Burden of cardiovascular disease risk factors over 13.5 years in a rural and urban South Indian cohort in comparison with global data
Authors: Vasan Senthil K , Antonisamy Belavendra , Gowri Mahasampath S , Selliah Hepsy Y , Geethanjali Finney S , Jebasingh Felix , Johnson Matthew , Paul Thomas V , Osmond Clive , Karpe Fredrik , Thomas Nihal , Fall Caroline HD 
Published: July 2020

Objectives

To estimate the prevalence, incidence and predictors of cardiovascular disease (CVD) risk factors in the Vellore Birth Cohort, South India.

Design

Prospective, cohort study

Setting

Population-based cohort of rural and urban communities in and around Vellore city in South India

Participants

Non-migrant individuals (n= 962, male 519) were studied at two time points 13.6 years apart i) 1998-2002 (baseline, mean age 28.2 years) and ii) 2013-2014 (follow-up, mean age 41.7 years).

Main outcome measures

Prevalence and incidence of CVD risk factors (obesity, central obesity, type 2 diabetes (T2D), hypertension, hypercholesterolemia and hypertriglyceridemia) studied at baseline (1998-2002) and follow-up (2013-2014), prevalence in comparison with the Non-Communicable Disease Risk Collaboration (global) data, incidence in comparison with another Indian cohort from New Delhi (NDBC), and baseline predictors of incident CVD risk factors.

Results

The prevalence at 28 and 42 years was 17% and 51% for overweight/obesity, 19% and 59% for central obesity, 3% and 16% for T2D, 2% and 19% for hypertension and 15% and 30% 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 in global terms. Our findings highlight a high burden of CVD risk factors at younger age with increasing trends observed among rural residents, similar to urban South Indians. Therefore, strategies to prevent CVD should be strengthened in both rural and urban settings to minimise health inequalities and should start young.

Trial registration

None

Key messages

What is known on this topic

Cardiovascular disease (CVD) risk burden is increasing in Low- and middle-income countries and contributes significantly to the overall morbidity and mortality.

Nation-wide data from India demonstrate heterogeneity in the prevalence of CVD risk factors within the country; there is very little incidence data.

What this study adds

The prevalence of CVD risk factors in India is comparable with or exceeds that in high income countries like USA and Europe, even though obesity levels are lower.

Adiposity at baseline, particularly waist circumference, is a strong predictor of incident risk factors.

The prevalence of CVD risk factors is higher in rural than urban communities, but the incidence is comparable or higher in the rural setting indicating that the rural population are catching up