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High levels of Subclinical Atherosclerosis and cardiovascular risk factors in rural South Indian adults
This paper was presented in Cardiac
Society Australia & New Zealand / ACC
Clara K Chow*1,2, Brendan M McQuillan5, Krishnam
Raju4, Rama Raju3, Bruce Neal1,2, David
Celermajer2,6
1 The George Institute For
International Health; 2
Royal Prince Alfred Hospital, Sydney, NSW; 3 Byrraju Foundation,
Hyderabad, India; 4 CARE Hospital, Hyderabad; 5
University of Western Australia, Sir Charles
Gardiner Hospital, Perth, Australia; 6
Department of Medicine, University of Sydney, Australia.
South Asian Indians in developed countries appear more susceptible lo
coronary disease than Caucasians, however the reasons for this are
unclear.
We therefore measured cardiovascular risk factors in 4,535 adults from
20 rural Indian villages and assessed carotid intima-media thickness (IMT),
as a measure of subclinical atherosclerosis, in 303 randomly selected
participants. Results were compared to those from a population in Perth,
WA (n=1111).
Carotid IMT levels were higher in rural Indians (mean 0.74, 95% CI
0.73-0.76) compared to urban Australians (0.69, 0.69-0.70; p<0.001) (age
and sex-adjusted). Risk factor levels were generally worse in
Australians and adjustment for blood pressure, diabetes, total
cholesterol and smoking did not attenuate observed IMT differences (0.75
versus 0.69mm, p<0.001). Total, LDL and HDL-cholesterol, blood pressure,
waist-hip ratio and body mass index were all associated with carotid IMT.
The association of total cholesterol and IMT was stronger in the Indian
compared to the Australian populations (p=0.009). Increasing HDL-cholesterol
was protective in Australians but associated with increasing IMT in
Indians (p<0.00l). Risk factor levels in the IMT subset were similar to
those in the entire group surveyed (eg total cholesterol 4.7mmol/L
(4.7-4.8); LDL-cholesterol 3.0 (2.9-3.0); HDL-cholesterol 1.2 (1.1-1.2);
hypertension in 27%; smoking in 25% and diabetes in 13%).
The higher level of subclinical atherosclerosis in rural Indians is of
enormous public health concern and our data suggest that this may be a
consequence of greater adverse effects of established cardiovascular
risk factors, in addition to a possible adverse effect of HDL-cholesterol
amongst South Indians.
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