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Vascular disease a MAJOR problem in Rural, India
Clara K Chow1,4, Brendan M McQuillan5, P Krishnam
Raju3, Rama Raju2, Bruce Neal1, David S
Celermajer4,6
1 Cardiac & Renal Division, The George Institute For
International Health, Sydney; 2 Byrraju Foundation,
Hyderabad, India; 3 CARE Foundation, Hyderabad, India; 4
Royal Prince Alfred Hospital, Sydney, 5 Sir Charles
Gardiner Hospital, University of Western Australia, Perth; 6
Department of Medicine, University of Sydney
Vascular disease appears to occur at disproportionately high rates
amongst individuals from South Asia but the reasons for this are
unclear. We explored this issue by evaluating vascular risk factor
levels and sub-clinical atherosclerosis among rural Indians and
comparing the findings with comparable measures made in urban
Australians.
Risk factors and ultrasound-assessed carotid intima-media thickness (IMT)
were measured in randomly selected adults from two villages in rural
India (n=303). Results were compared to those from a random population
sample selected form Perth (n=1111). Crude and multivariable adjusted
comparisons of mean levels of risk factors and IMT were made. Regression
models were used to define the associations of risk factors with IMT and
quantify any differences between populations.
Compared to rural Indians, urban Australians had worse levels of blood
pressure, total cholesterol, LDL-cholesterol, BMI and diabetes but
better levels of smoking, HDL-cholesterol and waist-hip ratio (all
p<0.001). Age and sex adjusted mean carotid IMT was 0.74mm, (95% CI
0.73-0.76) in rural Indians and 0.69mm (0.69-0.70) in urban Australians
(p<0.001). Adjustment for multiple risk factors did not change this
finding. The cross-sectional associations of IMT with each of
total-cholesterol, HDL-cholesterol and diabetes were different between
populations (all p<0.04) with more adverse effects of each detected for
rural Indians.
The worse sub-clinical atherosclerosis in the rural Indian population
did not appear to be explicable on the basis of different risk factor
levels. A greater susceptibility of rural Indians to adverse effects
from selected risk factors is an alternate possible reason for the
observed difference.
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