors as other types of cardiovascular disease, such as stroke and heart disease, and is itself a risk factor for heart disease, study author Dr. Longjian Liu of Drexel University School of Public Health told Reuters Health. "Therefore, the study of angina is also an indicator of the burden of cardiovascular diseases across nations," Liu noted.

Cardiovascular disease is the number one killer worldwide.

Among the 52 countries included in the survey, Tunisia showed the lowest rate of angina, which affected only two percent of the population. Slovakia, with 19 percent of adults in the study sample reporting chest pain, had the next highest rate, followed by the Russian Federation (17.66 percent), United Arab Emirates (16.33 percent) and Burkina Faso (15 percent).

The U.S. did not participate in the World Health Survey, developed by the World Health Organization, but other studies have indicated that angina affects between one and 10 percent of Americans, Liu noted.

Angina is chest pain that typically occurs in response to activity or stress, which may feel like tightness, heavy pressure, squeezing or crushing pain that usually begins slowly and worsens over the next few minutes before going away. It may quickly subside with medication or rest, but may happen again with additional activity or stress.

Symptoms of angina usually occur when the coronary arteries are narrowed or blocked by hardening of the arteries (atherosclerosis), or by a blood clot, and too little blood reaches the heart as a result.

To track rates of angina worldwide, Liu and his team reviewed data collected from more than 200,000 adult residents of 52 countries that participated in the World Health Survey.

By looking at the rate of angina across multiple countries, the authors were also able to examine the influence of different factors, such as body weight and poverty.

Not surprisingly, they found that people who were overweight or obese were more likely to have chest pain. Among the obese, the rate of angina approached 18 percent, versus only seven percent in people with normal weights, the authors report in the American Journal of Cardiology.

The link between body weight and angina makes sense, Liu noted in an e-mail, because increased body weight is a major cause of atherosclerosis, which is itself a cause of chest pain.

When he and his colleagues examined the interaction between poverty, body weight, and angina, things got more interesting - they saw that being overweight or obese appeared to increase the risk of angina regardless of where people lived, but the risk was higher among those residing in the wealthiest nations.

In relatively wealthy countries, Liu explained, people living in poverty are more likely to be obese, whereas in poor countries, the opposite is true - the wealthier people are relative to their compatriots, the more likely they are to be obese, perhaps because they can better afford junk and processed foods.

In addition, Liu noted, there are signs that being underweight can also increase the risk of angina, suggesting added risk to many of the poorest people living in poorer nations as well.

Chad has fairly low rates of obesity, but an estimated 37 percent of its population is malnourished, according to the U.N. Food and Agriculture Organization. In addition, Chad has relatively few health resources. "The average numbers of physicians and nurses (or) midwives are 0.4 and 2.8 per 10,000 (residents), respectively," Liu said. In contrast, Tunisia has more than 13 doctors and 10 nurses per 10,000 residents, he said.

SOURCE: bit.ly/eY2HHR The American Journal of Cardiology, online December 22, 2010.