Obesity is major determinant of coronary risk factors in India: Jaipur Heart Watch studies.

OBJECTIVE: The impact of rising population-wide obesity on cardiovascular risk factors has not been well studied in low-income countries. To correlate the prevalence of obesity with risk factors we performed epidemiological studies in India. METHODS: Multiple cross-sectional epidemiological studies, Jaipur Heart Watch (JHW), were performed in India in rural and urban locations. From these cohorts, subjects aged 20-59 years (men 4102, women 2872) were included. Prevalence of various risk factors: smoking/tobacco use, overweight/obesity (body mass index > or = 25 kg/m2) truncal obesity (waist:hip > or = 0.95 men, > or = 0.85 women), hypertension, dyslipidemias, metabolic syndrome and diabetes was determined. Trends were examined using least squares regression. RESULTS: Smoking/tobacco use was more in rural men (50.0% vs 40.6%) and urban women (8.9% vs 4.5%, p < 0.01). Obesity, truncal obesity, hypertension, hypercholesterolemia, diabetes, and metabolic syndrome were more in urban cohorts (p < 0.001). Age-adjusted prevalence (%) of obesity in various cohorts, rural JHW, and urban JHW-1, JHW-2, JHW-3, and JHW-4 respectively, in men was 9.4, 21.1, 35.6, 54.0, and 50.9 (r2 = 0.92, p = 0.009) and in women 8.9, 15.7, 45.1, 61.5, and 57.7 (r2 = 0.88, p = 0.018). Prevalence of truncal obesity in men was 3.2, 19.6, 39.6, 41.4, and 31.1 (r2 = 0.60, p = 0.124) and in women 10.1, 49.5, 42.1, 51.7, and 50.5 (r2 = 0.56, p = 0.1467). In successive cohorts increasing trends were observed in the prevalence of hypertension (r2 = 0.93, p = 0.008) and metabolic syndrome (r2 = 0.99, p = 0.005) with weaker trends for hypercholesterolemia (r2 = 0.41, p = 0.241) and diabetes (r2 = 0.79, p = 0.299) in men. In women, significant trends were observed for hypertension (r2 = 0.98, p = 0.001) and weaker trends for others. Increase in generalized obesity correlated significantly with hypertension (two-line regression r2, men 0.91, women 0.88), hypercholesterolemia (0.53, 0.44), metabolic syndrome (0.87, 0.94) and diabetes (0.84, 0.93). Truncal obesity correlated less strongly with the risk factors like hypertension (0.50, 0.57), hypercholesterolemia (0.88, 0.61), metabolic syndrome (0.76, 0.33), and diabetes (0.75, 0.33). CONCLUSIONS: In Asian Indian subjects, escalating population-wide generalized obesity correlates strongly with increasing cardiovascular risk factors.

Fasting glucose and cardiovascular risk factors in an urban population.

OBJECTIVE: To test the hypothesis that blood glucose levels in the range of normoglycemia are associated with increased cardiovascular risk we performed an epidemiological study in an urban population. METHODS: Randomly selected adults > or = 20 years were studied using stratified sampling. Target sample was 1800 (men 960, women 840) of which 1123 subjects participated. Blood samples were available in 1091 subjects (60.6%, men 532, women 559). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Cardiovascular risk factors were determined using US Adult Treatment Panel-3 guidelines. Pearson's correlation coefficients (r) of fasting glucose with various risk factors were determined. Fasting glucose levels were classified into various groups as < 75 mg/dl, 75-89 mg/dl, 90-109 mg/dl, 110-125 mg/dl and > 126 mg/dl or known diabetes. Prevalence of cardiovascular risk factors was determined in each group. RESULTS: There was a significant positive correlation of fasting glucose in men and women with body mass index (r = 0.20, 0.12), waist-hip ratio (0.17, 0.09), systolic blood pressure (0.07, 0.22), total cholesterol (0.21, 0.15) and triglycerides (0.21, 0.25). Prevalence (%) of cardiovascular risk factors in men and women was smoking/tobacco use in 37.6 and 11.6, hypertension in 37.0 and 37.6, overweight and obesity in 37.8 and 50.3, truncal obesity in 57.3 and 68.0, high cholesterol > or = 200 mg/dl in 37.4 and 45.8, high triglycerides > or = 150 mg/dl in 32.3 and 28.6 and metabolic syndrome in 22.9 and 31.6 percent. In various groups of fasting glucose there was an increasing trend in prevalence of overweight/obesity, hypertension, hypercholesterolaemia, hypertriglyceridaemia, and metabolic syndrome (Mantel-Haenzel X2 for trend, p < 0.05) and fasting glucose < 75 mg/dl was associated with the lowest prevalence of these risk factors. CONCLUSIONS: There is a continuous relationship of fasting glucose levels with many cardiovascular risk factors and level < 75 mg/dl is associated with the lowest prevalence.

