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Field Studies in Rural India Demonstrate A Surprisingly High Prevalence of Cardiovascular Risk and Disease.
Clara Chow*1,2, Rohina Joshi1, Magnolia Cardona1,
Krishnam Raju4, Rama Raju3, Bruce Neal1,
David Celermajer2.
1 The George Institute for International Health; 2
Royal Prince Alfred Hospital, Sydney, NSW; 3 Byrraju
Foundation, Hyderabad, India, 4 CARE Hospital, Hyderabad.
By 2020, cardiovascular (CV) disease is set to become the major cause of
mortality worldwide. India is the world's second most populous nation,
with 70% living in rural areas. The prevalence of CV risk factors (RFs),
subclinical atherosclerosis and CV death in this vast region, however,
is unknown.
During a series of field trips to rural Andhra Pradesh, we measured CV
RFs, ECG and ultrasound-assessed carotid intima-media thickness (IMT, a
marker of subclinical atherosclerosis) in 345 randomly selected adults
from two villages. In addition, 1300 verbal autopsy records were also
collected from 45 villages (population 181800) over a 12 month period to
determine the proportion of CV deaths.
Age & sex adjusted population means (SEM) were: age 41(0.3), 50% female,
blood pressure 116/73 (1/1), total cholesterol 4.6mmol/L (0.05), LDL
cholesterol 3.2 mmol/L (0.05), HDL cholesterol 0.8 mmol/L (0.01) and BMI
21 (1). 20% (2) were current smokers, 20% (2) were hypertensive
(BP>140/90 or treated), 17% (2) were overweight/obese (BMI>25), and 4%
(1) had diabetes. By ATPIII criteria, 91% had dyslipidaemia, mainly due
to abnormally low HDL levels. Mean IMT assessed in 280 subjects is 0.67
mm (0.01), similar to age-matched values in Western subjects. On
univariate analysis greater IMT correlated significantly (p<0.01) with
higher blood pressure, total cholesterol, LDL cholesterol, fasting blood
sugar, creatinine, weight, waist-hip-ratio (WHR), BMI, age, presence of
diabetes, smoking and low HDL. On multivariate analysis, greater mean
IMT was significantly associated with greater total cholesterol
(p=0.02), higher age (p<0.001), higher WHR (p=0.02) and diabetes
(p=0.01). Cardiovascular diseases were the leading causes of mortality
(34% of all deaths, 25% in those <60years). This comprehensive survey
has revealed that risk factors, subclinical atherosclerosis and
cardiovascular death rates are surprisingly high in rural villages in
India with important public health implications.
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