Prevalence and determinants of coronary heart disease in a rural population of India

Abstract

Background. The prevalence and determinants of coronary heart disease (CHD) have been inadequately studied in rural areas of developing countries. Methods. Entire communities were surveyed in randomly selected villages in Rajasthan, India. A physician-administered questionnaire, physical examination, and electrocardiogram (ECG) were performed on 3148 adults ≥ 20 years of age (1982 males, 1166 females). Fasting blood samples for determination of lipids were obtained from 202 males and 98 females. Prevalence of coronary risk factors—smoking, hypertension, sedentary life-style, obesity, and hypercholesterolemia—was determined. CHD was diagnosed on basis of past documentation, response to WHO-Rose questionnaire, or changes in ECG. Three methods were used: (a) documentation, history, and ECG criteria, (b) ECG-Q, ST, or T changes, and (c) presence of Q waves. Results. Coronary risk factors: smoking was present in 51% males and 5% females, hypertension (≥140/90 mmHg) in 24% males and 17% females, hypercholesterolemia (≥200 mg/dl) in 22%, diabetes history in 0.2%, and irregular physical activity or sedentary habits in 85%. Other risk factors were lack of formal education in 44%, obesity (body-mass index ≥27 kg/m 2) in 6% and truncal obesity (waist—hip ratio ≥ 0.95) in 5%. The prevalence of CHD (clinical + ECG criteria) was 3.4% in males and 3.7% in females. According to ECG criteria only, it was 2.8% in males and 3.3% in females and according to Q-waves only, it was 1.6% in males and 0.9% in females. Multivariate logistic regression analysis showed that age and smoking in males and age and systolic blood pressure in females were associated with higher prevalence of Q-wave CHD. In males, higher educational level and prayer habit were associated with lower prevalence. Conclusions. Prevalence of CHD in this rural community is higher than in previously reported Indian studies. Smoking, hypertension, and sedentary lifestyle have high prevalence. Significant determinants of CHD are increasing age and smoking while education and prayer-habit are protective.