Body-mass index, waist-size, waist-hip ratio and cardiovascular risk factors in urban subejcts.

BACKGROUND AND OBJECTIVE: Influence of obesity as determinant of cardiovascular risk factors has not been well studied. To determine association of obesity, measured by body-mass index (BMI), waist-size or waist-hip ratio (WHR), with multiple risk factors in an urban Indian population we performed an epidemiological study. METHODS: Randomly selected adults > or = 20 years were studied using stratified sampling. Target sample was 1800 (men 960, women 840). 1123 subjects (response 62.4%) were evaluated and blood samples were available in 532 men and 559 women (n=1091, response 60.6%). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Atherosclerosis risk factors were determined using current guidelines. Pearson's correlation coefficients (r) of BMI, waist and WHR with various risk factors were determined. BMI was categorized into five groups: <20.0 Kg/m2, 20.0-22.9, 23.0-24.9, 25.0-29.9, and > or = 30 Kg/m2; waist size was divided into five groups and WHR into six groups in both men and women. Prevalence of cardiovascular risk factors, smoking, hypertension, diabetes, metabolic syndrome and dyslipidaemias was determined in each group and trends analyzed using least-squares regression. RESULTS: There is a significant positive correlation of BMI, waist-size and WHR with systolic BP (r= 0.46 to 0.13), diastolic BP (0.42 to 0.16), fasting glucose (0.15 to 0.26), and LDL cholesterol (0.16 to 0.03) and negative correlation with physical activity and HDL cholesterol (-0.22 to -0.08) in both men and women (p<0.01). With increasing BMI, waist-size and WHR, prevalence of hypertension, diabetes, and metabolic syndrome increased significantly (p for trend <0.05). WHR increase also correlated significantly with prevalence of high total and LDL cholesterol and triglycerides (p <0.05). CONCLUSIONS: There is a continuous positive relationship of all markers of obesity (body-mass index, waist size and waist hip ratio) with major coronary risk factors- hypertension, diabetes and metabolic syndrome while WHR also correlates with lipid abnormalities.

Trends in prevalence of coronary risk factors in an urban Indian population: Jaipur Heart Watch-4.

BACKGROUND: To determine prevalence of multiple coronary risk factors in a North Indian Punjabi community and to compare these with previous population based studies in the same city in North India we performed an epidemiological study. METHODS: A community-based epidemiological study that focused on lifestyle determinants of obesity and its correlates in migrants from Punjab was performed at a single location in Jaipur. A house-to-house enumeration was performed to enroll all adults>or=20 years age in the locality who were then invited for participation in the study. Of the 1400 eligible subjects, 1127 participated (response rate 80.5%, men 556, women 571). Risk factor measurements included smoking or tobacco use, body-mass index (BMI), waist:hip ratio (WHR) and body fat, and in 644 (56.6%) subjects (men 340, women 304) blood examination for fasting blood glucose and lipids. Coronary risk factors were determined using pre-specified criteria. RESULTS: There was a significant prevalence of risk factors in both men and women respectively with smoking or tobacco use in 209 (37.6%) and 12 (2.2%), obesity (BMI>or=25 kg/m2) in 303 (54.5%) and 350 (61.3%), truncal obesity (high WHR) in 339 (61.0%) and 310 (54.30%), hypertension in 322 (57.9%) and 279 (48.9%), high total cholesterol>or=200 mg/dl in 111 (32.6%) and 120 (39.5%), low HDL cholesterol<40 mg/dl in 103 (30.3%) and 83 (27.3%), high triglycerides>or=150 mg/dl in 146 (42.9%) and 132 (43.4%), metabolic syndrome in 166 (48.8%) and 137 (45.1%), and diabetes in 88 (25.9%) and 64 (21.1%) subjects. In both men and women there was a significant age-associated escalation in obesity, central obesity, hypertension, high cholesterol and diabetes prevalence (Mantel-Haenszel chi2 for trend p<0.05). Logistic regression analyses revealed that obesity and truncal obesity were major determinants of multiple risk factors such as hypertension, hypercholesterolemia, metabolic syndrome and diabetes (age-adjusted odds ratios p<0.01). Comparison with previous population-based risk factor studies from the same city in years 1995 and 2002 revealed that risk factors were significantly greater in the present group. Age-stratified differences revealed that obesity at younger age was more frequent in the present cohort. CONCLUSIONS: There is a significant prevalence of multiple cardiovascular risk factors in this population group. Obesity is a major determinant of multiple risk factors and appears at a younger age compared to other studies in the same location.

