Serial epidemiological surveys in an urban Indian population demonstrate increasing coronary risk factors among the lower socioeconomic strata

R Gupta, V P Gupta, M Sarna, H Prakash, Shweta Rastogi, K D Gupta
Journal of the Association of Physicians of India 2003, 51: 470-7

OBJECTIVE: To determine trends of coronary risk factors in an Indian urban population and their association with educational level as marker of socioeconomic status.

METHODS: Two successive coronary risk factor surveys were performed in randomly selected individuals. In the first study (in 1995) 2212 subjects (1415 men, 797 women) and in the second (in 2002) 1123 subjects (550 men, 573 women) were studied. Details of smoking, physical activity, hypertension, diabetes, coronary heart disease, body-mass index, waist-hip ratio, blood pressure and electrocardiography were evaluated. Fasting blood was examined for lipid levels in 297 (199 men, 98 women) in the first and in 1082 (532 men, 550 women) in the second study. Educational status was classified into Group 0: no formal education, Group I: 1-10 years, Group II: 11-15 years, and Group III: > 16 years. Current definitions were used for risk factors in both the studies.

RESULTS: Prevalence of coronary risk factors, adjusted for age and educational status, in the first and second study in men was smoking/tobacco in 38.7 vs. 40.5%, leisure time physical inactivity in 70.8 vs. 66.1%, hypertension (> or = 140 and/or 90 mm Hg) in 29.5 vs. 33.7%, diabetes history in 1.1 vs. 7.8%, obesity (body-mass index > or = 25 Kg/m2) in 20.7 vs. 33.0%, and truncal obesity (waist:hip > 0.9) in 54.7 vs. 54.4%. In women, tobacco use was in 18.7 vs. 20.5%, leisure time physical inactivity in 72.4 vs. 75.3%, hypertension in 36.9 vs. 33.7%, diabetes history in 1.0 vs. 7.3%, obesity in 19.9 vs. 39.4%, and truncal obesity (waist:hip > 0.8) in 70.1 vs. 69.2%. In men, high total cholesterol > or = 200 mg/dl was in 24.6 vs. 37.4%, high LDL cholesterol > or = 130 mg/dl in 22.1 vs. 37.0%, high triglycerides > or = 150 mg/dl in 26.6 vs. 30.6% and low HDL cholesterol < 40 mg/dl in 43.2 vs. 54.9%; while in women these were in 22.5 vs. 43.1%, 28.6 vs. 45.1%, 28.6 vs. 28.7% and 45.9 vs. 54.2% respectively. In the second study there was a significant increase in diabetes, obesity, hypertension (men), total- and LDL cholesterol and triglycerides and decrease in HDL cholesterol (p < 0.05). In the first study with increasing educational status a significant increase of obesity, total cholesterol, LDL cholesterol and triglycerides and decrease in smoking was observed. In the second study increasing education was associated with decrease in smoking, leisure-time physical inactivity, total and LDL cholesterol, and triglycerides and increase in obesity, truncal obesity and hypertension (Least-squares regression p < 0.05). Increase in smoking, diabetes and dyslipidaemias was greater in the less educated groups.

CONCLUSIONS: Significant increase in coronary risk factors--obesity, diabetes, total-, LDL-, and low HDL cholesterol, and triglycerides is seen in this urban Indian population over a seven year period. Smoking, diabetes and dyslipidaemias increased more in low educational status groups.

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