Lifestyle Associated Risk Factors Of Cardiovascular Diseases In The Asian Population Assignment Sample

Introduction

Cardiovascular diseases are considered a number one cause for death in the global scenario along with are the leading cause of death in Asian population as well (Ahajournals, 2023). The problem of increasing these factors for the specific disease in Asia refers to the lack of surveillance as well as lacking in proper diagnosis of disease (Ahajournals, 2023). Among the 18.6 million CVD deaths across the globe approximately 58% occurred in Asia which is considered the largest continent in the case of population (Ahajournals, 2023). The prevalence of cardiovascular disease is increasing every day and this is considered the accountability of the 17% of total mortality rate across the globe (Ncbi.nlm.nih.gov, 2023). The escalation of the prevalence of this specific disease is interrelated with the paradigm shift in terms of addressing changes in lifestyle for the affected population (Sterne et al. 2019). This factor includes significant changes in dietary patterns in the form of high consumption of refined carbohydrates along with saturated fats which are associated with the progressive escalation of the disease among the population (Ahajournals, 2023). It is also associated with physical inertia which also plays a crucial role in terms of addressing the prevalence of cardiovascular disease alongside the presence of progressive financial growth and urbanisation.

Background

From the conduction of research based on the appropriate database it can be stated that most of the prevalent cardiovascular diseases are observed in the group of 20 to 29 years who are leading a sedentary lifestyle along with suffering from overweight and obesity (Sterne et al. 2019). The prevalence of these also includes hypertension along with Dysglycemia and smoking among the population who lead sedentary lifestyles and consists of low HDL-C. In addition, it can also be addressed that sedentary lifestyle along with obesity and low HDL-C are considered most prevalent cardiovascular disease risk factors in the Indian population while clustering these factors which increase with advancing age (Senthilkumar and Tamilselvi, 2021). While addressing the gender specific analysis of identifying cardiovascular risk factors, it can be stated that women in the age group of 20 to 39 years are most prevalent for developing cardiovascular risk factors while leading a sedentary lifestyle in the Southern part of Asia (Durrani et al. 2021). On the other hand, addressing the Asian aspects of developing cardiovascular disease it can be stated that the continent faces many issues in terms of preventing cardiovascular disease and providing proper treatment. It is also evident that CVD is considered one of the leading causes of death in Asia which accounts for 35% of total deaths and approximately 39% deaths are caused due to CVD (Ahajournals, 2023). These death statistics are mostly shown for the age group of below 70 years old irrespective of gender and the reasons referred to ischemic heart disease with 47% deaths as well as strokes with 40% of death in this continent (Ahajournals, 2023). In addition, it is also evident that the death rate because of the prevalence of cardiovascular disease is also higher among the countries of southern Asia and India shows the rise of affected population with the statistics of 4.77 million in 2020 (Ncbi.nlm.nih.gov, 2023). However, the total CVD deaths are substantially lower among high income Asian countries including Japan with the death rate of 11% and Israel with the rate of 15% (Ncbi.nlm.nih.gov, 2023).

Figure 1: Mortality rate of cardiovascular disease among the Asian population

The prevailing hypertension alongside lower levels of serum total cholesterol among the Asian population also increases the chance of CVD (Zhao, 2021). In addition, high salt intake in East Asia along with low serum total cholesterol also induced high blood pressure among the population (Tharmaratnam et al. 2018). These reasons are accompanied by an increased rate of serum cholesterol in Asian countries which affects the elevation of fat consumption as well as increasing smoking habits. This factor is considered to be significant in order to increase total cholesterol in blood for many Asian countries (Väisänen et al. 2022). In comparison, East Asian countries such as Japan also show the deduction of smoking as an important strategy in order to reduce CVD and improve health which results in low prevalence of CVD death. Apart from this the prevalence of obese people is also increasing which is considered a significant cause of diabetes mellitus along with glucose intolerance and metabolic syndrome (Kim et al. 2019). These are considered traditional risk factors of CVD for Asian countries as well as western nations. Even though there are databases which signify the prevalence of risk factors for the Asian population while developing cardiovascular diseases, there is a lack of information which addresses the impact of these respects on the population irrespective of gender in Asia (Perini et al. 2018). Hence, it consulted the relevant databases including PubMed and Google Scholar in order to ensure the absence of review on this subject. In the case of systematic literature review where significant challenges, relationships and key issues are shown in chronological order, the following subject is intended to use this approach for addressing the same by focusing on a specific population to describe the role of lifestyle risk factors for developing CVDs.

