The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally. Despite unmet public health needs, these populations remain largely understudied in relation to cardiovascular diseases (CVD). Of all South Asian countries, Bangladesh probably has the highest rates of CVD and yet is one of the most neglected for vascular research. CHD and stroke are already the leading causes of death and disability in Bangladesh. Such increasing burden of vascular diseases in Bangladesh is not just of local concern. The incidence of both CHD and stroke is higher among immigrant Bangladeshis living in England and Wales than every other immigrant group (including those from other South Asian origins) and much higher than in indigenous Western populations.
Bangladesh Risk of Acute Vascular Events (BRAVE) study, in this regard, has been designed and funded by Cambridge as a pioneering large-scale case-control study of acute coronary disease in Bangladesh. Commenced in 2011, BRAVE is being implemented locally in collaboration with National Institute of Cardiovascular Disease Bangladesh, and Chronic Non-Communicable Diseases Unit of icddr,b. As of 2016, BRAVE has recruited over 7500 first-ever myocardial infarction cases and 7500 healthy controls from capital Dhaka city Information and biological specimen routinely collected include data using a 400-item questionnaire, physical measurements, blood, toe-nail and extracted DNA samples from all participants.
The main objectives of this study are to:
- assess the role of potential CVD risk factors (highly prevalent in Bangladeshis) that are yet to be characterized in detail, including: long-term arsenic and other toxic metal contaminations (both separately and in combination), indigenous tobacco consumption; sub-optimal nutrition and genetic variation.
- estimate the impact of modifiable conventional vascular risk factors (eg, smoking, history of hypertension, diabetes, physical inactivity, obesity, lipid fractions) on vascular disease in Bangladesh.
- evaluate the important local lifestyle, socioeconomic and nutritional exposures on CVD risk, such as diet (eg, local intake patterns of various oil, spices, dairy and fish) and different socio-economic groups;
- collect reliable information on knowledge, perception and practice to prevent CVD among participants in order to better understand public health awareness of vascular disease in Bangladesh; and
- collect detailed information on the economic burden of CVD events in Bangladesh better understand health economic impact of vascular disease in Bangladesh.
Joint Principal Investigators
Dr Dewan S Alam
Co-investigators, epidemiology/ public health
Dr Adnan Sheikh
Dr Rubhana Raqib
Dr Aliya Naheed
Co-investigators, clinical sciences
Professor Abu Azam Chowdhury
Professor Abdullah Al Shafi Majumder
Dr Ismail Ibrahim Fakir
Dr Mostafa Monower
Ms Sadia Afrin
Statistical sciences and data management
Mr Khaled Hasan