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Prevalence, Awareness and Control of Hypertension in Chennai - The Chennai Urban Rural Epidemiology Study (CURES – 52)
Get PDFObjective : To study the prevalence, awareness and control of hypertension in Chennai representing Urban
South India.
Methods : The Chennai Urban Rural Epidemiology Study (CURES) is one of the largest epidemiological
studies on diabetes carried out in India, where 26,001 individuals aged ≥ 20 years were screened using
systematic random sampling method. Every tenth subject recruited in Phase 1 of CURES was requested to
participate in Phase 3 of CURES and the response rate was 2,350/26,001 or 90.4%. An oral glucose tolerance
test was performed in all individuals except self-reported diabetic subjects. Anthropometric measurements
and lipid estimations were done in all subjects. Hypertension was diagnosed in all subjects who were on
drug treatment for hypertension or if the blood pressure ≥ 140/90 mmHg.
Results : Hypertension was present in 20% [men:23.2% vs. women:17.1%, p<0.001] of the study population.
Isolated systolic hypertension (Systolic BP ≥ 140 and Diastolic BP<90 mmHg) was present in 6.6% while
isolated diastolic hypertension (DBP ≥ 90 and SBP<140 mmHg) was present in 4.2% of the population.
Among the elderly population (aged ≥ 60 years), 25.2% had isolated systolic hypertension. Age, body mass
index, smoking, serum cholesterol and triglycerides were found to be strongly associated with hypertension.
Among the total hypertensive subjects, only 32.8% were aware of their blood pressure, of these, 70.8% were
under treatment and 45.9% had their blood pressure under control.
Conclusion : Hypertension was present in one-fifth of this urban south Indian population and isolated
systolic hypertension was more common among elderly population. Majority of hypertensive subjects still
remain undetected and the control of hypertension is also inadequate. This calls for urgent prevention and
control measures for hypertensio
Oxidized low-density lipoprotein and intimal medial thickness in subjects with glucose intolerance—The Chennai Urban Rural Epidemiology Study-25
No full textThe aim of the present study was to assess the association of oxidized low-density lipoprotein (OX-LDL) with carotid intimal medial
thickness (IMT) in different grades of glucose intolerance in Asian Indians. Three groups were recruited from the Chennai Urban Rural
Epidemiology Study, a population-based study: group 1, normal glucose tolerance (NGT) (n = 175); group 2, impaired glucose tolerance (IGT)
(n = 175); and group 3, type 2 diabetes mellitus (n = 175). Oxidized LDL (enzyme-linked immunosorbent assay) and carotid IMT
(high-resolution B-mode ultrasonography) were assessed. Subjects with diabetes had higher IMT values (0.85F0.30 mm) compared with those
who have IGT (0.79 F 0.16 mm, P b .05) and NGT (0.71 F 0.12 mm, P b .001). Subjects with diabetes (40.1 F 13.1 U/L) and IGT (34.3 F
12.8 U/L) had significantly higher mean OX-LDL values compared with the NGT group (26.2 F 16.6 U/L, P b .001). Oxidized LDL
showed a correlation with IMT (total population: r = 0.294, P b .001; subjects with NGT: r = 0.444, P b .001; and subjects with IGT: r =
0.481, P b .001). In multiple linear regression analysis, OX-LDL showed a strong association with IMT (b = .005, P b .001), even after
adjusting for age, sex (b = .003, P b .001), and glucose intolerance (b = .002, P b .001). In conclusion, OX-LDL levels increase with increasing
glucose intolerance. Oxidized LDL is associated with carotid IMT and this is independent of age, sex, and glucose intolerance statu
The G1057D polymorphism of IRS-2 gene and its relationship with obesity in conferring susceptibility to type 2 diabetes in Asian Indians.
