Persistent high prevalence of cardiovascular risk factors in the urban middle class in India: Jaipur Heart Watch-5

Rajeev Gupta, K K Sharma, Arvind Gupta, Aachu Agrawal, Indu Mohan, V P Gupta, R S Khedar, Soneil Guptha
Journal of the Association of Physicians of India 2012, 60: 11-6

BACKGROUND AND OBJECTIVE: Urban subjects have high burden of cardiovascular risk factors, therefore, to evaluate risk factors in middle socioeconomic subjects and to study secular trends we performed an epidemiological study.

METHODS: The study was performed at urban middle class locations defined according to municipal records in years 2009-10. Stratified random sampling using house-to-house survey was performed. Details of medical history, anthropometry and clinical examination were recorded and biochemical tests performed for estimation of fasting glucose and lipids. Current definitions were used for risk factor classification. Descriptive statistics are provided. Trends were calculated using ANOVA or Mantel Haenszel chi-square. Univariate and multivariate logistic regression was performed to assess risk factor determinants. To determine secular trends we compared risk factors with previous cross-sectional studies performed in same locations in years 2002-3 and 2004-5 in subjects 20-59 years age.

RESULTS: We evaluated 739 subjects (men 451, women 288, response 67%). Age-adjusted prevalence (%) of risk factors in men and women respectively was smoking 95 (21.1) and 12 (4.2), low physical activity 316 (69.6) and 147 (52.3), high fat intake > or = 20 gm/day 278 (73.4) and 171 (68.7), low fruits and vegetables intake < 3 helpings/day 249 (70.3) and 165 (76.4), overweight/obesity 205 (46.2) and 142 (50.7), high waist size 58 (12.9) and 76 (26.6), high waist:hip 143 (31.9) and 154 (53.9), hypertension 177 (39.5) and 71 (24.6), high total cholesterol > or = 200 mg/ dl 148 (33.0) and 93 (32.7), low HDL cholesterol < 40/50 mg/dl 113 (25.1) and 157 (55.3), diabetes 62 (15.5) and 25 (10.8) and metabolic syndrome 109 (25.1) and 61 (22.0). Age-associated increase was observed in body mass index, waist size, waist ratio:hip, systolic blood pressure and fasting and total cholesterol, non-HDL cholesterol and triglycerides in women (Ptrend < 0.01). Age related increase was also observed in prevalence of obesity, truncal obesity, hypertension, diabetes and metabolic syndrome (Ptrend < 0.01). On univariate analysis significant determinants of risk factors were low educational and socioeconomic status for smoking, high fat diet for obesity and hypertension, low fruits and vegetables intake for metabolic syndrome, and low physical activity or obesity but on age-and sex-adjusted multivariate analysis only association was high fat diet with obesity and hypertension (logistic regression analysis p < 0.05). Compared to studies performed at similar locations in years 2002-03 and 2005-06 there was increasing trend in prevalence of high non-HDL cholesterol and hypertriglyceridemia (Ptrend < 0.05) while other risk factors did not change significantly.

CONCLUSIONS: There is a high prevalence of multiple cardiovascular risk factors in Indian middle class individuals. Secular trends demonstrate a persistent high prevalence and increasing non-HDL cholesterol and triglycerides over 8-year period.

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