Thanikachalam Sadagopan, Harivanzan Vijayakumar, Mahadevan Murugappapillai V, Murthy J S N, Anbarasi Chandrasekar, Saravanababu Chidambaram S, Must Aviva, Baliga Ragavendra R, Abraham William T, Thanikachalam Mohan
Cardiac Care Centre, Sri Ramachandra University, Chennai, India.
National Institute of Siddha, Tambaram Sanitorium, Chennai, India.
Glob Heart. 2015 Dec;10(4):281-9. doi: 10.1016/j.gheart.2014.11.002. Epub 2015 Feb 7.
We designed and implemented the PURSE-HIS (Population Study of Urban, Rural and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study) to understand the prevalence and progression of subclinical and overt endovascular disease (EVD) and its risk factors in urban, semiurban, and rural communities in South India. The study is also designed to generate clinical evidence for effective, affordable, and sustainable community-specific intervention strategies to control risks factors for EVD. As of June 2012, 8,080 (urban: 2,221; semiurban: 2,821; rural: 3,038) participants >20 years of age were recruited using 2-stage cluster sampling. Baseline measurements included standard cardiovascular disease risk factors, sociodemographic factors, lifestyle habits, psychosocial factors, and nutritional assessment. Fasting blood samples were assayed for putative biochemical risk factors and urine samples for microalbuminuria. All nondiabetic participants underwent oral glucose tolerance test with blood and urine samples collected every 30 min for 2 h. Additional baseline measurements included flow-mediated brachial artery endothelial vasodilation, assessment of carotid intimal medial wall thickness using ultrasonography, screening for peripheral vascular disease using ankle and brachial blood pressures, hemodynamic screening using a high-fidelity applanation tonometry to measure central blood pressure parameters, and aortic pulse wave velocity. To assess prevalence of coronary artery disease, all participants underwent surface electrocardiography and documentation of ventricular wall motion abnormality and function using echocardiography imaging. To detect subclinical lesions, all eligible participants completed an exercise treadmill test. Prospectively, the study will assess progression of subclinical and overt EVD, including risk factor-outcome relation differences across communities. The study will also evaluate community-specific EVD prevention using traditional Indian system of medicine versus recognized allopathic (mainstream) systems of medicine.
我们设计并实施了PURSE-HIS（城市、农村和半城市地区血管内疾病检测、危险因素患病率及整体干预研究），以了解印度南部城市、半城市和农村社区亚临床和显性血管内疾病（EVD）及其危险因素的患病率和进展情况。该研究还旨在为有效、经济且可持续的针对特定社区的干预策略生成临床证据，以控制EVD的危险因素。截至2012年6月，采用两阶段整群抽样方法招募了8080名年龄大于20岁的参与者（城市：2221名；半城市：2821名；农村：3038名）。基线测量包括标准心血管疾病危险因素、社会人口统计学因素、生活方式习惯、心理社会因素和营养评估。采集空腹血样检测假定的生化危险因素，采集尿样检测微量白蛋白尿。所有非糖尿病参与者均接受口服葡萄糖耐量试验，每30分钟采集一次血样和尿样，共采集2小时。额外的基线测量包括血流介导的肱动脉内皮血管舒张、使用超声检查评估颈动脉内膜中层厚度、使用踝部和肱动脉血压筛查外周血管疾病、使用高保真压平式眼压计测量中心血压参数进行血流动力学筛查以及主动脉脉搏波速度。为评估冠状动脉疾病的患病率，所有参与者均接受体表心电图检查，并使用超声心动图成像记录心室壁运动异常和功能。为检测亚临床病变，所有符合条件的参与者均完成运动平板试验。前瞻性地，该研究将评估亚临床和显性EVD的进展情况，包括不同社区危险因素与结局关系的差异。该研究还将评估使用印度传统医学体系与公认的对抗疗法（主流）医学体系预防特定社区EVD的效果。
