Coronary Risk Factors in India

Urban-Rural Difference in Coronary Risk Factor Prevalence (%)

A study in Rajasthan was conducted to determine the prevalence of risk factors in the sample population. 3397 men (1415 urban, 1982 rural) and 1963 women (797 urban, 1166 rural) aged more than 20 years were studied. The findings are enumerated in the table.

	Urban	Rural
	Men (urban=1415, rural=1982)
Smoking and tobacco use	548 (38.7)	1006 (50.8)
Leisure time activity	202 (14.3)	363 (18.3)
Diabetes history	15 (1.1)	4 (0.2)
BP₃ 140/90 mm Hg	417 (29.5)	470 (23.7)
BP₃ 160/95	146 (29.5)	150 (7.6)
Obesity BMI₃ 27	161 (11.4)	104 (5.2)
Truncal Obesity > 0.95	64/252 (25.4)	17/399 (4.3)
Cholesterol ₃ 200 mg/dl	52/199 (26.1)	45/202 (22.3)
HDL cholesterol < 35 mg/dl	47/199 (23.6)	49/202 (24.2)
	Women (urban=797, rural=1166)
Smoking and tobacco use	149 (18.7)	54 (4.6)
Leisure time activity	64 (8.0)	88(7.5)
Diabetes history	8.0 (1.0)	2 (0.1)
BP₃ 140/90 mm Hg	67 (33.5)	197 (16.9)
BP₃ 160/95	97 (12.2)	72 (6.2)
Obesity BMI₃ 27	87 (10.9)	74 (6.4)
Truncal Obesity > 0.95	33/193 (17.1)	5/104 (4.8)
Cholesterol ₃ 200 mg/dl	-	22/98 (22.5)
HDL cholesterol < 35 mg/dl	-	40/98 (40.8)

 

It is evident from the table that there are certain risk factors that are greater in urban subjects like sedentary lifestyle, hypertension, obesity, and smoking/tobacco use in women, cholesterol levels, LDL levels, triglyceride levels, fasting insulin levels. Smoking/tobacco use in men was found to be more in rural subjects.

Lipid Tetrad Index – The Deadly Lipid Quartet            

Lp (a) is lately being projected as an independent risk factor of coronary artery disease. Its effects get multiplied by high triglycerides, high LDL, cholesterol and low HDL cholesterol. This constitutes a ‘deadly lipid quartet’ and may help explain high premature coronary artery disease in Indians especially Asian Indians. This also explains the African paradox of Lp (a), who inspite of having high Lp (a) have lower rates of heart disease. The adverse effects of Lp (a) in them gets mitigated by low LDL, low TG and high HDL.

Comprehensive lipid tetrad index is calculated by the formula TC x TG x Lp (a) / HDL. The values are taken as mg/dl. An index <10000 is desirable, 10000-20000 borderline abnormal and > 20000 as high. Retrospective analysis shows an index of 12899 in Asian Indian men and 10814 in Asian Indian women.

So it is best to keep your cholesterol and triglycerides under control since Lp (a) value is fixed for your life.

Note:

1.       Check ups are not authentic.

2.       Expensive, Rs. 300.00-400.00

 

Who Learns Faster?

Bad lifestyle or wrong lifestyle is often related to affluence and socioeconomic prosperity. People who used to work hard physically, travel by foot, eat conventional foods like rice and chapatti, changed to cars, stopped physical activities, started eating meat and fatty food, increased frequency of visiting restaurants, started stressing excessively and increased smoking once they prospered  economically.

Mechanical and electronic devices like washing machines, mobile phones and television further added to their sedentary habit. No doubt heart disease would come soon or later.

There are three kinds of people in our society.

1.       Upper socioeconomic group (prosperous, living in high urban society and mostly well-educated).

2.       Lower socio-economic group (less affluent living in villages/poor group).

3.       A big group which is in between these two groups, i.e. the middle class (may be small businessman, not so much educated class, clerical staff etc.).

 

Epidemiologists have shown that the affluent i.e. the high income group, start developing heart disease first. They lead the population in wrong way of life (fatty food, stresses, lack of exercise). By the time the habit spreads to the middle-income group, who also eventually become heart patients in very high numbers, the affluent group gets educated and starts taking care of their habits and improves the lifestyle. They are termed as “Early learners”.

The middle-income group in the meantime gathers the momentum and a substantial number of them suffer from the disease. Their numbers start increasing at speed and suddenly they constitute the main chunk of the population. India is probably in this stage now. A time comes when the education and know-how about preventing the disease becomes popular for this group. Eventually they also would change their lifestyle and get the disease under control.

The last group is the low socio-economic group. They are the last to fall into the trap of bad lifestyle. Naturally they are the last to get out of this situation since they take time to learn bad lifestyle. They also take time to learn the good ways. They are thus called the “late learners”.

CHECK YOUR RISK FACTORS
Causes of CAD	Normal and best level	What to Do?
Total Cholesterol	The normal level of cholesterol is 130 mg/dl 200 mg/dl. Saaol recommends 130 mg/dl to avoid heart disease.	1. Avoid all kinds of animal fats. We can name this animal fat in one word i.e. It can be of different types like chicken, mutton, beef, pork etc. Fish is also a source of animal fat.   2.Avoid all kind of milk products like ghee, cheese, butter, ice cream, milk based sweets.   3. Take more of green leafy vegetables. 4. take lot of fiber and fresh fruits. 5. Take plenty of sprouts. 6. Regular walking and stress management is also helpful in cholesterol reduction.
Serum Triglyceride	The normal level of triglyceride is 40-160mg/dl Saaol recommends below 130 mg/dl	1. All cooking oils are triglycerides. So avoid all kinds of oils like Sundrop, Dhara, Rath, Saffola, Fortune, olive oil and so on.   2. Increase fibre intake.   3. Avoid nuts and dry fruits since these are the sources of invisible oil.   4. Consume plenty of salads.
Serum HDL	The normal level of HDL is 30-60 mg/dl. Saaol recommends above 40 mg/dl	1. HDL is a good cholesterol. It helps to break down the blockages.   2. It can be increased by exercising regularly, taking sprouts/green vegetablesand reducing stress.
LDL Cholesterol	The normal level of LDL is 40-130 mg/dl. SAAOL recommends below 100 mg/dl	1. LDL is calculated value. If the TC, TG and HDL is normal then LDL wll be normal.   2. The formula to calculate LDL value is TC-TG/5-HDL
CHOL/HLD	Normal level of CHOL/HDL ratio is 3-6%. SAAOL recommends below 4.	1. CHOL/HDL ratio is also calculated value. If the CHOL and HDL level will be normal then this ratio also will be normal.
Blood Sugar	Normal fasting sugar is 80-120 mg/dl and after food 100-140 mg/dl.	1. Avoid taking milk products which are sweet.   2. Avoid talking fruits which are sweet to taste.     3. Regular exercise helps to keep sugar level low.   4. Reduce weight if you are overweight

 

 

Hope you liked this article!

This article is written by Dr. Bimal Chhajer (India’s leading Heart specialist)