Five-year blood pressure trends and regression-to-the-mean in an industrial population.

OBJECTIVE: To determine trends in blood pressure (BP) and assess the statistical phenomenon of regression to the mean we performed sequential examinations in an industrial population. METHODS: All the employees in an industrial plant were examined. Height, weight, body mass index (BMI) and blood pressure were measured using standardised techniques successively for 5 years as part of annual medical check-up of these employees. All the male employees (n=145) were targeted in the first year of which 122 (84.1%) were examined. These numbers declined to 121, 99, 90 and 87 in subsequent years respectively due to employee attrition. Trends in levels of systolic and diastolic BP and hypertension prevalence were examined using standard regression analysis, least-squares regression and graphic analyses using a commercially available statistical programme. RESULTS: The mean age 31.3 +/- 5.9 years (range 23-41). The mean height was 1.68 + 0.06 m, weight 60.0 + 9.1 kg and BMI 21.2 +/- 3.1 kg/m2. 18 subjects (14.8%) were overweight. From the first to the fifth year, respectively, BMI increased from 21.2 +/- 3.1 kg/m2 to 21.3 +/- 3.9, 21.9 +/- 3.0, 22.3 +/- 3.0 and 22.6 +/- 2.9 kg/m2 (r = 0.93, p = 0.011), systolic BP declined from 127.1 +/- 13.5 to 125.7 +/- 15.4, 125.5 +/- 12.9, 125.0 +/- 12.6 and 124.9 +/- 14.0 mm Hg (r = -0.60, p = 0.034) while diastolic BP remained unchanged (r = 0.15). Prevalence of hypertension (> or =140 / > or =90) declined from 34.4% at baseline to 28.9, 28.3, 24.4 and 24.1% respectively (r = -0.948, p = 0.021). CONCLUSIONS: A high prevalence of hypertension in observed in this young industrial cohort. Without treatment, the hypertension prevalence as well as mean systolic BP decline over time demonstrating the statistical phenomenon of regression to the mean.

High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3.

BACKGROUND: Studies among emigrant Indian populations have shown a high prevalence of obesity and many coronary risk factors in Bhatia community. To determine the prevalence of risk factors in this community within India we performed an epidemiological study. METHODS AND RESULTS: An ethnic-group sample survey to determine prevalence of cardiovascular risk factors was performed using community registers for enrollment. Methodology used was similar to Jaipur Heart Watch studies performed in 1995 and 2002. We invited 600 randomly selected subjects listed in Punjabi Bhatia community registers and could examine 458 (76.7%) persons (men 226, women 232). Evaluation for coronary risk factors, anthropometric measurements, blood pressure, electrocardiogram, fasting blood glucose and serum lipids was performed using standard definitions. Mean age was 43.2 +/- 14.6 years in men and 44.7 +/- 15.3 years in women. In both men and women there was a high prevalence of family history of coronary heart disease in 45 (19.9%) and 50 (21.6%), family history of diabetes in 96 (42.5%) and 77 (33.2%), sedentary habits in 82 (36.3%) and 73 (31.5%), smoking or tobacco use in 59 (26.1%) and 4 (1.7%), overweight or obesity (body mass index > or = 25 kg/m2) in 123 (54.0%) and 161 (69.4%), severe obesity (body mass index >30 kg/m2) in 47 (20.8%) and 75 (32.3%), truncal obesity (waist-hip ratio: men >0.9, women >0.8) in 175 (77.4%) and 186 (80.2%), increased waist (waist size: men >102 cm, women >88 cm) in 78 (34.5%) and 129 (55.6%), hypertension (blood pressure > or = 140/90 mmHg) in 116 (51.3%) and 120 (51.3%), diabetes in 40 (17.7%) and 33 (14.2%), hypercholesterolemia (total cholesterol > or = 200 mg/dl) in 75 (33.2%) and 67 (28.9%), high triglycerides in 55 (24.3%) and 34 (14.7%), low high-density lipoprotein cholesterol in 169 (74.8%) and 155 (66.8%), and the metabolic syndrome (defined by American National Cholesterol Education Program) in 84 (36.2%) and 111 (47.8%) respectively. Body mass index correlated significantly with (age-adjusted r2 value--men, women) waist diameter (0.52, 0.12), waist-hip ratio (0.21, 0.10), truncal obesity (0.54, 0.60), systolic blood pressure (0.19, 0.16), diastolic blood pressure (0.12, 0.16), hypertension (0.19, 0.31), and metabolic syndrome (0.28, 0.44) (p<0.05). There was a significant linear relationship of body mass index with the prevalence of hypertension, hypercholesterolemia, diabetes (women), and the metabolic syndrome (chi2 for trend p<0.05). Prevalence of these risk factors was the lowest in subjects with body mass index <20 kg/m2. A multivariate ordinal logistic regression analysis revealed that obesity was independently associated with multiple risk factors characterized by metabolic syndrome after adjustment for age, hypertension, and diabetes in both men (odds ratio 2.45, 95% confidence intervals 1.69, 3.57) as well as in women (odds ratio 2.93, 95% confidence intervals 1.86, 4.61) (p<0.01). CONCLUSIONS: There is a high prevalence of obesity, abdominal obesity, hypertension, diabetes, lipid abnormalities and the metabolic syndrome in this community that is significantly greater than reported studies in Jaipur and urban populations elsewhere in India. Obesity correlates strongly with multiple coronary risk factors of which it is an important determinant.

