Regional variations in cardiovascular risk factors in India: India heart watch

Table 1 Top five causes of deaths in India classified according to areas of residence and gender

Rank	India (all age groups)	Economically backward states	Economically advanced states	Rural populations	Urban populations	Men	Women	Middle-age (25-69 yr)
1	Cardiovascular	Cardiovascular	Cardiovascular	Cardiovascular	Cardiovascular	Cardiovascular	Cardiovascular	Cardiovascular
2	COPD, asthma	Diarrhea	COPD, asthma	COPD, asthma	Cancers	COPD, asthma	Diarrhea	COPD, asthma
3	Diarrhea	Respiratory infections	Cancers	Diarrhea	COPD, asthma	Tuberculosis	COPD, asthma	Tuberculosis
4	Perinatal	COPD, asthma	Senility	Perinatal	Tuberculosis	Diarrhea	Respiratory infections	Cancers
5	Respiratory infections	Perinatal	Diarrheas	Respiratory infections	Senility	Perinatal	Senility	Ill-defined

Adapted from Registrar General of India Report[5]. COPD: Chronic obstructive pulmonary disease.

Table 2 Population attributable risks (%) of various cardiovascular risk factors for coronary heart disease and stroke in [11,12]

Risk factor	INTERHEART(acute myocardial infarction)	INTERSTROKE(thrombotic or hemorrhagic strokes)
Apolipoprotein A/B ratio	49.2	24.9
Hypertension	17.9 (history)	34.6
Smoking	35.7	18.9
Diabetes history	9.9	5.0
High waist-hip ratio	20.1	26.5
Psychosocial stress	32.5	9.8
Regular physical activity	12.2	28.5
Diet/diet score	13.7	18.8
Lack of alcohol intake	6.7	3.8
Cardiac causes	-	6.7

Table 3 Recent studies of hypertension prevalence in India

First author	Year	Place	Age (yr)	Sample size	Prevalence (%)
Urban Populations
Gupta R	1995	Jaipur	≥ 20	2212	30.9
Anand MP	2000	Mumbai	30-60	1662	34.0
Gupta R	2002	Jaipur	≥ 20	1123	33.4
Shanthirani CS	2003	Chennai	≥ 20	1262	21.1
Gupta PC	2004	Mumbai	≥ 35	88 653	47.9
Prabhakaran D	2005	Delhi	20-59	2935	30.0
Reddy KS	2006	National	20-69	19 973	27.2
Mohan V	2007	Chennai	≥ 20	2350	20.0
Kaur P	2007	Chennai	18-69	2262	27.2
Yadav S	2008	Lucknow	≥ 30	1746	32.2
Rural Populations
Gupta R	1994	Rajasthan	≥ 20	3148	16.9
Kusuma Y	2004	Andhra	≥ 20	1316	21.0
Hazarika NC	2004	Assam	≥ 30	3180	33.3
Krishnan A	2008	Haryana	15-64	2828	9.3
Todkar SS	2009	Maharashtra	≥ 20	1297	7.2
Bhardwaj R	2010	Himachal	≥ 18	1092	35.9
By Y	2010	Karnataka	≥ 18	1900	18.3
Kinra S	2010	National	20-69	1983	20.0

Table 4 Risk factor prevalence (%) among men and women (15-64 years) in 8 Indian states in Indian Council of Medical Research Noncommunicable Disease Risk Factor Surveillance Study[25]

Risk factor	Andhra Pradesh		Madhya Pradesh		Maharashtra		Mizoram		Kerala		Tamilnadu		Uttarakhand
	Men	Women	Men	Women	Men	Women	Men	Women	Men	Women	Men	Women	Men	Women
Numbers	2719	3499	2857	2996	3084	3007	2297	2198	1710	3128	2077	3028	2147	3286
Current smoking	31.5	4.0	41.2	0.9	15.9	2.5	67	18.8	27.3	0.2	27.4	0.0	35.2	5.0
Smokeless tobacco use	13.6	4.5	53.8	22.6	40.7	23.6	46.5	55.4	7.0	3.4	13.6	8.4	21.0	2.2
Low physical activity	55.9	79.7	33.5	52.0	75.4	87.7	60.9	82.4	64.7	86.2	57.3	74.2	64.6	69.7
Obese, BMI ≥ 25 kg/m2	19.4		8.2		13.1		10.3		27.1		22.6		14.5
Hypertension	16.6		21.1		20.1		19.4		18.0		17.7		18.8
Diabetes history	2.7	1.7	0.6	0.6	0.9	1.0	0.7	0.5	6.5	5.3	3.4	2.6	1.2	1.1

BMI: Body mass index.

Table 5 Greater prevalence of cardiovascular risk factors among urban women in India[24]

Variable	Urban (n = 2008)	Rural (n = 2616)	Age-adjusted urban-rural relative risk (95% CI)
Smoking/tobacco use
Current users	326 (19.6)	871 (41.6)	0.35 (0.18-0.65)1
Smoking	14 (0.7)	276 (10.6)	0.09 (0.01-0.70)
Non-smoked tobacco use	325 (16.2)	607 (23.2)	0.64 (0.31-1.30)
Sedentary lifestyle PALs < 1.55 units	1406 (71.0)	1558 (60.1)	1.63 (0.90-2.94)
Overweight/obesity
BMI 23.0-24.99 kg/m2	355 (11.6)	324 (12.5)	0.91 (0.40-2.11)
BMI 25.0-29.99 kg/m2	640 (31.7)	451 (16.8)	2.30 (1.12-3.47)1
BMI ≥ 30.0 kg/m2	288 (13.9)	152 (5.7)	2.55 (1.61-3.49)1
Truncal obesity
WHR > 0.9	880 (44.3)	318 (13.03)	5.26 (2.61-10.63)1
Waist circumference > 90 cm	638 (31.4)	226 (8.4)	5.17 (2.24-11.94)1
Hypertension	925 (48.2)	746 (31.6)	1.96 (1.10-3.49)1
Hypercholesterolemia ≥ 200 mg/dL	552 (27.7)	322 (13.5)	2.39 (1.17-4.88)1
Diabetes (history or fasting glucose ≥ 126 mg/dL)	292 (15.1)	98 (4.3)	4.24 (1.35-13.26)1

¹Significant. PAL: Physical activity levels; WHR: Waist-hip ratio; BMI: Body mass index.