No full textOBJECTIVE: To investigate the association of insulin receptor substrate-2 (IRS-2) G1057D polymorphism with type 2 diabetes and obesity in Asian Indians. METHODS: The study comprised of 1193 normal glucose tolerant (NGT) subjects and 1018 subjects with type 2 diabetes, aged >/=20 years with an average body mass index of 23.7+/-4.6 and 25.3+/-4.2 kg/m(2), respectively. The subjects were unrelated and randomly selected from the Chennai Urban Rural Epidemiology Study (CURES), a population-based study in Chennai in southern India. The G1057D polymorphism of the IRS-2 gene was genotyped using PCR-RFLP assay. RESULTS: The genotype frequency of the IRS-2 G1057D polymorphism was significantly different between the NGT and type 2 diabetic groups (P=0.0007) in the total study subjects and among the obese subjects (P=0.00007). Logistic regression analysis showed that the DD genotype showed an increased susceptibility to diabetes with an odds ratio (adjusted for age and sex) of 2.19 (95% CI: 1.34-3.57, P=0.002) when compared to the GG+GD genotype, among the obese subjects, but not in non obese subjects. In order to explore possible interaction with obesity, logistic regression analysis was performed and the coefficient corresponding to the interaction parameter (genotype x obesity) was significant (P=0.0001). CONCLUSION: In Asian Indians, the DD genotype increases susceptibility to type 2 diabetes by interacting with obesity
Gene-environment interactions and the diabetes epidemic in India.
No full textThe prevalence of diabetes is rising rapidly in all developing countries and India already has the largest number of people with diabetes. Evidence for the rising prevalence of diabetes in India comes from recent population-based studies such as the Chennai Urban Population Study (n = 1,262) and the Chennai Urban Rural Epidemiology Study (n = 26,001). These two studies revealed that the current age-standardized prevalence of diabetes in Chennai in adults >/=20 years of age is 14.3%, which is 70% higher than that seen in the year 1989 (8.3%). In the Chennai Urban Population Study, we observed that the higher-income group who consumed excess fat and calorie-rich food had an increased prevalence of diabetes compared to the lowerincome group. There was also a linear increase in the prevalence of diabetes with an increase in visible fat consumption. In addition, we observed that visible fat consumption and physical inactivity showed a cumulative effect on increasing the prevalence of diabetes. We carried out gene-diet interaction studies, which revealed that the adiponectin gene polymorphism (+10211T - G) contributed to insulin resistance and diabetes and this was exaggerated in those consuming diets with higher glycemic loads. These subjects also had an increased risk for hypoadiponectinemia. Similarly, the Ala54Thr polymorphism of the fatty acid-binding protein 2 gene showed a synergistic effect with a high glycemic load increasing the risk for hypertriglyceridemia. These studies indicate that gene-diet interactions could play a major role in increasing the risk for diabetes. However, given the imprecision in measuring dietary intake, very large sample sizes would be needed for meaningful conclusions to be drawn
Anthropometric cut points for identification of cardiometabolic risk factors in an urban Asian Indian population.
No full textThe aim of this study was to determine the anthropometric cut points for risk of cardiometabolic risk factors in an urban Asian Indian population. The Chennai Urban Rural Epidemiology Study representatively sampled 26001 individuals aged 20 years or older and detailed measures were obtained in every 10th subject: 90.4% (2350/2600). An oral glucose tolerance test was performed in all individuals except self-reported diabetic subjects. Anthropometric measurements such as body mass index (BMI) and waist circumference (WC) were obtained and serum lipid estimations were done in all subjects. Sensitivity, specificity, and distance on receiver operating characteristic curve were used to determine the optimal cut points for BMI and WC with cardiometabolic risk factors. Maximum sensitivity and specificity of BMI for all cardiometabolic risk factors such as diabetes