Although the metabolic syndrome is a known predictor of coronary heart disease and type-2 diabetes mellitus, it has no agreed definition. The concordance of its various definitions has been studied for a limited number of populations and there are few studies on the rural populations in India. The present study was done to determine the prevalence of metabolic syndrome in a rural population of South India and to evaluate the concordance of the modified National Cholesterol Education Programme-Adult Treatment Panel III definition and International Diabetes Federation definition for the diagnosis of Metabolic Syndrome. Anthropometric and biochemical parameters (fasting blood glucose and lipid profile) and blood pressure were measured using standard procedures. The prevalence of metabolic syndrome was calculated using the two sets of criteria and compared for their concordance. Descriptive statistics was used to analyze age and risk factors of metabolic syndrome. The chi-square test was applied to compare the prevalence of metabolic syndrome obtained from the two criteria (significant if p<0.05). An inter-rater reliability analysis using the kappa statistic was performed to determine consistency between the two sets of criteria in diagnosing the metabolic syndrome. The modified National Cholesterol Education Programme-Adult Treatment Panel III definition and International Diabetes Federation definition for metabolic syndrome identified overall age-adjusted prevalence of 17.8% and 20.5% respectively, which were not significantly different. Kappa statistics revealed only moderate agreement of 0.44 between the two sets of criteria. The impact of economic development and preponderance of genetic factors is increasing the prevalence of metabolic syndrome in rural India. It is important to determine which definition of the metabolic syndrome best predicts coronary heart disease and type 2 diabetes in this population in order to formulate effective public health policy.
Background Hypertension (HTN) is a key risk-factor for cardiovascular diseases (CVDs). Blood-pressure (BP) categorizations between systolic blood pressure (SBP) of 120 and 140 remain debatable. In the current study we aim to evaluate if individuals with a baseline SBP between 130-140 mm Hg (hypertension as per AHA 2017 guidelines) have a significantly higher proportion of incident hypertension on follow-up, as compared to those with SBP between 120-130 mm Hg. Methods Secondary data analysis was performed in a community-based cohort, instituted, and followed since 2017. Participants were aged ≥30 years, residents of urban slums in Bhopal. BP was measured at or near home by Community Health Workers (CHWs). Two-year follow up was completed in 2019. We excluded participants who were on BP reduction therapy, had fewer than two out-of-office BP measurements and who could not be followed. Eligible participants were re-classified based on baseline BP in four categories: Normal (Category-A), Elevated-BP (Category-B), Variable-BP (Category-C) and reclassified HTN based on AHA-2017 (Category-D). Proportion of individuals who developed incident hypertension on follow up was primary outcome. Result Out of 2649 records, 768 (28.9%), 647 (24.4%), 586 (22.1%), 648 (24.4%) belonged to Categories A, B, C and D respectively. Incident HTN with cut-off of 140/90 mm Hg was, 1.6%, 2.6%, 6.7%, 12% in categories A, B, C and D respectively. Incidence of incident hypertension in individuals with a baseline SBP between 130-140 mm Hg (Category D) was significantly higher as compared to those with SBP between 120-130 mm Hg (Category B). Conclusion We conclude that biological basis for AHA-2017 definition of hypertension is relatively robust also for low income and resource-limited settings. Evidence from our longitudinal study will be useful for policy makers for harmonizing national guidelines with AHA-2017. Keywords- hypertension, elevated blood pressure, community health worker, cardiovascular diseases
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