Serial epidemiological surveys in an urban Indian population demonstrate increasing coronary risk factors among the lower socioeconomic strata.

OBJECTIVE: To determine trends of coronary risk factors in an Indian urban population and their association with educational level as marker of socioeconomic status. METHODS: Two successive coronary risk factor surveys were performed in randomly selected individuals. In the first study (in 1995) 2212 subjects (1415 men, 797 women) and in the second (in 2002) 1123 subjects (550 men, 573 women) were studied. Details of smoking, physical activity, hypertension, diabetes, coronary heart disease, body-mass index, waist-hip ratio, blood pressure and electrocardiography were evaluated. Fasting blood was examined for lipid levels in 297 (199 men, 98 women) in the first and in 1082 (532 men, 550 women) in the second study. Educational status was classified into Group 0: no formal education, Group I: 1-10 years, Group II: 11-15 years, and Group III: > 16 years. Current definitions were used for risk factors in both the studies. RESULTS: Prevalence of coronary risk factors, adjusted for age and educational status, in the first and second study in men was smoking/tobacco in 38.7 vs. 40.5%, leisure time physical inactivity in 70.8 vs. 66.1%, hypertension (> or = 140 and/or 90 mm Hg) in 29.5 vs. 33.7%, diabetes history in 1.1 vs. 7.8%, obesity (body-mass index > or = 25 Kg/m2) in 20.7 vs. 33.0%, and truncal obesity (waist:hip > 0.9) in 54.7 vs. 54.4%. In women, tobacco use was in 18.7 vs. 20.5%, leisure time physical inactivity in 72.4 vs. 75.3%, hypertension in 36.9 vs. 33.7%, diabetes history in 1.0 vs. 7.3%, obesity in 19.9 vs. 39.4%, and truncal obesity (waist:hip > 0.8) in 70.1 vs. 69.2%. In men, high total cholesterol > or = 200 mg/dl was in 24.6 vs. 37.4%, high LDL cholesterol > or = 130 mg/dl in 22.1 vs. 37.0%, high triglycerides > or = 150 mg/dl in 26.6 vs. 30.6% and low HDL cholesterol < 40 mg/dl in 43.2 vs. 54.9%; while in women these were in 22.5 vs. 43.1%, 28.6 vs. 45.1%, 28.6 vs. 28.7% and 45.9 vs. 54.2% respectively. In the second study there was a significant increase in diabetes, obesity, hypertension (men), total- and LDL cholesterol and triglycerides and decrease in HDL cholesterol (p < 0.05). In the first study with increasing educational status a significant increase of obesity, total cholesterol, LDL cholesterol and triglycerides and decrease in smoking was observed. In the second study increasing education was associated with decrease in smoking, leisure-time physical inactivity, total and LDL cholesterol, and triglycerides and increase in obesity, truncal obesity and hypertension (Least-squares regression p < 0.05). Increase in smoking, diabetes and dyslipidaemias was greater in the less educated groups. CONCLUSIONS: Significant increase in coronary risk factors--obesity, diabetes, total-, LDL-, and low HDL cholesterol, and triglycerides is seen in this urban Indian population over a seven year period. Smoking, diabetes and dyslipidaemias increased more in low educational status groups.

Hindu-Muslim differences in the prevalence of coronary heart disease and risk factors.

