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.