Original Article

http://mjiri.iums.ac.ir
Medical Journal of the Islamic Republic of Iran (MJIRI)
Med J Islam Repub Iran. 2018(24 Dec);32.129. https://doi.org/10.14196/mjiri.32.129
[ DOI: 10.14196/mjiri.32.129 ]

Cardiovascular risk factors of hypertension, smoking and

obesity: Emerging concerns among Pathan and Persian
young adults?
Hammad Shah*1, Afrasyab Altaf1, Momin Salahuddin1, Muneeb Ullah Jan2, Adnan Khan3

Received: 30 Dec 2017 Published: 24 Dec 2018

Abstract
Background: Hypertension was considered as a disease of the elderly but due to unhealthy dietary and lifestyle changes its incidence
has increased in younger population. Smoking and obesity are emerging concerns the world is facing globally in younger age groups.
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This study is therefore aimed to identify these cardiovascular risk factors among Pathan and Persian young adults.
Methods: It was a cross-sectional study carried out at multiple undergraduate, postgraduate educational institutes and hospitals using
non-probability convenient sampling among young adults aged between 15 to 40 years for a period of six months from Apr 1st, 2017 to
Sep 30th, 2017. Mean±SD was calculated for continuous variables and categorical variables were expressed as frequencies. Chi-square
test and Fisher exact test were used for statistical analysis.
Results: A total of 708 subjects were included. Mean±SD age was 26.12±3.7 years. Out of 708, 300(42.37%) were smokers with 209
(29.52%) active and 91 (12.85%) passive smokers. Among smokers, 216 (30.5%) were males while 84 (11.87%) were females. A total
of 432 (61.02%) subjects were not doing any exercise, and 636 (89.83%) were consuming junk food. A total of 165 (23.3%) subjects
were overweight, and 15 (2.1%) were obese. Stage-1 hypertension was present in 72 (10.2%), while 16 (2.25%) subjects had stage-2
hypertension.
Conclusion: There is an increased prevalence of cardiovascular risk factors which includes hypertension, smoking, and obesity among
Pathan and Persian young adults.

Keywords: Cardiovascular, Risk factors, Hypertension, Smoking, Obesity, Young adults

Conflicts of Interest: None declared

Funding: None

*This work has been published under CC BY-NC-SA 1.0 license.

Copyright© Iran University of Medical Sciences

Cite this article as: Shah H, Altaf A, Salahuddin M, Ullah Jan M, Khan A. Cardiovascular risk factors of hypertension, smoking and obesity: Emerging
concerns among Pathan and Persian young adults? Med J Islam Repub Iran. 2018 (24 Dec);32:129. https://doi.org/10.14196/mjiri.32.129

Introduction
Hypertension is a global public health concern. About which is causing a total of 7.5 million deaths (1). The hy-
one billion people are suffering from high blood pressure pertension is considered as the silent killer, because it is

______________________________
Corresponding author: Dr Hammad Shah, drhammadshah@gmail.com
↑What is “already known” in this topic:
1. Cardiology Department, Rehman Medical Institute, Peshawar, Pakistan Hypertension, obesity and smoking are already established
2. Medicine Department, Khyber Teaching Hospital, Peshawar, Pakistan causes of adverse cardiovascular events. Previously
3. Paediatric Department, Rehman Medical Institute, Peshawar, Pakistan
hypertension was considered as a disease of the elderly but now
due to modernization, sedentary lifestyle, mushroom growth of
fast food industry; increase use of in indoor gadgets and
unhealthy dietary habits, obesity is becoming a global concern.

→What this article adds:

Due to increasing obesity and more inclination of young adults
towards smoking, incidence of hypertension is increasing in
younger age groups. This study will help in identification of
these emerging concerns. Highlighting these adverse
cardiovascular hazards will provide evidence for efforts to curb
down and control these risk factors to which our community is
highly ignorant.
 Cardiovascular risk factors in young adults

difficult to diagnose clinically and remains undetected be- 95% confidence interval according to WHO formula:
fore causing complications. It is the most common modifi-
[ DOI: 10.14196/mjiri.32.129 ]

able risk factor to decrease both mortality and morbidity.

