PREVALENCE AND DETERMINANTS OF CORONARY HEART-DISEASE IN A RURAL-POPULATION OF INDIA

Background. The prevalence and determinants of coronary heart disease (CHD) have been inadequately studied in rural areas of developing coun tries. Methods. Entire communities were surveyed in randomly selected villages in Rajasthan, India. A physician-administered questionnaire, physical examination, and electrocardiogram (EGG) were performed on 31 48 adults greater than or equal to 20 years of age (1982 males, 1166 f emales). Easting blood samples for determination of lipids were obtain ed from 202 males and 98 females. Prevalence of coronary risk factors- -smoking, hypertension, sedentary life-style, obesity, and hypercholes terolemia-was determined. CHD was diagnosed on basis of past documenta tion, response to WHO-Rose questionnaire, or changes in EGG. Three met hods were used: (a) documentation, history, and ECG criteria, (b) ECG- Q, ST, or T changes, and (c) presence of Q waves. Results. Coronary ri sk factors: smoking was present in 51% males and 5% females, hypertens ion (greater than or equal to 140/90 mmHg) in 24% males and 17% female s, hypercholesterolemia (greater than or equal to 200 mg/dl) in 22%, d iabetes history in 0.2%, and irregular physical activity or sedentary habits in 85%. Other risk factors were lack of formal education in 44% , obesity (body-mass index greater than or equal to 27 kg/m(2)) in 6% and truncal obesity (waist-hip ratio greater than or equal to 0.95) in 5%. The prevalence of CHD (clinical + ECG criteria) was 3.4% in males and 3.7% in females. According to ECG criteria only, it was 2.8% in m ales and 3.3% in females and according to Q-waves only, it was 1.6% in males and 0.9% in females. Multivariate logistic regression analysis showed that age and smoking in males and age and systolic blood pressu re in females were associated with higher prevalence of Q-wave CHD. In males, higher educational level and prayer habit were associated with lower prevalence. Conclusions. Prevalence of CHD in this rural commun ity is higher than in previously reported Indian studies. Smoking, hyp ertension, and sedentary lifestyle have high prevalence. Significant d eterminants of CHD are increasing age and smoking while education and prayer-habit are protective. Copyright (C) 1997 Elsevier Science Inc.