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Surveillance for Risk Factors of Cardiovascular Disease among an Industrial Population in Southern India
Get PDFWe assessed (i) the risk of cardiovascular disease in an industrial population in Chennai, southern India and (ii) whether the status of treatment and control of diabetes and hypertension would be different in an industrial population, which is provided free healthcare, compared with the general population of Chennai. Subjects residing in the residential areas of 2 industries (Indian Airlines and Integral Coach Factory) in Chennai in southern India were recruited. The subjects were employees (n=440) selected by an age- and sex-stratified random sampling method, and their family members (n=727) in the age group of 20–69 years; a total of 1167 subjects. Fasting plasma glucose, lipid estimations and anthropometric measurements were done in all the subjects. Information on demographic and lifestyle determinants was obtained using a questionnaire. Diabetes was diagnosed using the American Diabetes Association criteria and metabolic syndrome was defined by the Adult Treatment Panel III criteria with modified waist definition for Asian Indians.
Results. Age-adjusted prevalence of major risk factors for cardiovascular disease using the 2001 Census of India were as follows: diabetes 11.9%; hypertension 25.4%; dyslipidaemia 40.2%; hypertriglyceridaemia 28.3%; overweight (body mass index ³23 kg/m2) 60.2%; and metabolic syndrome 34.1%. Use of tobacco in any form was present in 22.9% of men and 0.5% of women; 79% of the subjects followed a sedentary lifestyle. Among subjects receiving medication, 42.1% of subjects with diabetes and 55.3% of subjects with hypertension had their disease under adequate control. A comparison of these results with the general population of Chennai showed that the industrial population had a higher prevalence of cardiovascular risk factors in spite of having better access to healthcare facilities.
Conclusions. The prevalence of cardiovascular disease was high in this industrial population of Chennai. Although the overall treatment and control of diabetes and hypertension was better than that in the general population, it was still inadequate and this emphasizes the need for greater awareness about non-communicable diseases
Increased Awareness about Diabetes and Its Complications in a Whole City: Effectiveness of the “Prevention, Awareness, Counselling and Evaluation” [PACE] Diabetes Project [PACE-6]
Get PDFAbstract
Aims and Objectives : To determine the effectiveness of a large scale multipronged diabetes awareness program
provided through community involvement in Chennai.
Material and Methods: Mass awareness and free screening camps were conducted between 2004-2007 at various
locations of Chennai as part of the Prevention, Awareness, Counselling and Evaluation [PACE] Diabetes Project. During
a 3-year period, 774 diabetes awareness camps were conducted to reach the public directly. After the PACE project
was completed, 3,000 individuals, representative of Chennai, were surveyed in 2007 using a systematic stratified
random sampling technique. The results were compared to a similar survey carried out, as part of the Chennai Urban
Rural Epidemiology Study [CURES] in 2001 - 2002, which served as a measure of baseline diabetes awareness.
Results: Awareness of a condition called “diabetes” increased significantly from 75.5% in 2001-2002 (CURES) to
81% (p < 0.001) in 2007 (PACE). 74.1% of the citizens of Chennai are now aware that the prevalence of diabetes is
increasing as compared to 60.2% earlier [p<0.001]. Significantly more people felt that diabetes could be prevented
(p<0.001), and that a combination of diet and exercise were needed to do so (p<0.001). Respondents reporting
obesity, family history of diabetes, hypertension and mental stress as risk factors increased significantly after PACE
(p<0.001). More people were able to correctly identify the eyes (PACE 38.1% compared to CURES -16.1%, p < 0.001),
kidney (PACE 42.3% compared to CURES 16.1%, p < 0.001), heart (PACE 4.6% compared to CURES 5.8%, p < 0.001)
and feet (PACE 35.0% vs CURES 21.9%, p < 0.001) as the main organs affected by diabetes.
Conclusion: Through direct public education and mass media campaigns, awareness about diabetes and its
complications can be improved even in a whole city. If similar efforts are implemented state-wise and nationally,
prevention and control of non-communicable diseases, specifically diabetes and cardiovascular disease, is an
achievable goal in India.
Prevention Awareness Counselling and Evaluation (PACE) Diabetes Project: A Mega Multi-pronged Program for Diabetes Awareness and Prevention in South India (PACE - 5)
Get PDFObjective: The Prevention Awareness Counselling Evaluation (PACE) Diabetes Project is a large scale
community based project carried out to increase awareness of diabetes and its complications in Chennai city
(population : 4.7 million) through 1) public education 2) media campaigns 3) general practitioner training
4) blood sugar screening and 5) community based “real life” prevention program
Methods: Education took place in multiple forms and venues over the three-year period of the PACE project
between 2004 - 2007. With the help of the community, awareness programs were conducted at residential
sites, worksites, places of worship, public places and educational institutions through lectures, skits and
street plays. Messages were also conveyed through popular local television and radio channels and print
media. The General Practitioners (GPs) program included training in diabetes prevention, treatment and
the advantages of early detection of complications. Free random capillary blood glucose testing was done
for individuals who attended the awareness programs using glucose meter.