Although it is a disease of the elderly but an increasing
number of younger people are becoming victims of silent
however, we included more subjects from multiple cen-
undiagnosed hypertension (2). Due to different socioeco-
ters, to further increase the authenticity of our results. A to-
nomic issues, psychological factors, unhealthy dietary hab-
tal of 708 subjects were included in the study population
its, and sedentary lifestyle an increasing number of younger
from 10 different centers. It included those who gave con-
people are becoming hypertensive (3, 4). As it has numer-
sent for it and had age between 15 to 40 years, belonging to
ous negative impacts on different vital organs of the body
both sexes (male and female), different ethnic background,
includin g heart, brain, kidneys, and eyes, therefore it is
socioeconomic status, and geographical location. Those
very important to diagnose it early to prevent unwanted
subjects who did not give written consent, were taking al-
complications (5).
pha agonists, had nasal obstruction, were suffering from
Smoking has a positive linear relationship with hyperten-
chronic kidney disease, diabetes, pre-ductal or post-ductal
sion mediated by inflammation (6). According to WHO sta-
coarctation of aorta, renal artery stenosis, gestation hyper-
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tistics about 6 million people are killed every year by to-

tension, pre-eclampsia, eclampsia, thyroid hormone abnor-
bacco smoke, of which 10% are passive smokers (7). Ele-
malities, pheochromocytoma were excluded from the
vated resting heart rate is a major cardiovascular risk factor
study.
and leading cause of mortality (8). Smoking decreases heart
Data was collected using a printed performa. It was trans-
rate variability by affecting the autonomic nervous system,
lated to mother tongue language for those who did not un-
hence increasing both cardiovascular mortality and morbid-
derstand English or were Afghans with the help of local
ity (9, 10). No effective legislation exists in our country to
translators.
prevent younger population from hazards of smoking. With
Blood pressure (BP) was determined using a portable
easy availability, lack of awareness and no legislation an
mercury sphygmomanometer, (Certeza CR 2002- San Juan,
increasing number of younger children and adults are be-
Philippines) in sitting position, which was standardized
coming victims of smoking locally (11, 12).
with an arterial BP monitor (iMEC-12: Mindray North
Obesity and smoking are two emerging concerns the
America, United States) of RMI operation theatre. Three
world is facing globally (13). Similar to smoking, obesity
different readings were taken using both hands each 10
has a very paramount negative impact in developing hyper-
minutes of rest apart in sitting position. Average of all the
tension and is a well-established risk factor (14-17). Obe-
three readings was documented as blood pressure of the
sity contributes to different hormonal imbalances and is a
subject. Body Mass Index (BMI) was calculated by divid-
major cause of both mortality and morbidity (18). Use of
ing weight in kilogram (kg) over height in meter square
technology and modernization is limiting our daily physical
(m2). Weight was determined using the portable weight ma-
activities. Rapid growth of fast-food industry, increasing
chine (Westpoint 7007-United States) without shoes and
urbanization, and sedentary lifestyles are further making
extra upper over the clothes. Height was measured in me-
the people vulnerable to obesity.
ters, using a measuring tape and portable stadiometer (seca
Evidence from the aforementioned data identifies hyper-
213-Hamburg Germany), from heel to vertex of the skull
tension, smoking, and obesity as emerging concerns affect-
without shoes.
ing the younger population, thereby making them prone to
Informed written consent was taken from all individuals.
adverse cardiovascular events. This study was therefore
Confidentiality of patients was ensured. This study was ap-
aimed at identifying the prevalence of these cardiovascular
proved by research and ethics committee of RMI, Pesha-
risk factors among young adults of Pathan and Persian pop-
war, Pakistan and abided by the declaration of Helsinki.
ulation. It will help in the early detection of these risk fac-
Data was analyzed using SPSS 20. The Shapiro-Wilk test
tors, and appropriate preventive measures will curb down
was used to assess the normality in the data. Continuous
both cardiovascular mortality and morbidity.
variables were measured as mean ± standard deviation
(SD). Categorical variables like gender, smoking, junk food
Methods intake, exercise activity, BMI, systolic and diastolic blood
This study was carried out at Rehman Medical Institute pressure were expressed as frequencies. Chi-square test
Peshawar (RMI), Rehman Medical College Pesha- was applied to determine the statistical significance
war(RMC), Northwest General Hospital and Research between categorical variables. The Fisher exact test was
Centre Peshawar (NWGH), Khyber Medical University used where sample size was smaller. A p-valve less than
Peshawar (KMU), Hayatabad Medical Complex Peshawar 0.05 was considered significant.
(HMC), Khyber Medical College Peshawar(KMC), Islamia
College University Peshawar (ICUP), University of Engi- Operational Definitions
neering and Technology Peshawar (UET), University of Type-1 Hypertension was defined as a systolic blood
Peshawar (UoP) and Agriculture University Peshawar pressure of 140-159mmHg while type-II hypertension was
(AUP) from Apr 1st, 2017 to Sep 30th, 2017 a period of six defined as >160mmHg on a mercury sphygmomanometer
months. (19).
Subjects were identified via non-probability convenient Active Smoking was defined as exposure to tobacco
sampling. The sample size was calculated as 308, with

