A community based cross sectional study to estimate total cardiovascular risk in rural Punjab

Abstract

Background: Cardiovascular diseases (CVD) are leading cause of non communicable deaths in India. CVD risk prediction charts by World Health Organization/International Society of Hypertension (WHO/ISH) are designed for implementing timely preventive measures. The objective of the study was to assess the prevalence of CVD risk parameters and to estimate total CVD risk among adults aged ≥40 years, using the WHO/ISH risk charts alone and also to assess the effect of the inclusion of additional criteria on CVD risk.Methods: A community based cross sectional study was conducted in fifteen villages of Ludhiana district under rural health training centre of Department of Community Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab. Desired information was obtained using WHO STEPS survey (STEP wise approach to surveillance) from 324 adults aged ≥40 years. Anthropometric, clinical and laboratory measurements were also performed. WHO/ISH risk prediction chart for South East Asian region (SEAR-D) was used to assess the cardiovascular risk among the subjects.Results: WHO/ISH risk prediction charts identified 16.0% of the subjects with high risk (≥20%) of developing a cardiovascular event. The study population showed higher prevalence of physical inactivity, obesity, abdominal obesity, hypertension and diabetes. Amongst high risk CVD group, maximum prevalence was of hypertension and high perceived stress level. However, the proportion of high CVD risk (≥20%) increased to 33.6% when subjects with blood pressure ≥160/100 mmHg and /or on hypertension medication were added as high risk.Conclusions: A substantial proportion of this community is at high risk of developing cardiovascular diseases.

Cardiovascular disease risk factors and 10 year risk of cardiovascular events among women over the age of 40 years in an urban underprivileged area of Bangalore City

“…Our study found an alarmingly high prevalence of hypertension, with more than half of the women having hypertension and one-third in the pre-hypertensive phase. Similarly high proportion of hypertension among women aged 40–70 years has been described in studies in Ludhiana (53.4%)[ 8 ] and Fatehgarh Sahib (70%)[ 25 ] in Punjab and in slums of Kolkatta (51.8%). [ 26 ] This finding indicates an opportunity for action, as reduction in blood pressure significantly lowers CVD risk.…”

“…Our study found that more than one in ten women had a high risk of CVD, that is ≥20% chance of a cardiovascular event occurring within the next 10 years, which was aligned with the finding of a study in rural Ludhiana, where 15.3% of the women had high CVD risk. [ 8 ] However, a lower proportion was seen in two studies in Tamil Nadu. One in Salem, among women aged 40–70 years which found 6.5% high CVD risk[ 15 ] and the other in a village near Chennai among both men and women, where 6.25% had high CVD risk.…”

“…Study participants: Adult women aged 40–79 years residing in this community. Sampling: Based on a previous study in rural Punjab, where 15.3% women had a high 10-year CVD using the WHO/ISH risk prediction chart,[ 8 ] the sample size was calculated with 20% relative precision and 95% confidence limits to be 531. However, since the subjects would be screened for CVD risk factors, including diabetes and hypertension, referred to the UHTC for further evaluation and management of NCDs, as well as receive lifestyle and dietary counseling, it was felt that no woman in this underprivileged community should miss this opportunity for screening.…”

Predicting 10-year cardiovascular risk using WHO/ISH risk prediction chart among urban population in Salem

“…5 In contrast a study conducted in rural Punjab to estimate cardiovascular risk by Vikramaditya et al reported 19.1% of the study population having moderate risk(10-20%) and 16% of the population having high risk (>20%) using WHO/ISH risk prediction chart. 7 Out of total medium and high CVD risk individuals, 56.36% were males. This may be due to higher prevalence of smoking (15.3%) in males.…”

Ten years risk assessment of cardiovascular events among adult population visiting urban health and training centre of a tertiary care institution, Farrukhabad, Uttar Pradesh, India

“…6 In contrast a study conducted in rural Punjab to estimate cardiovascular risk by Vikramaditya et al, reported 19.1% of the study population having moderate risk (10-20%) and 16% of the population having high risk (>20%) using WHO/ISH risk prediction chart. 7 Another study at Mongolia, Malaysia and Cambodia, reveals prevalence of "high CVD risk" (≥20% chance of developing a cardiovascular event over 10 years) was 6%, 2.3% and 1.3% respectively. Of those at "moderate risk" (10≤20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor.…”