Risk factors for cardiovascular disease in rural South India: cohort study.

BACKGROUND AND OBJECTIVES: Cardiovascular diseases (CVD) accounted for one-third of the deaths in India. We conducted a cohort study to estimate the incidence of CVD and the association of established risk factors with the incident CVD in a rural population in South India. DESIGN, SETTING AND PARTICIPANTS: We conducted a community-based cohort study among 6026 adults aged 25-64 years in five villages in Tiruvallur, Tamil Nadu. We did baseline (2005-2007) and two follow-up surveys in 2008-2009 and 2013-2015. Risk factors studied were tobacco, alcohol, hypertension, self-reported diabetes and central obesity. OUTCOME MEASURES: Outcome measures were fatal or non-fatal ischaemic heart disease or cerebrovascular event. We estimated HRs for the risk factors and population attributable fraction (PAF). RESULTS: We followed up 5641 (94.4%) subjects, and follow-up duration was 33 371 person years. The overall incidence of cardiovascular event or death was 4.6 per 1000 person years. Current smoking (HR 1.6, 95% CI 1.1 to 2.6) and hypertension (HR 2.2, 95% CI 1.5 to 3.4) were the risk factors among men and accounted for 47% of the PAF. Among women, hypertension (HR 1.8, 95% CI 1.0 to 3.4), self-reported diabetes (HR 4.3, 95% CI 2.2 to 8.1) and central obesity (HR 2.2, 95% CI 1.2 to 4.0) were associated with CVD and accounted for more than half of the PAF. CONCLUSIONS: We described the high burden of fatal CVD and identified the role of CVD risk factors such as hypertension, self-reported diabetes, smoking and central obesity. There is an urgent need to implement low-cost interventions such as smoking cessation and treat hypertension and diabetes in primary care settings.

Prevalence, awareness, treatment, control and risk factors for hypertension in a rural population in South India.

OBJECTIVES: Hypertension is a major public health problem with prevalence ranging 22-30% in urban India. There are few data on hypertension epidemiology in rural India. We conducted a survey to estimate prevalence, awareness, treatment, control and risk factors for hypertension in a rural population in south India. METHODS: We did cross-sectional survey in 11 villages in Tamil Nadu. We collected data on behavioral risk factors, anthropometric and blood pressure measurements. We defined hypertension according to WHO criteria. RESULTS: Study population included 10,463 subjects aged 25-64 years. Among them, 4,900 (46.8%) were males. Hypertension was present for 2,247 (21.4%) subjects and 1,682 (74.9%) among hypertensives were newly detected. Overall 20% were on treatment and 6.6% had blood pressure control. Age ≥35 years, BMI ≥ 23 kg/m(2) and central obesity were risk factors significantly associated with hypertension (p < 0.05). In addition, alcohol consumption, higher education level were risk factor among males and family history of hypertension was risk factor among females (p < 0.05). CONCLUSION: Hypertension is an emerging challenge in rural India. We need health promotion programs and reorientation of primary health care to improve hypertension detection and management.

The metabolic syndrome and associated risk factors in an urban industrial male population in South India.

BACKGROUND: The metabolic syndrome is characterized by clustering of risk factors, which predisposes subjects to increased risk of diabetes and cardiovascular disease. Objectives of this study were to estimate prevalence of the metabolic syndrome and determine the association of risk factors with the metabolic syndrome in an urban industrial male population in Chennai, India. METHODS: We conducted a cross-sectional survey for male employees working in an industrial unit. The survey included questionnaire for risk factors, anthropometric and blood pressure measurements. Blood samples were collected for the fasting plasma glucose, serum cholesterol, high-density lipoprotein cholesterol and triglycerides. The metabolic syndrome was defined using International Diabetes Federation (IDF) and American Heart Association (AHA)/National Heart Lung and Blood Institute (NHLBI) criteria. RESULTS: The total numbers of male subjects included in the study were 1077. The prevalence of the metabolic syndrome was 41.3% and 51.4% using IDF and AHA/NHLBI criteria respectively. Risk factors were age above 35 years, family history of diabetes and body mass index (BMI) above 23.9 kg/m2. The consumption of more than three servings of fruits and vegetables was protective. CONCLUSION: The prevalence of the metabolic syndrome was very high in select industrial population in south India. Higher BMI and low intake of fruits and vegetables are modifiable by life style modification. Work site screening for the metabolic syndrome would facilitate the early detection and treatment.

A comparison of anthropometric indices for predicting hypertension and type 2 diabetes in a male industrial population of Chennai, South India.

OBJECTIVES: To assess the association of four obesity-related indices--body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR)--with hypertension and type 2 diabetes among a male industrial population in south India. DESIGN, SETTING, AND PARTICIPANTS: A cross sectional study of 2148 men aged 18-69 years in two purposely selected industrial units in Chennai, India, in 2003-2005. MAIN OUTCOME MEASURES: The examination included blood pressure and anthropometric measurements (height, weight, hip circumference, and WC) to calculate BMI, WHR, and WSR. Fasting blood samples were taken to assess plasma glucose. RESULTS: Prevalence of overweight was 43.4%; prevalences of central obesity using WC > or = 90.0 cm and WHR > 0.90 were 50.0% and 70%, respectively. The prevalences of hypertension and type 2 diabetes were 26.5% and 16.3%, respectively. There was a significant increase in the prevalence of type 2 diabetes and hypertension across the quintiles for the four anthropometric indices. In logistic regression analysis, BMI and WC showed a significant graded increase in the odds ratio for hypertension after adjusting for age. In case of type 2 diabetes, only WHR showed significant increase in odds ratio across quintiles after adjusting for age and BMI. CONCLUSIONS: WHR was the best predictor for type 2 diabetes in the study sample. BMI and WC were good predictors for hypertension. We recommend that WHR should be routinely used in this clinical setting in addition to BMI to detect persons at high risk in these industrial units. Prospective studies are needed to provide evidence of the predictive power of anthropometric indices for Asian Indians.