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2 Med J Islam Repub Iran. 2018 (24 Dec); 32:129.
 H. Shah, et al.

smoke while puffing the cigarette by himself/herself. Pas- and 84 (11.87%) females as shown in Figure 1.
[ DOI: 10.14196/mjiri.32.129 ]

sive smoking was defined as exposure to tobacco smoke Junk food intake was observed daily in 54(7.6%), on al-
daily while not puffing by himself/herself (20, 21). ternate days in 102(14.4%), twice per week in 276 (39%),
Obesity was determined by evaluating the BMI which weekly in 138 (19.5%) and fortnightly in 66 (9.3%) making
was calculated by dividing the weight of the person in kil- 636 (89.8%) subjects of the total included as shown in Fig-
ogram with the height of the person in meters. A BMI of ure 2.
>30 was considered as obese while BMI between 25-30 A total of 432(61%) subjects were not doing any sort of
was considered as overweight while BMI of 20-24.9 was exercises. In the remaining 276(39%) only 36(5.1%) were
considered as normal weight. A BMI of <20 was consid- doing daily exercise, 50(7%) doing it on alternate days,
ered as underweight (22). 88(12.5%) doing it only twice per week, 84(11.9%) doing
Active lifestyle was defined as at least 20 minutes of it only once per week while 18(2.5%) had other trends as
brisk walk 5 times a week (23). shown in Figure 2.
Both these unhealthy dietary and lifestyle factors are big-
Results gest contributors to obesity. Calculating the BMI,
A total of 708 subjects were included in the study, includ- 151(21.2%) of the subjects were overweight and 15(2.1%)
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ing 465 (62.7%) males and 243 (37.3%) females. Mean age were obese. A total of 513(72.5%) had normal and
was 26.12±3.7 years. 300 (42.37%) subjects were smokers, 30(4.2%) had low BMI as shown in Table 1.
including 209 (29.51%) active smokers and 91 (12.79%) Among 708 patients, 30 (4.2%) had a BP of lower than
passive smokers. Among smokers, 216 (30.5%) were males 100/60mmHg. Normal BP were obtained in 458 (64.6%) of

45.00%
40.00%
35.00%
30.00%
Frequency(%)

25.00%
Males
20.00%
Females
15.00%
10.00%
5.00%
0.00%
Active Smokers Passive Smokers Non Smokers
Fig. 1. Smokers (Active and Passive) and non-smokers frequency distribution by gender

70.00%
60.00%
Frequency(Percentages)