Research questions and aims 

Cardiovascular disease prevention among the Asian population is considered a prevalent issue for world health. The East Asian population including Japan, Korea, China, Taiwan along with Hong Kong and Thailand have significantly lower prevalence of cardiovascular disease in comparison with Southern Asian countries (Fu et al. 2022). The former group intake low fat intake along with the presence of a lower rate of serum cholesterol which are considered significant factors for developing CVDs among the population. Therefore, it is necessary to understand the lifestyle management factors including dietary intake in terms of understanding the cause of CVD prevalence in the overall Asian population in comparison.

Review aim

To determine the role of risk factors which are associated with the improper management of lifestyle in terms of developing cardiovascular diseases among the Asian population.

Sub aim

1. To identify the role of lifestyle management while controlling the prevalence of cardiovascular disease among the Asian population

Questions

Q.1 What are the significant risk factors of CVD which are associated with lifestyle management?

Q.2 How do these factors affect the development of cardiovascular disease?

Q.3 What are the potential solutions for mitigating these lifestyle risk factors in order to develop cardiovascular diseases?

Perspective and Methodology

Perspective

Lifestyle factors including proper dietary intake along with smoking, alcohol drinking, consuming supplements, low physical activities and sedentary lifestyles are specific reasons for increasing the prevalence of cardiovascular disease across the globe (Tani et al. 2020). In the case of the Asian population, it can be stated that the South Asian communities are at increased risk of developing cardiovascular diseases because of lower income and less accessibility of healthy foods. This factor leads to unhealthy dietary intake and increasing stress (Wu et al. 2020). These factors are followed by leading a sedentary lifestyle with not enough exercise which leads to the physical activity of the population and unhealthy weight gain. In addition, smoking and alcohol consumption are significant reasons among Chinese men in order to develop cardiovascular disease (Yu et al. 2021). These also affect the population by increasing the risk of diabetes and young age as well as the presence of abnormal cholesterol levels in blood. Apart from this, a high sodium intake in diet also induced high hypertension rates among the Asian population and Asians are genetically more sensitive to sodium (Li et al. 2020). This factor leads to an increasing chance of developing cardiovascular disease. Apart from this, lifestyle behaviour such as not getting enough sleep as well as not taking a healthy diet and being physically active while maintaining a healthy body weight and avoiding smoking and limiting alcohol are significant reasons which are predominant in the Asian population in order to induce the risk of cardiovascular disease (Wu et al. 202). Apart from these, several lifestyle choices including socio-economic status of population, level of education as well as family and kin social network along with gender, age and interpersonal influence are significant reasons for increasing the chance of developing this specific disease.

Figure 2: CVD among Asian people

Methodology

The chapter of mythological aspects for the systematic review process is focusing on the lifestyle related risk factors which are significant for developing cardiovascular disease in the Asian population. The methodology part is intended to address the enhanced strategy design while implying quantitative systematic literature review process for the following research subject. This is opted because of enabling the final outcome to be maximally informed and minimally biassed (Klonizakis et al. 2021). It is also associated with addressing the feasibility, appropriateness and effectiveness of the identified research subject. On the other hand, randomisation of information helps in balancing the participant characteristics which helps in attributing the final outcome in order to address the lifestyle related factors for elevating the risk of cardiovascular diseases (Sara et al. 2018). The strategy of searching has been implied for the following research subject is efficient in terms of offering the highest level of evidence of mythological aspect and advocating PRISMA guidelines in order to complete the systematic review. Study design is mostly based on the basic strategic plan for the identification of lifestyle related risk factors which are contemplated to play a crucial role in order to elevate the prevalence of cardiovascular disease among the Asian population (Acciarini et al. 2021). This factor is considered the fundamental aim and question of the research process for the following topic.