mellitus, prediabetes, hypertension, hypertriglyceridemia, hypercholesterolemia, and low high-density lipoprotein cholesterol ranged from 22.7 to 23.2 kg/m(2) for men and 22.7 to 23.8 kg/m(2) for women, and that of WC ranged from 86 to 88.2 cm for men and 81 to 83.8 cm for women. The optimal BMI cut point for identifying any 2 cardiometabolic risk factors was 23 kg/m(2) in both sexes, whereas that of WC was 87 cm for men and 82 cm for women. The study validates the World Health Organization Asia Pacific guidelines of BMI of 23 kg/m(2) for the designation of overweight; WC of 87 cm for men and 82 cm for women appear to be appropriate cut points to identify cardiometabolic risk factors including prediabetes in urban Asian Indians
Serum levels of interleukin 6, C-reactive protein, vascular cell adhesion molecule 1, and monocyte chemotactic protein 1 in relation to insulin resistance and glucose intolerance—the Chennai Urban Rural Epidemiology Study (CURES)☆
No full textThe aim of this cross-sectional study was to assess the association of insulin resistance (IR) with inflammatory molecules C-reactive
protein (CRP), interleukin 6 (IL-6), vascular cell adhesion molecule 1 (VCAM-1), and monocyte chemotactic protein 1 (MCP-1) in urban
South Indian subjects. The following groups were selected from the population-based Chennai Urban Rural Epidemiology Study: group 1
composed of 50 healthy subjects with normal glucose tolerance without IR; group 2 consisted of 50 normal glucose-tolerant subjects with IR
as defined by homeostasis model assessment of IR (HOMA-IR); group 3 consisted of 50 subjects with impaired glucose tolerance (IGT); and
groups 4 and 5 each comprised 50 newly diagnosed and known type 2 diabetic subjects, respectively. The inclusion criteria included
nonsmokers; normal resting 12-lead electrocardiogram; and absence of angina, myocardial infarction, or history of any known vascular,
infectious, or inflammatory diseases, and not on statins or aspirin. Normal glucose tolerance without IR had the lowest values of CRP, IL-6,
and VCAM-1 (CRP, 1.32 mg/L; IL-6, 12.56 pg/mL; VCAM-1, 277 pg/mL) followed by normal glucose tolerance with IR (CRP, 2.25 mg/L;
IL-6, 20.97 pg/mL; VCAM-1, 289 pg/mL), impaired glucose tolerance (CRP, 2.37 mg/L; IL-6, 22.11 pg/mL; VCAM-1, 335 pg/mL), newly
diagnosed diabetic subjects (CRP, 3.24 mg/L; IL-6, 23.21 pg/mL; VCAM-1, 568 pg/mL), and the highest levels were in the known diabetic
subjects (CRP, 4.08 mg/L; IL-6, 29.44 pg/mL; VCAM-1, 577 pg/mL). This trend was statistically significant ( P b .001). However, monocyte
chemotactic protein 1 did not show such a trend and did not differ significantly between groups. In nondiabetic subjects, Pearson correlation
analysis revealed that CRP (r = 0.299; P b .001) and IL-6 (r = 0.180, P = .025) had a significant correlation with HOMA-IR. Monocyte
chemotactic protein 1 did not show any correlation with HOMA-IR. Multiple linear regression analysis revealed CRP to be significantly
associated with HOMA-IR (b = .229; P b .001) and this was unaltered by the addition of waist and IL-6 into the model (b = .158;
P = .028). In conclusion, this study shows that in Asian Indians, inflammatory markers (CRP, IL-6, and VCAM-1) increase with increasing
degrees of glucose intolerance
Intimal media thickness, glucose intolerance and metabolic syndrome in Asian Indians—the Chennai Urban Rural Epidemiology Study (CURES −22)
No full textAims
The aim of the present study was to assess carotid intimal media thickness
(IMT) in different grades of glucose intolerance and the metabolic syndrome
(MS) in Asian Indians, a high-risk group for diabetes and coronary artery disease.
Methods
Subjects with normal glucose tolerance (NGT) (
n
= 1600), impaired
glucose tolerance (IGT) (
n
= 330), newly diagnosed diabetes (NDD) (
n
= 330) and
known diabetes (KD) (
n
= 1170) were recruited from the Chennai Urban Rural
Epidemiology Study (CURES), an ongoing study on a representative population
of Chennai (formerly Madras), in southern India. Assessment of carotid IMT was
performed using high-resolution B-mode ultrasonography. MS was defined using
modified adult treatment parel (ATP) III guidelines. Subjects with self-reported
diabetes, hypertension and dyslipidaemia were excluded from the analysis on MS.
