Andhra Pradesh
- Although no state wide data are available, several studies show a high prevalence of diabetes and other risk factors for heart disease in the state. The prevalence of risk factors in a unique sample of 3307 workers (mean age 43, 12% women) of a political party drawn from all over the state of Andhra Pradesh provide a microcosm for the state.1
- The prevalence of risk factors was as follows: diabetes 24%; high blood pressure 28%; dyslipidemia 58% (cholesterol problems); smoking 24%; obesity 36%. All coronary risk factors, except family history, were significantly more prevalent in males.1 Lipid disorders were equally prevalent in all the regions.
- Sudden cardiac death (SCD) contributed to 10% of overall mortality in this population. On an average, SCD cases were 5-8years younger compared to populations reported in the western hemisphere. The prevalence of risk factors was also very high.2
Rural Andhra Pradesh
- Another study of 45 villages in rural Andhra Pradesh showed that cardiovascular disease (CVD) was the leading cause of mortality accounting for 32% of all deaths, a rate as high as in Canada (35%) and the US.3 The prevalence of coronary artery disease (CAD) was only 5% and stroke is 2% possibly due to high mortality from poor medical care.3
- A majority of the subjects were of low socioeconomic class. The average household size was 4 and the mean combined household income was about Rupees 25,454 ($580) per year and less than half the national average for India.3
- The prevalence of risk factors is high ─ current smoking and high blood pressure 20% each.4 Obesity (BMI >25) is common and found in 32% of men and 41% of women (compared to 33% among Americans). The rate of diabetes was low at 4%, considerably lower than the 24% reported among the political workers study.1, 3, 4
- Dyslipidemia is common. The mean total cholesterol ranged from 173 – 178mg/dl, HDL ranged from 31- 42mg/dl, triglycerides of 133mg/dl, LDL of 108mg/dl and non-HDL of 131mg/dl with no significant difference between men and women including HDL (difference of 4 mg/dl).5 TC/HDL ratio (the most powerful predictor of heart disease), however, was higher than 4 -6. 3
- The use of guideline-mandated, proven, low-cost preventive medications is dismally low.6 Among individuals with CVD the reported use of medications was 14% for aspirin, 41% for blood pressure-lowering medication, and only 5% for cholesterol-lowering medication.3
- These data show a disturbing burden of CAD risk factors in both urban and rural Andhra Pradesh and very low implementation of evidence based medicine in people with CVD.1, 3
Sources
1. Reddy NK, Kumar DN, Rayudu NV, Sastry BK, Raju BS. Prevalence of risk factors for coronary atherosclerosis in a cross-sectional population of Andhra Pradesh. Indian Heart J. Nov-Dec 2002;54(6):697-701.
2. Rao BH, Sastry BK, Chugh SS, et al. Contribution of sudden cardiac death to total mortality in India – A population based study. Int J Cardiol. Sep 30 2010.
3. Joshi R, Cardona M, Iyengar S, et al. Chronic diseases now a leading cause of death in rural India–mortality data from the Andhra Pradesh Rural Health Initiative. Int J Epidemiol. Sep 22 2006.
4. Chow C, Cardona M, Raju PK, et al. Cardiovascular disease and risk factors among 345 adults in rural India–the Andhra Pradesh Rural Health Initiative. Int J Cardiol. Mar 20 2007;116(2):180-185.
5. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA. Jan 20 1984;251(3):351-364.
6. Joshi R, Chow CK, Raju PK, et al. Fatal and nonfatal cardiovascular disease and the use of therapies for secondary prevention in a rural region of India. Circulation. Apr 14 2009;119(14):1950-1955.