Prevalence, incidence and predictors of cardiovascular risk factors: longitudinal data from rural and urban South India and comparison with global data

Introduction India has high mortality rates from cardiovascular disease (CVD). Understanding the trends and identifying modifiable determinants of CVD risk factors will guide preventive strategies and policy making. Research design and methods CVD risk factors (obesity, central obesity, and type 2 diabetes (T2D), hypertension, hypercholesterolemia and hypertriglyceridemia) prevalence and incidence were estimated in 962 (male 519) non-migrant adults from Vellore, South India, studied in: (1) 1998–2002 (mean age 28.2 years) and (2) 2013–2014 (mean age 41.7 years). Prevalence was compared with the Non-Communicable Disease Risk Collaboration (global) data. Incidence was compared with another Indian cohort from New Delhi Birth Cohort (NDBC). Regression analysis was used to test baseline predictors of incident CVD risk factors. Results The prevalence at 28 and 42 years was 17% (95% CI 14% to 19%) and 51% (95% CI 48% to 55%) for overweight/obesity, 19% (95% CI 17% to 22%) and 59% (95% CI 56% to 62%) for central obesity, 3% (95% CI 2% to 4%) and 16% (95% CI 14% to 19%) for T2D, 2% (95% CI 1% to 3%) and 19% (95% CI 17% to 22%) for hypertension and 15% (95% CI 13% to 18%) and 30% (95% CI 27% to 33%) for hypertriglyceridemia. The prevalence of T2D at baseline and follow-up and hypertension at follow-up was comparable with or exceeded that in high-income countries despite lower obesity rates. The incidence of most risk factors was lower in Vellore than in the NDBC. Waist circumference strongly predicted incident T2D, hypertension and hypertriglyceridemia. Conclusions A high prevalence of CVD risk factors was evident at a young age among Indians compared with high and upper middle income countries, with rural rates catching up with urban estimates. Adiposity predicted higher incident CVD risk, but the prevalence of hypertension and T2D was higher given a relatively low obesity prevalence. Preventive efforts should target both rural and urban India and should start young.

[1]  Stephen S. Lim,et al.  The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017 , 2019, The Lancet. Planetary health.

[2]  V. Mohan,et al.  Ethnic differences in the prevalence of diabetes in underweight and normal weight individuals: The CARRS and NHANES studies. , 2018, Diabetes research and clinical practice.

[3]  Stephen S. Lim,et al.  The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016 , 2018, The Lancet. Global health.

[4]  D. Prabhakaran,et al.  IndEcho study: cohort study investigating birth size, childhood growth and young adult cardiovascular risk factors as predictors of midlife myocardial structure and function in South Asians , 2018, BMJ Open.

[5]  S. Vollmer,et al.  Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 Million Adults , 2018, JAMA internal medicine.

[6]  Stephen S. Lim,et al.  Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study , 2017, The Lancet.

[7]  Ashok Kumar Das,et al.  Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. , 2017, The lancet. Diabetes & endocrinology.

[8]  V. Mohan,et al.  Prevalence and incidence of hypertension: Results from a representative cohort of over 16,000 adults in three cities of South Asia☆ , 2017, Indian heart journal.

[9]  D. Prabhakaran,et al.  20-Year Trend of CVD Risk Factors: Urban and Rural National Capital Region of India. , 2017, Global heart.

[10]  Hynek Pikhart,et al.  Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants , 2017, The Lancet.

[11]  M. M. Rahman,et al.  Worldwide trends in diabetes since 1980 : pooled analysis of 751 population-based measurement studies with over 4 . 4 million participants , 2016 .

[12]  Tran Quoc Bao,et al.  Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants , 2016, The Lancet.

[13]  Tom R. Gaunt,et al.  Epigenome-wide association of DNA methylation markers in peripheral blood from Indian Asians and Europeans with incident type 2 diabetes: a nested case-control study. , 2015, The lancet. Diabetes & endocrinology.

[14]  V. Mohan,et al.  Incidence of Diabetes and Prediabetes and Predictors of Progression Among Asian Indians: 10-Year Follow-up of the Chennai Urban Rural Epidemiology Study (CURES) , 2015, Diabetes Care.

[15]  Wei Q. Deng,et al.  Does genetic heterogeneity account for the divergent risk of type 2 diabetes in South Asian and white European populations? , 2014, Diabetologia.

[16]  V. Mohan,et al.  Prevalence of Dyslipidemia in Urban and Rural India: The ICMR–INDIAB Study , 2014, PloS one.

[17]  C. Fall,et al.  Socio-economic status and cardiovascular risk factors in rural and urban areas of Vellore, Tamilnadu, South India. , 2012, International journal of epidemiology.

[18]  Anuj Maheshwari,et al.  Association of Educational, Occupational and Socioeconomic Status with Cardiovascular Risk Factors in Asian Indians: A Cross-Sectional Study , 2012, PloS one.

[19]  K. Narayan,et al.  Rural diabetes prevalence quintuples over twenty-five years in low- and middle-income countries: a systematic review and meta-analysis. , 2012, Diabetes research and clinical practice.

[20]  Mark D. Huffman,et al.  Incidence of cardiovascular risk factors in an Indian urban cohort results from the New Delhi birth cohort. , 2011, Journal of the American College of Cardiology.

[21]  J. Chan,et al.  Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk—a review of the literature , 2010, European Journal of Clinical Nutrition.

[22]  C. Fall,et al.  Cohort Profile: the 1969-73 Vellore birth cohort study in South India. , 2009, International journal of epidemiology.

[23]  S. Yusuf,et al.  Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. , 2007, JAMA.

[24]  S. Yusuf,et al.  Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study , 2004, The Lancet.

[25]  C. Yajnik,et al.  Neonatal anthropometry: the thin–fat Indian baby. The Pune Maternal Nutrition Study , 2003, International Journal of Obesity.

[26]  P. Deurenberg,et al.  Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians , 2002, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[27]  D. Barker.  Rise and fall of Western diseases , 1989, Nature.