PRISMA

The implementation of the PRISMA diagram is associated with the completion of the screening process for the inclusion and exclusion criteria while identifying suitable articles for systematic literature review process (Rethlefsen et al. 2021). This also helps in addressing a detailed distribution of required inclusion and exclusion criteria on the basis of identifying informative articles as well as the use of ethical context in order to maintain the transparent process for conducting review.

Figure 3: PRISMA

Methods: Literature Search Strategy

Inclusion and exclusion technique

The inclusion and exclusion criteria are considered a significant state in order to understand the crucial element for identifying suitable information based on the given study context. It also helps in continuing the overall process along with achievement of desirable outcomes while conducting systematic review processes (Ahlholm et al. 2018). The inclusion and exclusion technique effectively used in the case of writing and collecting literature while reviewing the overall process. This technique is contemplated to play a crucial role in terms of inclining the methodological aspect while selecting potential articles with the aim of achieving desirable results (Bodison and Parham, 2018). This is also used for the given contacts on the basis of identifying lifestyle ref factors which are associated with the development of cardiovascular risk among Asian population and the inclusion and exclusion criteria is as below-

Inclusion

Exclusion

2. Full text PDF are included 3. PR review journals are prioritised while conducting the study 4. Articles on lifestyle risk factors of cardiovascular disease have been collected 5. Articles focusing on the Asian population and the risk of increasing cardiovascular diseases have been collected 6. Narrative research base systematic reviewed article has been collected 7. Authentic source of articles is collected on randomised controlled trial 8. Last 5 years of articles and journals are prioritised while collecting information

1. Non-English language articles are excluded from the list of information 2. Publications without full text PDFs are removed 3. Articles without full information are excluded along with qualitative measurements 4. Any other population in comparison with the Asian have been removed from the list 5. Removal of duplicate and biassed articles 6. Other than randomised control trials, articles are removed

Table 2: Inclusion and exclusion criteria for the systematic review process

PICO

The narrative context of the research in the following systematic literature aspect uses the table of PICO with the aim of maintaining focus in the research process while utilising theoretical aspects. The PICO table for the given context is as follows-

Initial Factors	Terms	Determinants
P	Population	20 years old and above
I	Intervention	exposure of CVD and risk factors
C	Control	Healthy lifestyle, proper dietary intake, limited alcohol consumption, no smoking, exercise and healthy body weight maintenance, regular sleep cycle maintenance and free of Diabetes and Hypertension along with limited salt intake
O	Outcomes	Providence of a balanced diet and low sodium intake, lowering blood pressure and serum cholesterol level along with limited alcohol and no drugs and smoking

Table 1: PICO table for the systematic review process on the lifestyle risk factors of CVD among the Asian population

Database description

This factor of the following review process is associated with the existing information regarding the following research context in terms of addressing the lifestyle related risk factors for developing cardiovascular disease among the Asian population (Rodriguez-Ayllon et al. 2019). This step includes the use of publications which are considered significant databases for accessing information on the given context. These databases are Google Scholar, Cochrane Library, PubMed, ProQuest along with NICE, CINAHL and these are considered significant in terms of collecting efficient information on the following subject.

Scientific databases for the following systematic review process
Database’s names	Illustration	Rationale for using database
PubMed	This is used for accessing biomedical science related research information (Fiorini et al. 2018)	Authentic reference along with proper citation for the biomedical clinical research studies
Cochrane Library	This is important for academic literature along with system literature review system	It is important in terms of providing high quality and independent evidence regarding healthcare related studies. It also helps in informing decision making in the medical field along with medicines and specificities for the healthcare sector related research information
CINAHL	It provides fast and full text pdfs regarding the clinical information	It is associated with full text PDF, nursing journals, evidence based practising information for the clinical field
Alternative search engines for information
ProQuest	It is used in order to access evidence-based practice and clinical review papers	It is associated with information regarding the care services along with academic and governmental information
Google Scholar	It is used for accessing academic literature alongside information in scholarly articles	It helps in providing disciplinary source of information on specific articles and published research topics
NICE guidelines	Clinical information along with evidence-based practices on clinical review process	It helps in accessing information on care process of specific disease condition along with suitable policies and prevention measurements

