Key result
Rural residence is linked to nearly 3-fold higher prevalence of good cardiovascular health versus metropolitan cities.
Why the study?
Markers of ideal cardiovascular health predict cardiovascular events, but their prevalence across different urban and rural settings in India needed estimation.
Does the prevalence of ideal cardiovascular health metrics vary across urban and rural settings and socioeconomic groups in India?
Cross-Sectional (n=22,144)
Yes
Does the prevalence of ideal cardiovascular health metrics vary across urban and rural settings and socioeconomic groups in India?
The achievement of ideal cardiovascular health metrics is dismally low in India, particularly among metropolitan populations and higher asset strata, highlighting the need for multisectoral policies targeting urbanization and lifestyle factors.
Ideal CVH prevalence is low across India with urban gradients; hypothesis-generating for urbanization effects, needing longitudinal studies before informing policy.
Background: Markers of ideal cardiovascular health (CVH) predict cardiovascular events. We estimated the prevalence of ideal CVH markers in two levels of cities and villages in India. Methods: We did pooled analysis of individual-level data from three cross sectional surveys of adults ≥ 30 years over 2010–14 (CARRS: Centre for cArdiometabolic Risk Reduction in South Asia; UDAY and Solan Surveillance Study) representing metropolitan cities; smaller cities and rural areas in diverse locations of India. We defined ideal CVH using modified American Heart Association recommendations: not smoking, ≥ 5 servings of fruits and vegetables (F&V), high physical activity (PA), body mass index (BMI) <25 Kg/m², blood pressure (BP) <120/80 mm Hg, fasting plasma glucose (FPG) <100 mg/dl, and total cholesterol (TC) <200 mg/dL. We estimated (1) age-and sex-standardized prevalence of ideal CVH and (2) prevalence of good (≥6 markers), moderate (4–5), and poor CVH (≤3) adjusted for age, sex, education, and stratified by setting and asset tertiles. Results: Of the total 22,144 participants, the prevalence of ideal CVH markers were: not smoking (76.7% [95% CI 76.1, 77.2]), consumed ≥5 F&V (4.2% [3.9, 4.5]), high PA (67.5% [66.8, 68.2]), optimum BMI (59.6% [58.9, 60.3]), ideal BP (34.5% [33.9, 35.2]), FPG (65.8% [65.1, 66.5]) and TC (65.4% [64.7, 66.1]). The mean number of ideal CVH metrics was 3.7(95% CI: 3.7, 3.8). Adjusted prevalence of good, moderate, and poor CVH, varied across settings: metropolitan (3.9%, 41.0%, and 55.1%), smaller cities (7.8%, 49.2%, and 43%), and rural (10.4%, 60.9%, and 28.7%) and across asset tertiles: Low (11.0%, 55.9%, 33.1%), Middle (6.3%, 52.2%, 41.5%), and High (5.0%, 46.4%, 48.7%), respectively. Conclusion: Achievement of ideal CVH varied, with higher prevalence in rural and lower asset tertiles. Multi-sectoral and targeted policy and program actions are needed to improve CVH in diverse contexts in India.
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Shivashankar et al. (2022) conducted a cross-sectional in Cardiovascular Health (n=22,144). Urban vs. rural setting and asset tertiles was evaluated on Adjusted prevalence of good cardiovascular health (≥6 ideal CVH metrics). The adjusted prevalence of good cardiovascular health varied significantly across settings, being 3.9% in metropolitan cities, 7.8% in smaller cities, and 10.4% in rural areas.
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