Trend in prevalence of coronary artery disease and risk factors over two decades in rural Punjab

Q: What are the key findings of this study?

Age-standardised coronary artery disease prevalence in rural Punjab increased from 2.79% in 1994 to 4.06% in 2014, alongside rises in hypertension, diabetes, and obesity.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary artery disease and cardiovascular risk factors (n=3832). Intervention: 2014 survey period (20-year epidemiological and lifestyle transition) vs. 1994 baseline survey period. Primary outcome: Overall age-standardised prevalence of coronary artery disease (CAD) diagnosed by Epstein and clinical criteria (p=<0.05).

Q: What does this research mean for the field?

Age-standardised prevalence of coronary artery disease in rural Punjab increased from 2.79% in 1994 to 4.06% in 2014, accompanied by marked increases in hypertension, diabetes, obesity, and physical inactivity. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Abhishek Goyal; Praneet Kahlon; Dinesh Jain; Rajendra Kumar Soni; Rohit Gulati; Shibba Takkar Chhabra; Naved Aslam; Bishav Mohan; Inder S. Anand; Gurpreet Singh Wander

doi:10.1136/heartasia-2017-010938

September 1, 2017Heart AsiaOpen Access

Trend in prevalence of coronary artery disease and risk factors over two decades in rural Punjab

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Key result

Rural Punjab CAD prevalence rises ~1.3 percentage points over 20 years alongside cardiometabolic risk factors.

P<0.05
n=3,832

Why the study?

Did the prevalence of coronary artery disease and cardiovascular risk factors change over a 20-year period (1994 to 2014) among adults aged >30 years in rural Punjab, India?

Key Points

To assess the 20-year changes in the prevalence of coronary artery disease and its major cardiovascular risk factors within a rural Indian population.
Conducted population-based surveys of adults older than 30 years in three villages of Punjab in 1994 (n=1100, 68% of eligible) and 2014 (n=2732, 92.4% of eligible).
Diagnosed CAD using Epstein and clinical criteria along with resting electrocardiograms, blood pressure measurements, anthropometric profiling, and biochemical blood testing.
Overall age-standardised CAD prevalence increased from 2.79% in 1994 to 4.06% in 2014 (p<0.05), rising significantly in men (2.28% to 4.04%, p<0.05) with a non-significant rise in women (3.76% to 4.06%, p>0.05).
Multiple risk factors rose significantly between 1994 and 2014: sedentary lifestyle (8.2% vs 41.3%, p<0.001), hypertension (14.5% vs 26.5%, p<0.001), diabetes (4.7% vs 9.7%, p<0.001), obesity (16.6% vs 35.4%, p<0.001), and hypercholesterolaemia (7% vs 9.6%, p=0.011).
Cigarette smoking decreased from 8.9% to 3% (p<0.001) and cooking with traditional desi ghee declined from 51.4% to 28.5% (p<0.001).

Study Design

Type

Cross-Sectional (n=3,832)

Multicenter

No

Structured PICO

Did the prevalence of coronary artery disease and cardiovascular risk factors change over a 20-year period (1994 to 2014) among adults aged >30 years in rural Punjab, India?

P

Population

3,832 adults aged over 30 years (1,100 in 1994 and 2,732 in 2014) from three rural villages in Punjab, India, evaluated across two repeated cross-sectional surveys 20 years apart.

E

Exposure

2014 cross-sectional epidemiological door-to-door survey (assessing 20-year temporal and lifestyle transition)

C

Comparator

1994 cross-sectional epidemiological door-to-door survey in the same three villages

O

Outcome

Age-standardised prevalence of coronary artery disease (CAD) diagnosed using clinical criteria (documented ACS, CAD treatment, PCI/CABG, or coronary angiography) and ECG-based Epstein criteria (probable cases only) over a 20-year interval (1994 vs 2014)hard clinical

Main Result

Absolute Event Rate: 4.06% vs 2.79%

p-value: p=<0.05

Over two decades in rural Punjab, India, major cardiometabolic risk factors (sedentary lifestyle, hypertension, diabetes, obesity, hypercholesterolaemia) increased substantially alongside a significant rise in age-standardised CAD prevalence (2.79% to 4.06%), highlighting an urgent need for rural primary care preventive strategies.

Limitations

Low population coverage in the 1994 survey (68%), meaning selection bias cannot be entirely excluded
Non-random sampling restricted to three villages under the field practice areas of the Department of Community Medicine due to scarcity of resources and manpower
Incomplete availability of blood samples for blood sugar analysis (73.54% in 1994) and cholesterol analysis (71.81% in 1994 and 92.68% in 2014)
Population coverage attained in 1994 was low (68%), so selection bias cannot be entirely excluded.
Random sampling method was not used; sampling was restricted to three villages under the field practice areas of the Department of Community Medicine due to scarcity of resources and manpower.
Blood samples were not available for all subjects: blood sugar analysis was available in 73.54% in 1994, and cholesterol analysis was available in 71.81% in 1994 and 92.68% in 2014.

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Implication

May signal rising rural CAD burden; extends urban trends but leaves open causality and prevention effects.

Abstract

OBJECTIVES: The burden of coronary artery disease (CAD) has increased in the last three decades in low-income and middle-income countries including India. CAD is responsible for 20% deaths in India. The burden of CAD has increased due to a higher prevalence of risk factors related to the changing lifestyle. We studied the change in prevalence of CAD and risk factors over 20 years in a rural area. METHODS: A rural population of adults over the age of 30 years from three villages of Punjab was surveyed for the prevalence of CAD and its risk factors in 1994 and 2014 using similar research methodology. CAD was diagnosed by Epstein and clinical criteria. Blood pressure, anthropometry, ECG and biochemical analysis were carried out. The findings of two surveys were compared with a look at the change in the prevalence of CAD and its risk factors over 20 years. RESULTS: The overall age standardised prevalence of CAD increased from 2.79% in 1994 to 4.06% (p<0.05) in 2014. There was a significant increase in the prevalence of several risk factors including sedentary lifestyle (8.2% vs 41.3%, p<0.001), hypertension (14.5% vs 26.5%, p<0.001), diabetes (4.7% vs 9.7%, p<0.001), obesity (16.6% vs 35.4, p<0.001) and hypercholesterolaemia (7% vs 9.6%, p 0.011). In contrast, cigarette smoking (8.9% vs 3%, p<0.001) and use of desi ghee (51.4% vs 28.5%, p<0.001) decreased. CONCLUSIONS: In a rural population of Punjab, the prevalence of several CAD risk factors like sedentary lifestyle, hypertension, diabetes, obesity and hypercholesterolaemia increased over 20 years. These changes in risk factors were associated with a modest increase in prevalence of CAD.

Discussion

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Cite This Study

Goyal et al. (2017) conducted a cross-sectional in Coronary artery disease and cardiovascular risk factors (n=3,832). 2014 survey period (20-year epidemiological and lifestyle transition) vs. 1994 baseline survey period was evaluated on Overall age-standardised prevalence of coronary artery disease (CAD) diagnosed by Epstein and clinical criteria (p=<0.05). Age-standardised coronary artery disease prevalence in rural Punjab increased from 2.79% in 1994 to 4.06% in 2014, alongside rises in hypertension, diabetes, and obesity.

synapsesocial.com/papers/6a8440067b4d6f59a47bffdb https://doi.org/10.1136/heartasia-2017-010938

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Trend in prevalence of coronary artery disease and risk factors over two decades in rural Punjab

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Trend in prevalence of coronary artery disease and risk factors over two decades in rural Punjab

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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