Differences in coronary risk factors and coronary heart disease (CHD) prevalence between the Hindus and the Muslims have not been adequately studied. This study aims to determine the prevalence of certain socio-economic and biological coronary risk factors in urban communities and to compare the findings found in the Hindus and the Muslims. The study employed a cross-sectional survey design and stratified random sampling technique consisting of 1,415 males and 797 females. Among males there were 1,092 Hindus (77.2%) and 272 Muslims (19.2%) while in females there were 685 Hindus (85.9%) and 91 Muslims (11.4%). Prevalence of illiteracy and sedentary lifestyle were significantly more in Muslims (p<0.05). Smoking or tobacco use in males was similar but in females it was more in the Hindus. Self-reported diabetes was found in 1.4% Hindu males and in 1.2% Hindu females. No Muslim reported diabetes. Hindu males were significantly taller than Muslims (163.9 +/- 8.3 versus 160.9 +/- 8.9 cm; p < 0.001). In both males and females there was no significant difference in body mass index and obesity. In Hindu males the diastolic BP was significantly greater than in Muslims (81.2 +/- 9.2 versus 79.0 +/- 8.6 mm Hg; p < 0.001); prevalence of hypertension (30.5% versus 25.7%) was also significantly more (p = 0.048). In Hindu females the mean systolic BP was significantly more and there was also difference in hypertension prevalence (35.2% versus 25.3%). CHD prevalence was significantly greater in Hindu males as compared to the Muslims when determined by the presence of either ECG changes alone (4.3% versus 0.7%; p = 0.008) or ECG changes combined with clinical history (7.1% versus 1.8%; p = 0.002). A similar, though not significant, trend was seen in females (ECG changes: 8.9% versus 6.6%, clinical and ECG changes: 10.4% versus 6.6%). The prevalence of CHD is significantly more in Hindu males as compared to the Muslims and is associated with a greater prevalence of diabetes and hypertension.

Prevalence of coronary heart disease and risk factors in an urban Indian population: Jaipur Heart Watch-2.

BACKGROUND: The prevalence of risk factors for coronary heart disease has been inadequately studied in India. A repeat cross-sectional survey was carried out to evaluate the changes in the major coronary risk factors in the urban population of Jaipur previously studied in the early 1990s. METHODS AND RESULTS: Randomly selected adults > or =20 years of age were studied using stratified sampling. The target study sample was 1800 with a population proportionate gender distribution (males 960, females 840). Coronary risk factors, anthropometric variables, blood pressure, ECG, fasting blood glucose and lipids were evaluated. A total of 1123 subjects (62.4%) (males 550, females 573) were examined. Fasting blood samples were available in 523 males and 559 females. Overall coronary heart diesase prevalence, diagnosed by history or ECG changes, was found in 34 males (6.18%) and 58 females (10.12%). Risk factor prevalence showed that smoking/tobacco use was present in 201 males (36.5%) and 67 females (11.7%). Physical inactivity, either work-related or leisure time, was seen in 157 males (28.5%) and 130 females (22.7%). Hypertension (> or =140 and/or 90 mmHg) was present in 200 males (36.4%) and 215 females (37.5%). Diabetes diagnosed by history or fasting glucose > or =126 mg/dl was found in 72 males (13.1%) and 65 females (11.3%). Obesity, body mass index > or =27 kg/m2 was present in 135 males (24.5%) and 173 females (30.2%), while truncal obesity (waist:hip >0.9 males, >0.8 females) was found in 316 males (57.4%) and 392 females (68.4%). The most common dyslipidemia in both males and females was low HDL-cholesterol (<40 mg/dl: males 54.9%, females 54.2%). High total cholesterol levels of > or =200 mg/dl (males 37.4%, females 4.1%), high LDL-cholesterol levels of > or =130 mg/dl (males 37.0%, females 45.8%) and high levels of triglycerides > or = 150 mg/dl (males 32.3%, females 28.6%) were also seen in a significant number. Hypertension, obesity, truncal obesity, diabetes and dyslipidemias increased significantly with age in both males and females (Mantel-Haenzel chi2 for trend, p<0.05). CONCLUSIONS: There is a high prevalence of standard coronary risk factors--smoking, physical inactivity, hypertension, hypercholesterolemia, diabetes and obesity--as well as factors peculiar to south Asians--truncal obesity, low HDL-cholesterol and high triglycerides--in this urban Indian population. As compared to a previous study in the early 1900s in a similar population, there is a significant increase in the number of people with obesity, diabetes and dyslipidemias.

Lipid abnormalities in coronary heart disease: a population-based case-control study.

