Raj Deepa

Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5)

OBJECTIVES The aim of this study was to assess the prevalence and risk factors for coronary artery disease (CAD) in a native urban South Indian population. BACKGROUND High prevalence rates of premature CAD have been reported in migrant Asian Indians. There are very few studies on CAD in native Indians living in the Indian subcontinent. METHODS The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennai in South India. Of the total of 1,399 eligible subjects (age > or =20 years), 1,262 (90.2%) participated in the study. All the study subjects underwent a glucose tolerance test and were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or diabetes. Twelve-lead electrocardiogram (ECG) was performed in 1,175 individuals (84%). Coronary artery disease was diagnosed based on previous medical history or Minnesota coding of ECGs. RESULTS The overall prevalence rate of CAD is 11.0% (age standardized, 9.0%). The prevalence rates of CAD were 9.1%, 14.9% and 21.4% in those with NGT, IGT and diabetes, respectively. Prevalence of CAD increased with an increase in total cholesterol (trend chi-square: 26.2, p < 0.001), low-density lipoprotein (LDL) cholesterol (trend chi-square: 24.5, p < 0.001), triglycerides (trend chi-square: 9.96, p = 0.002) and total cholesterol/high-density lipoprotein ratio (trend chi-square: 6.14, p = 0.0132). Multiple logistic regression analysis identified age (odds ratio [OR]: 1.05, p < 0.001) and LDL cholesterol (OR: 1.009, p = 0.051) as the risk factors for CAD. CONCLUSIONS The prevalence of CAD is rising rapidly in urban India. Lifestyle changes and aggressive control of risk factors are urgently needed to reverse this trend.

Intra-urban differences in the prevalence of the metabolic syndrome in southern India -- the Chennai Urban Population Study (CUPS No. 4).

SUMMARY

Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34)

To compare the prevalence of metabolic syndrome (MS) using the World Health Organisation (WHO), Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) criteria of MS in an urban south Indian population, and their ability to identify coronary artery disease (CAD) in males and females.

Urban rural differences in prevalence of self-reported diabetes in India—The WHO-ICMR Indian NCD risk factor surveillance

Recent 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.

PREVALENCE AND RISK FACTORS OF DIABETIC NEPHROPATHY IN AN URBAN SOUTH INDIAN POPULATION: THE CHENNAI URBAN RURAL EPIDEMIOLOGY STUDY (CURES - 45)

OBJECTIVE—The aim of this study was to determine the prevalence of diabetic nephropathy among urban Asian-Indian type 2 diabetic subjects. RESEARCH DESIGN AND METHODS—Type 2 diabetic subjects (n = 1,716), inclusive of known diabetic subjects (KD subjects) (1,363 of 1,529; response rate 89.1%) and randomly selected newly diagnosed diabetic subjects (NDD subjects) (n = 353) were selected from the Chennai Urban Rural Epidemiology Study (CURES). Microalbuminuria was estimated by immunoturbidometric assay and diagnosed if albumin excretion was between 30 and 299 μg/mg of creatinine, and overt nephropathy was diagnosed if albumin excretion was ≥300 μg/mg of creatinine in the presence of diabetic retinopathy, which was assessed by stereoscopic retinal color photography. RESULTS—The prevalence of overt nephropathy was 2.2% (95% CI 1.51–2.91). Microalbuminuria was present in 26.9% (24.8–28.9). Compared with the NDD subjects, KD subjects had greater prevalence rates of both microalbuminuria with retinopathy and overt nephropathy (8.4 vs. 1.4%, P < 0.001; and 2.6 vs. 0.8%, P = 0.043, respectively). Logistic regression analysis showed that A1C (odds ratio 1.325 [95% CI 1.256–1.399], P < 0.001), smoking (odds ratio 1.464, P = 0.011), duration of diabetes (1.023, P = 0.046), systolic blood pressure (1.020, P < 0.001), and diastolic blood pressure (1.016, P = 0.022) were associated with microalbuminuria. A1C (1.483, P < 0.0001), duration of diabetes (1.073, P = 0.003), and systolic blood pressure (1.031, P = 0.004) were associated with overt nephropathy. CONCLUSIONS—The results of the study suggest that in urban Asian Indians, the prevalence of overt nephropathy and microalbuminuria was 2.2 and 26.9%, respectively. Duration of diabetes, A1C, and systolic blood pressure were the common risk factors for overt nephropathy and microalbuminuria.

