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North India

North India

  • The prevalence rates of CAD among  North Indians was reported to be similar to that of  the US population  in 1968, when US  was at the height of the CAD epidemic and had the second highest (just behind Finland) death rate from this disease.1
  • The  prevalence of CAD  in urban north India has increased from about 2% in 1960 to 6.5% in 1970, 7.0% in 1980, 9.7% in 1990 and 10.5% in 2000; while in rural areas, it increased from 2% in 1970, to 2.5% in 1980, 4% in 1990, and 4.5% in 2000.2
  • Heart attack occurs at a much younger age in Indians as compared to those in North America and Western Europe leading to a huge burden of premature deaths.2
  • Low prevalence of multiple cardiovascular disease (CVD) risk factors (smoking, hypertension, dyslipidemia, diabetes, and metabolic syndrome) in adolescents and rapid escalation of these risk factors by age of 30-39 years is noted in urban Asian Indians. This underscores the need of early intervention in this population.3, 4
  • The prevalence of most of CVD risk factors is markedly high and is increasing with time. In addition, a significant proportion of these individuals are not aware of their risk status.5 This is particularly true for office executives participating in health check ups.
  • Secular trends of obesity (BMI >25 kg/m2) and hypertension prevalence from the Jaipur Heart Watch between 1993 and 2005 demonstrated a significant increase in the prevalence of both risk factors (See Jaipur).6
  • A recent study found prevalence of overweight 80% and obesity 50% using Asian cut points among young Indians 36 years of age along with high prevalence of other risk factors (See Delhi).4
  • In urban North Indian population, trends reveal increase in mean total cholesterol, triglycerides, and a decline in HDL cholesterol levels. Currently, non-HDL >160 mg/dl is found in 27% and LDL-C >130 mg/dl in 22% of the population.7  Non-HDL cholesterol is obtained by subtracting the HDL from the total cholesterol (See Cholesterol). Increasing dyslipidemia correlates significantly with increasing abdominal obesity.4
  • There was a high prevalence of various components of metabolic syndrome─ a predictor and precursor of diabetes and heart disease. Prevalence of components of metabolic syndrome in men and women was: low HDL cholesterol (men <40 mg/dl and women <50 mg/dl, ) in 55% of men and 90% of women; high triglycerides  (>150 mg/dl)  in 32.% of men and  29% of women ; impaired fasting glucose or diabetes in 17% of men and 16% of women and  central obesity (waist, men >102 cm, women >88 cm) in 26% of men and 44% of women.8 This would have been double if the Asian Indian cut points were used;
  • The prevalence of physical inactivity, hypertension, hypercholesterolemia (>200 mg/dl, and high LDL cholesterol (>130 mg/dl)  was greater in the metabolic syndrome group in both men and women. 8 

Sources

1. Sarvotham SG, Berry JN. Prevalence of coronary heart disease in an urban population in northern India. Circulation. 1968;37(6):939-953.

2. Gupta R. Recent trends in coronary heart disease epidemiology in India. Indian heart journal. Mar-Apr 2008;60(2 Suppl B):B4-18.

3. Gupta R, Misra A, Vikram NK, et al. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC cardiovascular disorders. 2009;9:28.

4. Huffman M D, Prabhakaran D, Osmond C, et al. Incidence of cardiovascular risk factors in an Indian urban cohort results from the new delhi birth cohort. J Am Coll Cardiol. Apr 26 2011;57(17):1765-1774.

5. Bansal M, Shrivastava S, Mehotra Rahul, Agrawal V KR. Timep-trends in prevalence and awareness of vcardiovascular risk factors in an asmptomatic North Indian Urban population. JAPI. 2009;57.

6. Gupta  R, Misra A, Vikram NK, et al. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC cardiovascular disorders. 2009;9:28.

7. Gupta R, Guptha S, Agrawal A, Kaul V, Gaur K, Gupta VP. Secular trends in cholesterol lipoproteins and triglycerides and prevalence of dyslipidemias in an urban Indian population. Lipids in health and disease. 2008;7:40.

8. Gupta R, Deedwania PC, Gupta A, Rastogi S, Panwar RB, Kothari K. Prevalence of metabolic syndrome in an Indian urban population. Int J Cardiol. Nov 2004;97(2):257-261.

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