50.00%
40.00%
30.00%
Exercise activity
20.00%
Junk Food Intake
10.00%
0.00%

Fig. 2. Frequency of exercise activity and junk food intake

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Med J Islam Repub Iran. 2018 (24 Dec); 32.129. 3
 Cardiovascular risk factors in young adults

Table 1. Weight distribution by BMI-categories

[ DOI: 10.14196/mjiri.32.129 ]

BMI category Frequency

N (%)
Underweight (BMI<20kg/m2) 30 (4.2%)
Normal (BMI 20-24.9kg/m2) 513 (72.5%)
Overweight(BMI 25-29.9 kg/m2) 151 (21.2%)
Obese (BMI > 30 kg/m2) 15 (2.1%)

Table 2. Frequency of systolic and diastolic blood pressure

Systolic BP Frequency Diastolic BP Frequency
(mmHg) N (%) (mmHg) N (%)
<100 30 (4.2%) <60 30 (4.2%)
100-109 290 (40.9 %) 60-69 290 (40.9%)
110-129 168 (23.7%) 70-79 168 (23.7%)
130-139 132 (18.6%) 80-89 132 (18.6%)
140-159 72 (10.2%) 90-99 72 (10.2%)
>160 16 (2.2%) >100 16 (2.2%)
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subjects. However, 132 (18.6%) of the subjects were in the from stage-1 and 2.2% subjects from stage-2 hypertension.
pre-hypertensive stage. A total of 72 (10.2%) subjects Different studies have established that active individuals
suffered from stage-I hypertension, and stage-II hyperten- and athletes are free from hypertension but obesity, un-
sion was observed in 16 (2.25%) subjects as shown in Table healthy dietary habits, and sedentary lifestyle are the
2. biggest factors contributing to hypertension (31, 32).

Discussion Limitations
Our study showed that 42.37% of young adults are smok- Considering the cross-sectional design of this study we
ers which was comparable with a study done on young were not able to predict the true prevalence in the general
adults of Karachi, which showed 39% smokers. They also population. However, it will serve as a base for further
established several factors responsible for increasing smok- population-based epidemiological studies to bring into
ing trend in young adults. Family smoking behavior and limelight the impact of increased prevalence of cardiovas-
close friends who smoke increase the likelihood of smoking cular risk factors such as hypertension, smoking, and obe-
in subjects (24). sity in young adults.
In our study smoking was more common in male subjects
(30.5%) as compared to females (11.87%). However fe- Conclusion
males were more vulnerable to passive smoking as com- Active smoking is more common in young males while
pared to males. Similar propensity was observed in another young females are victims of passive smoking. Unhealthy
population-based study in which trends of smoking is in- lifestyle, dietary habits and lack of physical activities are
creasing in men as compared to women (25). According to contributing to the increase in obesity. These factors lead to
WHO statistics, 40% of men around the world are smokers an increase in the prevalence of hypertension in young
as compared to 9% women, but women are more prone to adults of Pathan and Persian population.
passive smoking accounting for 64% of the passive smok-
ers globally (26). Besides different social, psychological Recommendation
and genetic norms, easy availability and lack of effective Efforts should be made to curb down the increase in
legislation are major causes of increased prevalence of smoking trend, by raising awareness of general public
smoking in male subjects. However the false belief that it about its hazards. Physical activities, exercise, and healthy
causes weight loss is a major cause of the increasing trend dietary habits should be encouraged. Screening for hyper-
of smoking in young girls. tension should be started at younger ages.
In our study, about 23.3% of young adults had above nor-
mal weights compared to the calculated appropriate Conflict of Interest
weights for their height. There is an increasing concern We all authors certify that we have no conflict of interest
about obesity throughout the world, although the preva- including special financial interest and association relevant
lence of becoming overweight and obese has increased tre- to the subject matter or material discussed in the
mendously (27). Our results showed that 61% of young manuscript.
adults did not perform any sort of exercises and 89.8% of
subjects were consuming junk food. Sedentary lifestyle and
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