BACKGROUND: We performed a case-control study to estimate lipid-cholesterol fractions in patients with coronary heart disease and compared them with population-based controls. METHODS AND RESULTS: A total of 635 newly diagnosed patients with coronary heart disease (518 males and 117 females) and 632 subjects (346 males and 286 females) obtained from an ongoing urban coronary heart disease risk factor epidemiological study were evaluated. Age-specific lipid values (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and total:high-density lipoprotein cholesterol ratio) were compared using the t-test. Age-adjusted prevalence of dyslipidemia as defined by the US National Cholesterol Education Program was compared using the Chi-square test. In all the age groups, and in both males and females, levels of total and low-density lipoprotein cholesterol were not significantly different. In males, the high-density lipoprotein cholesterol (mg/dl) was significantly lower in patients with coronary heart disease as compared to controls in the age groups 30-39 years (35.1+/-11 v. 43.7+/-9), 40-49 years (39.0+/-10 v. 47.1+/-8), 50-59 years (38.9+/-11 v. 43.8+/-9) and 60-69 years (38.6+/-11, v. 42.8+/-7) (p<0.05). In females, high-density lipoprotein cholesterol was less in the age groups 30-39 years (30.2+/-9 v. 40.7+/-9), 50-59 years (39.7+/-12 v. 44.7+/-8) and 60-69 years (35.6+/-11 v. 42.2+/-9). The level of triglycerides was significantly higher in male patients in the age groups 40-49 years (195.3+/-96 v. 152.8+/-78), 50-59 years (176.7+/-76 v. 162.9+/-97), 60-69 years (175.5+/-93 v. 148.1+/-65) and >70 years (159.8+/-62 v. 100.0+/-22); and in female patients in the age group 30-39 years (170.8+/-20 v. 149.9+/-9) (p<0.05). The total:high-density lipoprotein cholesterol ratio was significantly higher in all age groups in male as well as female patients with coronary heart disease (p<0.05). CONCLUSIONS: An age-adjusted case-control comparison showed that the prevalence of hypertension, diabetes, high total cholesterol (> or =200 mg/dl) (males 48.8% v. 20.2%; females 59.8% v. 33.4%) and high low-density lipoprotein cholesterol (> or =130 mg/dl) (males 42.1% v. 15.0%; females 52.1% v. 31.0%) was significantly more in cases than in controls. The prevalence of low high-density lipoprotein cholesterol (<35 mg/dl) (males 39.6% v. 6.2%; females 39.3% iv 9.5%), high total:high-density lipoprotein ratio (> or = 5.0) and high triglycerides (> or =200 mg/ dl: males 39.6%, v. 10.2%; females 17.1% v. 11.9%) was also significantly higher in cases (p<0.05).

Meta-analysis of coronary heart disease prevalence in India.

This meta-analysis was performed to determine the time-trends in the prevalence of coronary heart disease in India and age-and gender-specific changes. Inter-study differences, urban-rural differences and age-and gender-specific differences were examined using the Chi-square test and Mantel-Haenzel Chi-square statistics for linear association. The prevalence of coronary heart disease increased from 1.05% in 1960 to 9.67% and 7.90% in 1995 in urban populations (X2 = 277.5, p < 0.0001; Mantel-Haenzel X2 = 5.63, p = 0.018). In rural areas, the prevalence increased from 2.03% in 1974 to 3.7% in 1995 (X2 = 90.0, p < 0.0001; Mantel-Haenzel X2 = 2.94, p = 0.086). In urban areas there was a significant increase in the prevalence of coronary heart disease in men in the age groups 20-29 and 30-39 years (p = 0.001) and in women in the age groups 20-29, 30-39 and 40-49 years (p = 0.002). In rural areas the increase in men was in the age groups 20-29 and 30-39 years (p = 0.001).

Prevalence of coronary heart disease and coronary risk factors in an urban population of Rajasthan.

To determine the prevalence of coronary heart disease (CHD) and coronary risk factors in an urban Indian population, we studied a random sample of population of Jaipur. A physician-administered questionnaire, physical examination and a 12-lead electrocardiogram was performed on 2,212 adults of > or = 20 years of age (males 1,415, females 797). CHD was diagnosed on the basis of past documentation, response to WHO-Rose questionnaire or changes in the electrocardiogram. The overall prevalence of CHD was 7.6 percent (168 cases). The prevalence rate was 6.0 percent (84) in males and 10.4 percent (84) in females with an age-related increase in prevalence ('p' for trend < 0.001). When diagnosed on the basis of electrocardiographic changes alone (Q, ST or T wave), the prevalence was 5.2 percent (116), with 3.5 percent in males and 8.4 percent in females. CHD was silent in 57 percent males and 79 percent females. Coronary risk factors were observed in a significant proportion: smoking in 32 percent (males 39 percent, females 19 percent), hypertension (> or = 140/90 mm Hg) in 31 percent (males 30 percent, females 34 percent-JNC-V) and > or = 160/95 mm Hg in 11 percent (males 10 percent, females 12 percent; WHO classification), diabetes in 1 percent and sedentary habits in 71 percent. Additional risk factors were generalised obesity (body-mass index > or = 27 Kg/m2) in 11 percent and truncal obesity (waist-hip ratio > 0.95) in 17 percent males and 13 percent females. Significant association of CHD prevalence were seen with age, sedentary habits and presence of hypertension in both males and females, and in addition with smoking in males.