Results: Over a three-year period, we conducted 774 education sessions, 675 of which were coupled with
opportunistic blood glucose screening. A total of 76,645 individuals underwent blood glucose screening. We
also set up 176 “PACE Diabetes Education Counters” across Chennai, which were regularly replenished with
educational materials. In addition, we trained 232 general practitioners in diabetology prevention, treatment
and screening for complications. Multiple television and radio shows were given and messages about diabetes
sent as Short Message Service (SMS) through mobile phones. Overall, we estimate that we reached diabetes
prevention messages to nearly two million people in Chennai through the PACE Diabetes Project, making
it one of the largest diabetes awareness and prevention programs ever conducted in India.
Conclusion: Mass awareness and screening programs are feasible and, through community empowerment,
can help in prevention and control of non-commuincable diseases such as diabetes and its complications
on a large scale
Self-monitoring of blood glucose in type 2 diabetes: an inter-country comparison.
No full textSelf-monitoring of blood glucose (SMBG) in type 2 diabetic patients was compared across 14 countries. There was an unexpectedly high SMBG-use in non-insulin-treated patients. Reimbursement polices differed by country, region, insurance status, and patient income. More rigorous and systematic data collection is needed to ensure evidence-based SMBG-use
Relation between age and coronary heart disease (CHD) risk in Asian Indian patients with diabetes: A cross-sectional and prospective cohort study
No full textObjective: Non-migrant Asian Indians have a high prevalence of diabetes and coronary heart
disease (CHD). Since the relation between age and CHD risk in this population is not known,
the appropriateness of existing age threshold for patients with diabetes to be suitable for
primary CHD prevention with statins is not known.Weaimed to determine an age threshold
above which patients develop a higher risk of CHD and would merit routine statin prescription.
Design: Cross-sectional analysis of 1087 patients with diabetes from the Chennai Urban
Rural Epidemiological Studies (CURES). CHD risk assessment was calculated using the
United Kingdom Prospective Study (UKPDS) risk engine, externally validated by using data
obtained from the 7-year follow-up cohort of the Chennai Urban Population Study (CUPS).
Relation between age and CHD risk was determined and the age threshold for increased CHD
risks was calculated using line of best fit.
Results: UKPDS risk engine overestimates CHD event rates by 50% in this population. Age is a
strong independent predictor of CHD risk. Transition from low to moderate-risk category for
men and women with diabetes occurred at ages 37 and 50 years, respectively. Sensitivity for
fulfilling this CHD risk criteria are 98.7% for men and 87.1% for women.
Conclusions: Statins should be routinely prescribed to all Asian Indian men and women with
diabetes above the ages of 37 and 50 years, respectively. For patients below these age
thresholds, decision to initiate statins should be based on patient’s individual cardiovascular
risk factors. This strategy may facilitate public health efforts to reduce CHD events in
India
Urban rural differences in prevalence of self-reported diabetes in India--the WHO-ICMR Indian NCD risk factor surveillance.
No full textRecent reports show strikingly high prevalence of diabetes among urban Asian Indians; however, there are very few studies comparing urban, peri-urban and rural prevalence rates of diabetes and their risk factors at the national level. This study is a part of the national non-communicable diseases (NCD) risk factor surveillance conducted in different geographical locations (North, South, East, West/Central) in India between April 2003 and March 2005. A total of 44,523 individuals (age: 15-64 years) inclusive of 15,239 from urban, 15,760 from peri-urban/slum and 13,524 from rural areas were recruited. Major risk factors were studied using modified WHO STEPS approach. Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%, odds ratio (OR) for urban areas: 2.48, 95% confidence interval (CI): 2.21-2.79, p<0.001). Urban residents with abdominal obesity and sedentary activity had the highest prevalence of self-reported diabetes (11.3%) while rural residents without abdominal obesity performing vigorous activity had the lowest prevalence (0.7%). In conclusion, this nation-wide NCD risk factor surveillance study shows that the prevalence of self-reported diabetes is higher in urban, intermediate in peri-urban and lowest in rural areas. Urban residence, abdominal obesity and physical inactivity are the risk factors associated with diabetes in this study
Association of fruit and vegetable intake with cardiovascular risk factors in urban south Indians
No full textThe study examines the relationship between fruit and vegetable intake (g/d) and CVD risk factors in urban south Indians. The study population
