Objective To establish a surveillance network for cardiovascular diseases (CVD) risk factors in industrial settings and estimate the risk factor burden using standardized tools. Methods We conducted a baseline cross-sectional survey (as part of a CVD surveillance programme) of industrial populations from 10 companies across India, situated in close proximity to medical colleges that served as study centres. The study subjects were employees (selected by age and sex stratified random sampling) and their family members. Information on behavioural, clinical and biochemical determinants was obtained through standardized methods (questionnaires, clinical measurements and biochemical analysis). Data collation and analyses were done at the national coordinating centre. Findings We report the prevalence of CVD risk factors among individuals aged 20-69 years (n = 19 973 for the questionnaire survey, n = 10 442 for biochemical investigations); mean age was 40 years. The overall prevalence of most risk factors was high, with 50.9% of men and 51.9% of women being overweight, central obesity was observed among 30.9% of men and 32.8% of women, and 40.2% of men and 14.9% of women reported current tobacco use. Self-reported prevalence of diabetes (5.3%) and hypertension (10.9%) was lower than when measured clinically and biochemically (10.1% and 27.7%, respectively). There was marked heterogeneity in the prevalence of risk factors among the study centres. Conclusion There is a high burden of CVD risk factors among industrial populations across India. The surveillance system can be used as a model for replication in India as well as other developing countries. Voir page 467 le résumé en français. En la página 468 figura un resumen en español. IntroductionCardiovascular diseases (CVDs are maj j jor contributors to the global burden of chronic diseases with 29.3% of global deaths and 9.9% of total disease burden, in terms of disabilityjadjusted life years (DALYs) lost, being reported in 2003. 4 Major causes for the inj j crease in disease burden are rising rates of hypertension, dyslipidaemia, diabetes, overweight, obesity, physical inactivity and tobacco use. 5In India, CVD is projected to be the largest cause of death and disabilj j ity by 2020, 5 with 2.6 million Indians predicted to die due to coronary heart disease, which constitutes 54.1% of all CVD deaths. Nearly half of these deaths are likely to occur among young and middlejaged individuals (30-69 years). This is because Indians experience CVD deaths at least a decade earlier than their counterparts in developed countries. This has the potential to adversely affect India's economy with 52% of CVD deaths occurring in those below the age of 70 years compared to 23% in countries in established market economies. 4 Demographic and health transij j tions, genejenvironmental interactions and early life influences of fetal malnuj j trition have been implicated as the causes of increasing CVD burden in India. • to conduct a baseline survey and continual surveillance of CVD risk f...

C ardiovascular diseases (CVDs) are the leading cause of death in many regions of the world (1). Elevated blood pressure, blood sugar, serum cholesterol, body mass index, and tobacco use, all established risk factors for CVD, have a direct and linear relationship with CVD (2-7). All of these risk factors are linked to lifestyle changes (4).Although reasonable evidence exists for the beneficial role of risk factor reduction in decreasing CVD risk among individuals at high risk, primary or primordial prevention programs that use populationbased approaches have yielded equivocal results (8,9). For example, a meta-analysis of all population-based studies conducted largely in developed countries has suggested that health promotion (involving health education, mass media, and community organization) does not reduce mortality significantly but leads to small yet potentially beneficial reduction in risk factor levels (10). Several reasons have been attributed to this equivocal result of health promotion. These include shorter duration of intervention, improper design to evaluate the benefits, contamination (adoption of components of health intervention by the control community), and a declining trend of CVD in developed countries during the intervention period. However, by contrast, in developing countries the current prevailing secular trend seems to be a rapidly increasing burden of CVD and its risk factors. Therefore it is likely that a community-based approach may show the desired results of reducing CVD risk factors in developing country settings. For example, a primary prevention and health promotion initiative in Mauritius showed a pronounced decrease in the population level total cholesterol concentrations after 5 years of the intervention program (11).India is experiencing an accelerated epidemiological transition with a consequent increase in the burden of CVD risk factors both in community-based studies and in industrial populations (12)(13)(14)(15)(16). Given this background, we hypothesized that a comprehensive CVD risk factor reduction program comprising of a multipronged strategy of health promotion, high-

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