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Epidemiology
Research
Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results)
  1. Panniyammakal Jeemon1,2,3,
  2. Dorairaj Prabhakaran1,3,4,
  3. Mark D Huffman1,5,
  4. Lakshmy Ramakrishnan6,
  5. Shifalika Goenka1,
  6. K R Thankappan7,
  7. V Mohan8,
  8. Prashant P Joshi9,
  9. B V M Mohan10,
  10. F Ahmed11,
  11. Meera Ramanathan12,
  12. R Ahuja13,
  13. Vivek Chaturvedi14,
  14. Donald M Lloyd-Jones5,
  15. K Srinath Reddy3 on behalf of the Sentinel Surveillance in Industrial Populations Study Group
  1. 1Centre for Chronic Disease Control, New Delhi, India
  2. 2Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  3. 3Public Health Foundation of India, New Delhi, India
  4. 4Center of Excellence, Center for Cardio-metabolic Risk Reduction in South Asia, New Delhi, India
  5. 5Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  6. 6All India Institute of Medical Sciences, New Delhi, India
  7. 7Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala
  8. 8Madras Diabetes Research Foundation, Chennai, India
  9. 9Indira Gandhi Government Medical College, Nagpur, India
  10. 10Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India
  11. 11KPC Medical College, Jadavpur, Kolkata, India
  12. 12PSGIMSR Medical College, Coimbatore, India
  13. 13King George Medical College, Lucknow, India
  14. 14GB Pant Hospital, New Delhi, India
  1. Correspondence to Dr Dorairaj Prabhakaran; dprabhakaran{at}ccdcindia.org

Abstract

Introduction Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date.

Methods The authors estimated short-term and lifetime predicted CVD risk among 10 054 disease-free, adult Indians in the 20–69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (≥10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups.

Results The mean age (SD) of the study population (men=63%) was 40.8±10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively.

Conclusion Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.

  • Cardiovascular disease
  • risk stratification
  • lifetime risk
  • cardiac epidemiology
  • diabetes and endocrinology
  • lipid disorders
  • epidemiology
  • coronary heart disease
  • echocardiography
  • hypertension
  • heart failure
  • qualitative research
  • research methodology
  • India
  • primary healthcare
  • diabetes
  • developing countries
  • adult cardiology

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2011-000068

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    Footnotes

    • To cite: Jeemon P, Prabhakaran D, Huffman MD, et al. Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results). BMJ Open 2011;1:e000068. doi:10.1136/bmjopen-2011-000068

    • Funding The original study received financial support from Ministry of Health and Family Welfare, Government of India and WHO. P Jeemon is supported by a Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of UK universities.

    • Competing interests PJ is supported by a Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a Consortium of UK Universities. M Huffman is supported by an NHLBI training grant in cardiovascular epidemiology and prevention (T32 HL069771-08).

    • Patient consent Written informed consent was obtained from all participants before starting study measurements.

    • Ethics approval Ethics approval was provided by the ethics committee/IRBs of all participating academic medical colleges.22

    • Contributors DP, KSR, PJ, SG and VC designed the data-collection tools and monitored data collection for the whole study. KRT, VM, PPJ, FA, BVMM, MR and RA coordinated the data collection. PJ and MDH wrote the statistical analysis plan, cleaned and analysed the data, and drafted the paper. LR performed the biochemical analysis and quality control. DML-J reviewed the statistical analysis plan. PJ, DP, MDH, LR, SG, KRT, VMM, PPJ, BVMM, FA, MR, RA, VC, DML-J and KSR revised and approved the final paper.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Only aggregate data are presented in the paper.