High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3.

BACKGROUND

Studies among emigrant Indian populations have shown a high prevalence of obesity and many coronary risk factors in Bhatia community. To determine the prevalence of risk factors in this community within India we performed an epidemiological study.

METHODS AND RESULTS

An ethnic-group sample survey to determine prevalence of cardiovascular risk factors was performed using community registers for enrollment. Methodology used was similar to Jaipur Heart Watch studies performed in 1995 and 2002. We invited 600 randomly selected subjects listed in Punjabi Bhatia community registers and could examine 458 (76.7%) persons (men 226, women 232). Evaluation for coronary risk factors, anthropometric measurements, blood pressure, electrocardiogram, fasting blood glucose and serum lipids was performed using standard definitions. Mean age was 43.2 +/- 14.6 years in men and 44.7 +/- 15.3 years in women. In both men and women there was a high prevalence of family history of coronary heart disease in 45 (19.9%) and 50 (21.6%), family history of diabetes in 96 (42.5%) and 77 (33.2%), sedentary habits in 82 (36.3%) and 73 (31.5%), smoking or tobacco use in 59 (26.1%) and 4 (1.7%), overweight or obesity (body mass index > or = 25 kg/m2) in 123 (54.0%) and 161 (69.4%), severe obesity (body mass index >30 kg/m2) in 47 (20.8%) and 75 (32.3%), truncal obesity (waist-hip ratio: men >0.9, women >0.8) in 175 (77.4%) and 186 (80.2%), increased waist (waist size: men >102 cm, women >88 cm) in 78 (34.5%) and 129 (55.6%), hypertension (blood pressure > or = 140/90 mmHg) in 116 (51.3%) and 120 (51.3%), diabetes in 40 (17.7%) and 33 (14.2%), hypercholesterolemia (total cholesterol > or = 200 mg/dl) in 75 (33.2%) and 67 (28.9%), high triglycerides in 55 (24.3%) and 34 (14.7%), low high-density lipoprotein cholesterol in 169 (74.8%) and 155 (66.8%), and the metabolic syndrome (defined by American National Cholesterol Education Program) in 84 (36.2%) and 111 (47.8%) respectively. Body mass index correlated significantly with (age-adjusted r2 value--men, women) waist diameter (0.52, 0.12), waist-hip ratio (0.21, 0.10), truncal obesity (0.54, 0.60), systolic blood pressure (0.19, 0.16), diastolic blood pressure (0.12, 0.16), hypertension (0.19, 0.31), and metabolic syndrome (0.28, 0.44) (p<0.05). There was a significant linear relationship of body mass index with the prevalence of hypertension, hypercholesterolemia, diabetes (women), and the metabolic syndrome (chi2 for trend p<0.05). Prevalence of these risk factors was the lowest in subjects with body mass index <20 kg/m2. A multivariate ordinal logistic regression analysis revealed that obesity was independently associated with multiple risk factors characterized by metabolic syndrome after adjustment for age, hypertension, and diabetes in both men (odds ratio 2.45, 95% confidence intervals 1.69, 3.57) as well as in women (odds ratio 2.93, 95% confidence intervals 1.86, 4.61) (p<0.01).

CONCLUSIONS

There is a high prevalence of obesity, abdominal obesity, hypertension, diabetes, lipid abnormalities and the metabolic syndrome in this community that is significantly greater than reported studies in Jaipur and urban populations elsewhere in India. Obesity correlates strongly with multiple coronary risk factors of which it is an important determinant.