Prevalence and associated risk factors of coronary artery disease in a rural south Indian population on a governmental health insurance scheme

ObjectivesTo examine the prevalence of Coronary heart disease (CHD) and associated risk factors based on coronary angiography among a geographically well-defined rural population of south India having an access to a governmental health insurance scheme.Study designObservational cross-sectional study.MethodsThis study in rural Andhra Pradesh covers 413 rural primary health centers each catering for 30,000 people was conducted between December 2007 and November 2011. From an eligible population of 43,025 subjects screened through health camps and clinically assessed for CHD based on (1) History of angina or myocardial infarction (2) ECG changes suggestive of Ischemic heart disease, 3692 subjects were CHD-diagnosed but 3248 got admitted as inpatients for additional clinical ascertainment before 3050 in-patients were studied finally based on angiographic findings.Results8.58% were diagnosed as CHD; all the conventional risk factors were significantly associated with CHD risk except BMI. 2005 subjects (65.7%) of those with diagnosed CHD had hypertension, 1013 (33.2%) had diabetes, 1292 (42.4%) were smokers (current and former), 938(30.8%) had Dyslipidemia and 848 (28%) had BMI >25 kg/m2 (Table 1) 0.1171 (38.4%) had single vessel disease, 1452 (47.6%) had two vessel disease and 427 (14%) had triple vessel disease (Table 3). Left ventricular dysfunction was found in 1187 (38.9%) patients and renal impairment was seen in 519 (17%) patients.ConclusionsThis study shows that CHD and associated cardio-metabolic risk factors are growing concerns in rural India even in rural populations. Both community based strategies and clinic based targeted approach to high risk patients are necessary to address such a public-health problem.