Life-course trajectories of cardiovascular disease risk factors in rural India: Andhra Pradesh Children and Parents Study (APCAPS) 2003–2023

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of disability-adjusted life years in South Asia, with adverse trends in CVD risk seen in rural residents in recent decades. Assessment of life-course trajectories of CVD risk factors is important to understand CVD aetiology. METHODS: The Andhra Pradesh Children and Parents cohort Study included all children (n = 2601) born during 1987-90 and their mothers (n = 1963) residing in 29 villages of South India. Participants were followed up in 2003-05, 2009-10, 2010-12, and 2021-23. Children (n = 4777 observations, 35% female) were assessed for body mass index (BMI), waist circumference, waist-hip ratio, waist-height ratio, fasting glucose, and central and peripheral skinfolds. For mothers (n = 3830 observations), repeated measures of BMI were available. Linear mixed-effect models with a random slope were used to model trajectories of CVD risk factors. RESULTS: BMI increased with age and the predicted mean BMI reached the World Health Organization's increased risk action point for adult South Asians (≥23 kg/m2) at 28 years for male and 31 years for female children, while, for mothers, it was much later at 43-65 years. In male children compared with females, there was a faster progression to prediabetes, higher abdominal fat deposition, and a higher rate of increase in subscapular skinfolds. CONCLUSION: South Asians living in rural areas showed increasing trajectories of several CVD risk factors, particularly in males. This highlights the need for interventions to mitigate the potential CVD burden.