Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India.
BMJ Open. 2019 Oct 28;9(10):e029759. doi: 10.1136/bmjopen-2019-029759.
Cardiovascular diseases (CVD) accounted for one-third of the deaths in India. We conducted a cohort study to estimate the incidence of CVD and the association of established risk factors with the incident CVD in a rural population in South India.
DESIGN, SETTING AND PARTICIPANTS: We conducted a community-based cohort study among 6026 adults aged 25-64 years in five villages in Tiruvallur, Tamil Nadu. We did baseline (2005-2007) and two follow-up surveys in 2008-2009 and 2013-2015. Risk factors studied were tobacco, alcohol, hypertension, self-reported diabetes and central obesity.
Outcome measures were fatal or non-fatal ischaemic heart disease or cerebrovascular event. We estimated HRs for the risk factors and population attributable fraction (PAF).
We followed up 5641 (94.4%) subjects, and follow-up duration was 33 371 person years. The overall incidence of cardiovascular event or death was 4.6 per 1000 person years. Current smoking (HR 1.6, 95% CI 1.1 to 2.6) and hypertension (HR 2.2, 95% CI 1.5 to 3.4) were the risk factors among men and accounted for 47% of the PAF. Among women, hypertension (HR 1.8, 95% CI 1.0 to 3.4), self-reported diabetes (HR 4.3, 95% CI 2.2 to 8.1) and central obesity (HR 2.2, 95% CI 1.2 to 4.0) were associated with CVD and accounted for more than half of the PAF.
We described the high burden of fatal CVD and identified the role of CVD risk factors such as hypertension, self-reported diabetes, smoking and central obesity. There is an urgent need to implement low-cost interventions such as smoking cessation and treat hypertension and diabetes in primary care settings.
心血管疾病（CVD）占印度死亡人数的三分之一。我们进行了一项队列研究，以估计印度南部农村人口 CVD 的发病率，并评估已确定的危险因素与 CVD 事件的相关性。
设计、地点和参与者：我们在泰米尔纳德邦蒂鲁瓦卢尔的五个村庄中进行了一项基于社区的队列研究，纳入了 6026 名 25-64 岁的成年人。我们在 2005-2007 年进行了基线调查，并分别于 2008-2009 年和 2013-2015 年进行了两次随访调查。研究的危险因素包括烟草、酒精、高血压、自我报告的糖尿病和中心性肥胖。
结局指标为致命或非致命性缺血性心脏病或脑血管事件。我们评估了危险因素的 HRs 和人群归因分数（PAF）。
我们对 5641 名（94.4%）受试者进行了随访，随访时间为 33371 人年。心血管事件或死亡的总发生率为每 1000 人年 4.6 例。当前吸烟（HR 1.6，95%CI 1.1-2.6）和高血压（HR 2.2，95%CI 1.5-3.4）是男性的危险因素，占 PAF 的 47%。在女性中，高血压（HR 1.8，95%CI 1.0-3.4）、自我报告的糖尿病（HR 4.3，95%CI 2.2-8.1）和中心性肥胖（HR 2.2，95%CI 1.2-4.0）与 CVD 相关，占 PAF 的一半以上。
我们描述了致命 CVD 的高负担，并确定了 CVD 危险因素（如高血压、自我报告的糖尿病、吸烟和中心性肥胖）的作用。迫切需要在初级保健环境中实施低成本干预措施，如戒烟和治疗高血压和糖尿病。