Smoking and alcohol intake in a rural Indian population and correlation with hypertension and coronary heart disease prevalence.

3148 persons (1982 males and 1166 females) aged more than 20 years in a cluster of three villages were examined. The overall prevalence of smoking was 51% in males (n = 1006) and 5% in females (n = 54). Among male smokers there were 26% light smokers (< or = 5 bidis/day), 51% moderate smokers (6-20/day) and 17% heavy smokers (> 20 day) and in females there were 54% light smokers, 41% moderate smokers and 5% heavy smokers. Smokers were less educated and had higher prevalence of work-related physical activity and alcohol intake. There was a higher prevalence of hypertension and of ECG Q-waves in male smokers. Regular alcohol intake was seen in 19% males (n = 377) and in 2% females (n = 26). Among males there were 43% light drinkers (< or = 28 gm ethanol/day), 32% moderate drinkers (28-56 gm ethanol/day) and 5% heavy drinkers (> 56 gm ethanol/day). Although this group had a higher prevalence of hypertension there was an insignificant difference in CHD prevalence and a significantly lower prevalence of ECG Q-waves. Subgroup analysis has also been performed taking non-smoker-non-alcohol consuming group as controls. It was found that group which comprised of smokers-non-alcohol consumers had a significantly higher prevalence of hypertension and of ECG Q-waves. Alcohol intake-smoker group had a significantly higher prevalence of hypertension. The habits of smoking and alcohol consumption are widely prevalent among males in this rural community. Smoking and alcohol-intake, both individually and collectively, are related to higher prevalence of hypertension as well as CHD. While the prevalence of hypertension is more among the alcohol consumers, smokers have a higher prevalence of CHD.

Circadian rhythms of renal phosphohydrolases analysed by Cosinor method.

Rhythmometric analysis of hydrolytic enzymes of mouse kidney has been performed on circadian time scale using the F test. Significant rhythms were detected in glucose-6-phosphatase (G6Pase), inorganic pyrophosphatase (InPPase) and alkaline phosphatase (AlPase) on protein and fresh weight basis. Acrophase (time for peak activity) of G6Pase, InPPase and AlPase per mg protein was at 9.9 degrees (1.0 hr), 88.5 degrees (6.0 hr) and at 342.3 degrees (20 hr) respectively. ATPase, which did not show significant rhythm (mean +/- SD = 4.51 +/- 0.30), had a peak value at 32.1 degrees (2.14 hr) with an amplitude of 0.31 units on protein basis. However, G6Pase and AlPase oscillated with high amplitudes (0.18 and 0.71) across the mean value (mesor) of 0.68 +/- 0.3 and 1.43 +/- 0.46 units respectively and with a phase shift of 5 hr. Since G6Pase is a multicomponent and multifunctional enzyme having several overlapping enzyme activities (viz. InPPase), coordinated events of G6Pase, InPPase and ATPase in the regulation of daily renal functions have been mapped in the intact animals, along a physiologic time scale.

Circadian rhythmometric analysis of hepatic phosphohydrolases with special reference to glucose-6-phosphatase and inorganic pyrophosphatase.

Rhythmometric analysis of a group of phosphohydrolases in mouse liver has been performed along a single 24 hr time scale. The presence of the rhythm was conducted by F test. Statistically significant circadian rhythm was detected in glucose-6-phosphatase (G6Pase) and inorganic pyrophosphatase (InPPase) activity expressed on fresh weight and protein basis. Both G6Pase and InPPase oscillated with a high amplitude of 0.44 U and 1.15 U respectively across the mean value (mesor) of 0.40 +/- 0.42 U and 2.81 +/- 1.14 U per mg protein and with a phase shift of 80 degrees (5.34 hr) among them. On the other hand, alkaline phosphatase (AlPase) did not show any rhythm whereas adenosine triphosphatase (ATPase) showed rhythmic activity on protein basis and oscillated across mesor of 1.84 +/- 0.5 U with an amplitude of 0.52. Acrophase (time for peak activity/mg protein) of G6Pase, InPPase and ATPase was found at 194.2 degrees (13.34 hr), 114.1 degrees (8.0 hr) and at 306.1 degrees (20.4 hr) respectively. AlPase, though did not show significant rhythm, had peak value at 231.8 degrees. Since hepatic G6Pase is a multicomponent and multifunctional enzyme with several overlapping activities (viz. InPPase), coordinated action of G6Pase and InPPase in the regulation of hepatic cell functions has been suggested.