comprised of 983 individuals aged $20 years selected from the Chennai Urban Rural Epidemiological Study (CURES), a population-based crosssectional
study on a representative population of Chennai in southern India. Fruit and vegetable intake (g/d) was measured using a validated semiquantitative
FFQ. Linear regression analysis revealed that after adjusting for potential confounders such as age, sex, smoking, alcohol, BMI and
total energy intake, the highest quartile of fruit and vegetable intake (g/d) showed a significant inverse association with systolic blood pressure
(b ¼ 22·6 (95% CI 25·92, 21·02) mmHg; P¼0·027), BMI (b ¼ 22·3 (95% CI 22·96, 21·57) kg/m2; P,0·0001), waist circumference
(b ¼ 22·6 (95% CI 23·69, 21·46) cm; P,0·0001), total cholesterol (b ¼ 250 (95% CI 2113·9, 213·6) mg/l; P¼0·017) and LDL-cholesterol
concentration (b ¼ 255 (95% CI 2110·8, 211·1) mg/l; P¼0·039) when compared with the lowest quartile. A higher intake of fruit and vegetables
explained 48% of the protective effect against CVD risk factors. Increased intake of fruits and vegetables could play a protective role
against CVD in Asian Indians who have high rates of premature coronary artery diseas
Curcumin Modulates SDF-1/CXCR4–Induced Migration of Human Retinal Endothelial Cells (HRECs)
No full textPURPOSE. The stromal-derived factor (SDF)-1 and the CXC
receptor (CXCR)-4 jointly regulate the trafficking of various cell
types and play a pivotal role in cell migration, proliferation, and
survival. The purpose of this study was to assess whether
curcumin inhibits human retinal endothelial cell (HREC) migration
by interfering with SDF-1/CXCR4 signaling.
METHODS. Primary HREC culture was established and maintained
in endothelial growth medium. The viability and proliferation
of HRECs were assessed by MTT and thymidine uptake
assays, respectively. The effect of SDF-1–induced HREC migration
(chemotaxis) in the presence and absence of curcumin
was determined using the Boyden chamber migration assay.
Intracellular Ca2 concentration was measured by fluorometric
analysis. Immunofluorescence and Western blot analyses
were performed to quantify CXCR4, phosphorylated AKT, and
PI3-kinase expression levels.
RESULTS. HREC migration increased in a dose-dependent manner
(1, 10, 50, and 100 ng/mL; P 0.001) in SDF-1–treated
cells. In contrast, AMD3100, an inhibitor of CXCR4 effectively
inhibited HREC migration dose dependently. HREC migration
was decreased when the cells were exposed to EGTA, a chelator
of Ca2. Curcumin also blocked Ca2 influx, an important
signal for HREC migration. In addition, curcumin significantly
(P 0.001) decreased SDF-1–induced HRECs migration and
downregulated SDF-1–induced expression of CXCR4, phospho-
AKT, phospho-phosphatidylinositol-3-kinase (PI3-K), and
eNOS.
CONCLUSIONS. This study indicates that curcumin has an inhibitory
effect on SDF-1–induced HREC migration. The plausible
mechanism of action could be upstream blockage of Ca2
influx and the downstream reduction of PI3-K/AKT signals
Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial
No full textObjective To determine whether integration of nutritional
supplementation with other public health programmes in
early life reduces the risk of cardiovascular disease in
undernourished populations.
Design Approximately 15 years’ follow-up of participants
born within an earlier controlled, community trial of
nutritional supplementation integrated with other public
health programmes.
Setting 29 villages (15 intervention, 14 control) near
Hyderabad city, south India.
Participants 1165 adolescents aged 13-18 years.
Intervention Balanced protein-calorie supplementation
(2.51 MJ, 20 g protein) offered daily to pregnant women
and preschool children aged under 6 years, coupled with
integrated delivery of vertical public health programmes.
Main outcome measures Height, adiposity, blood
pressures, lipids, insulin resistance (homoeostasis model
assessment (HOMA) score), and arterial stiffness
(augmentation index).
Results The participants from the intervention villages
were 14 mm (95% confidence interval 4 to 23; P=0.007)
taller than controls but had similar body composition. The
participants from the intervention villages had more
favourable measures of insulin resistance and arterial
stiffness: 20% (3% to 39%; P=0.02) lower HOMA score
and 3.3% (1% to 5.7%; P=0.008) lower augmentation
index. No strong evidence existed for differences in blood
pressures and serum lipids.
Conclusions In this undernourished population,
integrated delivery of supplemental nutrition with other
public health programmes in pregnancy and early
childhood was associated with a more favourable profile
of cardiovascular disease risk factors in adolescence. This
pragmatic study provides the most robust evidence to
date on this important hypothesis for which classic trials
are unlikely. Improved maternal and child nutrition may have a role in reducing the burden of cardiovascular
disease in low income and middle income countries