Table 3: Database description for the literature search strategy on the given research topic

Spider

This initial systematic review-based process helps in focusing on the risk factors which are interlinked with the lifestyle management and are significant causes for elevating the prevalence of cardiovascular health issues. By the implementation of significant searching databases, this spider table is used to conduct the systematic review process which is as follows-

S	Sample	Asian population in between the age group of 20 and consists of every part of Asian population including elderly
P	Phenomena	This factor includes the measurement of the lifestyle related risk factors including dietary supplement, sleep schedule, healthy and balanced meal, weight management, limited alcohol consumption and no smoking and drugs.
D	Design	The implementation of systematic analysis process while using thematic aspects for accessing desirable outcome
E	Evaluation	It includes lifestyle changing factors which are associated with the elevation of CVD prevalence among the Asian population while managing relevant dietary guidelines for a healthy lifestyle
R	Research type	Thematic research along with systematic approach while using the Cochrane review based RoB 2 tool as the part of the quantitative randomised controlled trials

Table 4: Spider table for conducting systematic review process on the given topic

Boolean table

This specific table refers to the similar words which are accountable for addressing the key factors regarding the given research context (Xiao and Watson, 2019). This factor includes lifestyle-based factors, cardiovascular health issues along with clinical guidelines for CVD as well as evidence based review process which are described as follows-

Lifestyle based factors	And	Cardiovascular disease	And	Clinical Guidelines for CVD	And	Evidence based review process	And	Screening process for this
Dietary intake Or Sleep cycle Or Alcohol consumption Or Medicine Or Drug and addiction Or Healthy meals Or Balanced diet Or Weight management Or Lifestyle based disease	Coronary heart disease Or Strokes Or Peripheral arterial disease Or Aortic dysfunction Or High blood pressure Or Cardiac arrest Or Congestive heart failure Or Arrhythmia Or Chest pain Or Shortness of breath Or Coronary artery disease	Limited tobacco use Or Reduction of salt intake in diet Or Consumption of fruit and vegetables Or Regular physical activities Or Avoiding drug addiction Or Limited alcohol consumption Or Balanced meal Or Blood thinning medicine Or Beta blockers Or ACE inhibitors Or Diuretics	Confirmation Or Documents Or Subtraction Or Testimonials	Filtering information Or Evaluation of data Or Shifting Or Examining Or Sorting out Or Presenting

Table 5: Boolean table for the conduction of systematic literature review of given subject

(Source: Self-developed)

Literature review matrix 

This justifies the identification of similar context in literature form where SLR has been performed and maintained quality assessment while using different tools. 

Quality Assessment

Assessment of quality of existing evidence within a conduction of systematic literature review is considered significant while analysing the information (Baethge et al. 2019). Results from the conducted systematic review study could lead to the presence of high biases from the research methodological aspect and has the potential of interrupting the desired outcome. There are several types of tools which can be used in terms of assassin quality of systematic review for a selected topic. These tools are also important to critically appraise the review system along with assessing quality and risk while conducting trials and meeting appraisal checklists for a wide range of study types (Birnie et al. 2019). CASP is considered a such significant quality assessment tool for a systematic review process which helps in appraising the strengths and limitations of any qualitative systematic review process. The process consists of ten questions which indicate the fundamental focus in the different methodological aspects of a qualitative review process in a systematic manner (Wallin et al. 2019). These ten questions are considered CASP checklists and these are developed in terms of using them as a pedagogical teaching tool. These are implied in the case of assessing the quality of a systematic qualitative research process while critically appraising the awareness of these ten questions. These also help in increasing critical thinking while conducting systematic review processes.