Comparison of carotid intima-media thickness, arterial stiffness, and brachial artery flow mediated dilatation in diabetic and nondiabetic subjects (The Chennai Urban Population Study [CUPS-9])

This study compares flow-mediated dilation (FMD) and the augmentation index (AI) in diabetic and nondiabetic subjects and correlates these measurements with carotid intima-media thickness (IMT). Fifty diabetic subjects and 50 age- and sex-matched nondiabetic control subjects were recruited from the Chennai Urban Population Study. IMT of the common carotid artery and FMD of the brachial artery were determined using high-resolution B-mode ultrasonography. AI was measured using the Sphygmocor apparatus. The mean AI of diabetic subjects was significantly higher than the nondiabetic subjects (27.48 +/- 7.41% vs 19.10 +/- 8.19%, p <0.0001). The FMD values were significantly lower among diabetic subjects compared with the nondiabetic subjects (2.1 +/- 2.95% vs 6.64 +/- 4.38%, p <0.0001). At any given age point, diabetic subjects had significantly higher AI and lower FMD values compared with nondiabetic subjects (p <0.05). In the total population, AI and FMD showed a correlation with age (p <0.001), fasting plasma glucose (p <0.01), glycosylated hemoglobin (p = 0.001), and IMT (p = 0.001). Among the nondiabetic subjects, FMD and AI showed a strong correlation with IMT. FMD also showed a strong correlation with age and systolic blood pressure, whereas AI showed a correlation with fasting plasma glucose in diabetic subjects. AI and FMD values showed a strong correlation with age. AI values increased and FMD values decreased with an increase in quartiles of IMT both in diabetic and nondiabetic subjects. Multivariate linear regression analyses in the total study population showed that age and glycosylated hemoglobin were the risk factors associated with AI and FMD, in addition to diastolic blood pressure with AI. Diabetic patients have decreased FMD and increased arterial stiffness compared with age- and sex-matched nondiabetic subjects. These functional changes correlate well with the structural changes of the arteries measured by IMT.

Type 2 diabetes in Asian Indian youth

Abstract:  The prevalence of youth‐onset type 2 diabetes is increasing worldwide in parallel with the obesity epidemic. In India, the age at onset of type 2 diabetes had traditionally been a decade or two earlier compared with the western population. Hence, it is not surprising that the prevalence of youth‐onset type 2 diabetes is rapidly escalating in India not only among the more affluent sections of society but also in the middle and lower socioeconomic groups as well. In India, type 2 diabetes in youth overlaps with monogenic forms of diabetes such as maturity‐onset diabetes of the young, fibrocalculous pancreatic diabetes, and malnutrition‐modulated diabetes, all of which are ketosis‐resistant forms of youth‐onset diabetes. Screening of high‐risk groups may help in the early detection of youth‐onset type 2 diabetes and prevention of its complications. Primary prevention would require a multisectoral approach involving the government and non‐governmental agencies with a focus on healthier lifestyles among children.

Peroxisome proliferator-activated receptor-gamma co-activator-1alpha (PGC-1alpha) gene polymorphisms and their relationship to Type 2 diabetes in Asian Indians.

Aims  The objective of the present investigation was to examine the relationship of three polymorphisms, Thr394Thr, Gly482Ser and +A2962G, of the peroxisome proliferator activated receptor‐γ co‐activator‐1 alpha (PGC‐1α) gene with Type 2 diabetes in Asian Indians.

Intimal medial thickness of the carotid artery in South Indian diabetic and non-diabetic subjects: the Chennai Urban Population Study (CUPS)

Aim/hypothesis. Increased intimal medial thickness (IMT) of the carotid arteries is considered a useful marker of atherosclerosis. The aim of this study was to compare the intimal medial thickness values in urban non-diabetic and diabetic South Indian subjects who have a high risk of coronary artery disease.¶Methods. The subjects for this study were 140 diabetic and 103 non-diabetic control subjects matched with them for age and sex selected from The Chennai Urban Population Study which is an ongoing epidemiological study. Intimal medial thickness of the right common carotid artery was determined using high resolution B mode ultrasonography.¶Results. The mean intimal medial thickness values of the diabetic subjects (0.95 ± 0.31 mm) were significantly higher than those of the non-diabetic (0.74 ± 0.14 mm) subjects (p < 0.001). Both in the normal and diabetic subjects, these values increased with age. At any given age, the diabetic subjects had higher values than the non-diabetic subjects but the difference reached statistical significance after age 50 years (p < 0.05).¶Intimal medial thickness showed a correlation with age, total cholesterol, LDL cholesterol, waist:hip ratio and systolic blood pressure in non-diabetic subjects and with age and duration of diabetes in the diabetic subjects. Multivariate linear regression analysis showed that age and diabetes were the major risk factors for intimal medial thickness.¶Conclusion/interpretation. Diabetic subjects have higher intimal medial thickness values than non-diabetic subjects. Diabetes and age are the most important risk factors associated with increased intimal medial thickness in this South Indian cohort. [Diabetologia (2000) 43: 494–499]

Familial clustering of diabetic retinopathy in South Indian Type 2 diabetic patients.

Aim The aim of the study was to determine whether there is familialclustering of diabetic retinopathy among South Indian Type 2 diabeticsubjects.