Results
Subjects with glucose intolerance had significantly higher mean carotid
IMT values compared with subjects with normal glucose tolerance (NGT
0.69
±
0.12 mm, IGT 0.75
±
0.16 mm, NDD 0.79
±
0.19 mm and KD
0.87
±
0.24 mm,
P
< 0.001). Regression analysis showed that there was a linear
increase in mean IMT values with increasing severity of glucose intolerance,
even after adjusting for age and gender. Mean IMT values were higher in those
with MS and increased with increase in number of metabolic abnormalities
(subjects without any metabolic abnormality 0.66
±
0.12 mm, one abnormality
0.67
±
0.13 mm, two 0.70
±
0.12 mm, three 0.72
±
0.12 mm, four 0.77
±
0.15 mm,
five 0.76
±
0.13 mm). Regression models showed MS to be associated with
IMT, even after adjusting for age, gender and presence of diabetes (
P
= 0.021).
Conclusio
In Asian Indians, carotid IMT increases progressively with increasing
severity of glucose intolerance and is also associated with the metabolic syndrome,
independent of age, gender and presence of diabetes
Role of Genetic Polymorphism Peroxisome Proliferator-Activated Receptor- 2 Pro12Ala on Ethnic Susceptibility to Diabetes in South-Asian and Caucasian Subjects: Evidence for Diabetes in South-Asian
Get PDFOBJECTIVE— To determine whether the peroxisome proliferator–activated receptor
(PPAR)- Pro12ala polymorphism modulates susceptibility to diabetes in South Asians.
RESEARCH DESIGNANDMETHODS— South Asians (n697) and Caucasians (n
457) living in Dallas/Forth Worth, Texas, and South Asians living in Chennai, India (n1,619),
were enrolled for this study. PPAR- Pro12Ala was determined using restriction fragment–
length polymorphism. Insulin responsiveness to an oral glucose tolerance test (OGTT) was
measured in nondiabetic subjects.
RESULTS— The Caucasian diabetic subjects had significantly lower prevalence of PPAR-
12Ala when compared with the Caucasian nondiabetic subjects (20 vs. 9%, P 0.006). However,
there were no significant differences between diabetic and nondiabetic subjects with reference
to the Pro12Ala polymorphism among the South Asians living in Dallas (20 vs. 23%) and
in India (19 vs. 19.3%). Although Caucasians carrying PPAR- Pro12Ala had lower plasma
insulin levels at 2 h of OGTT than the wild-type (Pro/Pro) carriers (7668 and 5433 U/ml,
respectively, P0.01), no differences in either fasting or 2-h plasma insulin concentrations were
found between South Asians carrying the PPAR- Pro12Ala polymorphism and those with the
wild-type genotype at either Chennai or Dallas.
CONCLUSIONS— Although further replication studies are necessary to test the validity of
the described genotype-phenotype relationship, our study supports the hypothesis that the
PPAR- Pro12Ala polymorphism is protective against diabetes in Caucasians but not in South
Asians
Prevalence of Diabetes Hypertension, Obesity, Dyslipidemia and Metabolic Syndrome in Urban South Indian Population
No full textPrevalence of type 2 diabetes is rising globally18, 19 and the impact is most marked in developing countries like India19 as Asian Indians have an increased predisposition to develop diabetes20. Many studies have reported that Asian Indians have an unusually high prevalence of diabetes mellitus21, 22. The risk variables associated with diabetes are similar in all countries, but their expression and
intensity vary widely between races and between countries. Though earlier studies have documented a rising prevalence of diabetes in India, they have compared data from different regions of India or different parts within a state. To compare secular trends, it would be more accurate to document the prevalence of diabetes within the same region. Hence the data obtained in the present study were
compared with three earlier epidemiological studies using similar methods carried out in the same city (Chennai)