On the other hand, RoB 2 tool or risk of bias tool is considered an update of recommended tool in terms of assessing the significant risks of biases in quantitative randomised controlled trials for systematic review (Sterne et al. 2019). This specific tool is structured into a fixed set of domains of bias while conducting a systematic review process. This tool is mostly implied in the case of Cochrane review system while identifying the fundamental protocol development and review development processes. This factor is followed by keeping the fundamental focus on the different aspects which are accountable for study and trial design along with the conduction of the review process and final report (Higgins et al. 2019). The ideal manner of implying this tool includes the planning of key approaches along with the identification of this tool for the subject related issues. This also includes appraising overall study, reporting assessment and using guidelines for the management of quality for a conduction of a systematic review process (Cumpston et al. 2019). The review is done by using RevMan web in terms of recording and displaying the tool approach, followed by the series of updates for the suitable methods and here, RoB 2 tool is implied.

Data Extraction Tool

Data extraction involves sourcing and recording of topic relevant information from the identified studies and it is mostly kept in draft while presenting the extraction of information. This part of the overall process of a systematic review is mostly conducted at the same time with the quality assessment as these two processes are linked for a desired outcome. Extraction of information forms consist of electronic media such as Excel spreadsheets in terms of lowering the disc of biases in data transcriptions (Baethge et al. 2019). The implementation of electronic media in the form of Excel spreadsheet provides advantages in data extraction process by enabling the overall extraction of information as well as the entry in a single step while presenting. This process is generally conducted in terms of entering data from the selected studies into the Excel spreadsheet under the name of different variables. The collection of information is done according to the major categories such as general information, methodological aspect, participants along with interventions, outcomes and notes (Baethge et al. 2019). The general information category refers to the number of records uniquely identified for the study and is followed by the author review process along with interventions for record keeping. These factors are capable of establishing the review materials into journals, articles along with seminar proceedings and grey literature. This factor also includes categorising these materials by how recent the study is conducted, whether participants were recruited or not along with the presence of conflicts when conducting the overall review system process (Bodison and Parham, 2018). It is also important that the extraction process includes variables which suggest the study designs, objective inclusion and exclusion criteria, duration of study along with unit of allocation and number of study locations while conducting methods. This is followed by ethical consent concealment of allocation as well as pre-stratification and level up blinding for participations and implementations while recording the quality appraisal components for appropriate study. These are significant factors in terms of establishing the extent of errors and biases while minimising their impact and improving rigours. The data extraction also includes a separate participant section which refers to age, gender, total number, number of group baseline characteristics along with follow up procedure while conducting systematic review process (Bodison and Parham, 2018). This is followed by intervening variables such as frequency of intervention and compliance with variables while participating for the systematic review. The outcome section consists of measurement of unit of assessment along with statistical technique primary outcomes secondary outcome and negative outcome. For the following, data extraction is done by using Excel spreadsheets while categorising into general information, methodologies, participants and interventions to identify outcomes and notes.

Data analysis

Narrative procedure is intended to be used for the following systematic research process while using Microsoft Excel in order to analyse the collected information based on the given research subject (Janssen et al. 2020). This also includes the providence of justifications in order to provide statistical findings based on the information of given research topic while addressing the prevalence of lifestyle based respected in terms of developing cardiovascular disease among the Asian population. This section is also important in order to justify the research aims for the given research context.

Timetable

Time table is used in order to associate with the streak timeline of various stages while conducting a systematic literature review for the students. The approximate date for starting the review process is February 2023 and the 3rd week of June 2023.

Activity	Month 1	Month 2	Month 3	Month 4	Month 5	Month 6	Duration
Discussion of selected topic							10 days
Introduction							20 days
Literature review							30 days
Methodology								50 days
Data collection and data extraction							20 days
Data analysis								20 days
Discussion							20 days

Table 6: Expected timeline for the systematic literature review

Budget and likely funding sources

The budget for this study will include accessing information and paid journals for their costs along with the sources of fundings while conducting the study. Some part of the fundings will be provided by the University while accessing information from outer sources and collecting information from paid journals and the remaining budget will be self-catered.

Dissemination of results 

This step denotes increasing awareness of interested parties along with accessing potential research findings which are capable of being implied in practice. The findings from the systematic literature review will be submitted in order to fulfil the requirement of a dissertation for this given research topic and it will be submitted for publication consideration.

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