Dynamics of Met5- and Leu5-enkephalin and their receptor binding activity in relation to morphine.

A complete normal coordinate analysis of Met5- and Leu5-enkephalins using Wilson's GF matrix method and Urey Bradley force field has been carried out to understand the dynamical behaviour of enkephalins. In addition, the charge distributions on different atoms of the two enkephalins and morphine using CNDO/2 method are also reported. The similarity in the charge distribution on the part of these two molecules is indicative of the possible interactions at the same receptor site as that of morphine and its derivatives. Apart from the topographical features and charge distribution, binding onto receptor site is not a static but a dynamic process and low frequency modes must play an important role in the recognition process. The significance of the out-of-plane amide VII band and other skeletal modes as characteristic of conformational states of Met5- and Leu5-enkephalins are discussed.

Coronary heart disease and coronary risk factor prevalence in rural Rajasthan.

To determine the prevalence of coronary risk factors and coronary heart disease (CHD) in rural Rajasthan, 1150 randomly selected individuals in a cluster of villages in central Rajasthan have been studied. These included 805 men and 345 women. The prevalence of various coronary risk factors in the whole group were: Smoking 488 (42.4%); Diabetes (history): 5(0.4%); Alcohol intake: 146 (12.7%); Sedentary lifestyle: 797 (69.3%); Stressful life events: 48 (4.2%); Hypertension (BP > or = 140/90) 152 (13.2%); obesity (BMI > or = 27 Kg/M2): 194 (10.9%); and Truncal obesity (waist:hip > or = 0.93): 20.8%. The overall prevalence of CHD was 46.1/1000. Patients with CHD had a higher prevalence of male sex (67.9 vs 51.5%); educated persons (30.2 vs 28.8%); businessmen (13.2 vs 10.2%); smoking (47.2 vs 40.5%); sedentary lifestyle (75.5 vs 62.3%); stressful life events (7.5 vs 4.8%); and hypertension (26.4 vs 14.8%). On the other hand, persons without CHD had higher prevalence of alcohol intake (10.8 vs 7.5%); regular prayers (23.1 vs 22.6%); physically active lifestyle (37.7 vs 24.5%); obesity (13.6 vs 6.9%), and truncal obesity (21.0 vs 20.0%). The following risk factors emerged significant on statistical analysis (Odds ratio, 95% confidence intervals): male sex (1.99, 1.04 to 3.7); hypertension (2.04, 1.01 to 4.09); male smokers (1.80, 1.28 to 4.09); and sedentary lifestyle (1.86, 1.01 to 3.59). This study shows a low prevalence of CHD in rural population which is however more than previously reported studies from India.

Influence of cessation of smoking on long term mortality in patients with coronary heart disease.

Cessation of smoking in patients with coronary artery disease (CAD) has shown variable results. The long term mortality in patients of coronary heart disease (CHD) who quit smoking following diagnosis of their disease has been variable. We have analysed the long term effects of cessation of smoking on mortality in a cohort of 173 patients with CAD and compared the mortality of this group with 299 nonsmokers and 52 current smokers. The baseline data were identical for major risk factors like age, hypertension, diabetes, cholesterol levels, and congestive heart failure among the three groups (p > 0.1). There were more patients with previous myocardial infarction in past (38.7%) and current smokers (40.4%) than among nonsmokers (25.4%). All patients were followed for a period extending upto 11 years. The mean duration of follow up was 6.81 +/- 2.95 years in non-smokers, 5.98 +/- 2.94 years in exsmokers, and 6.32 +/- 3.44 years in current smokers. Actuarial analysis shows that overall mortality was significantly more among exsmokers than nonsmokers (Logrank test = 3.72, 1p < 0.05). The exsmokers showed similar mortality as current smokers during the first three years of follow up (Logrank test = 1.10, 1p < 0.1); but afterwards the mortality was significantly less in exsmokers than in current smokers (Logrank test = 6.29, 1p < 0.025). However, the overall mortality was lowest in nonsmokers when compared to that of exsmokers and current smokers (Logrank test = 3.92, p < 0.05). The total mortality was 28.1% in nonsmokers, 32.4% in exsmokers, and 46.2% in current smokers. The incidence of sudden death was, however, similar in all the groups.(ABSTRACT TRUNCATED AT 250 WORDS)