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Prevention of cardiovascular disease in a rural region of India and strategies to address the unmet need
  1. Anna Wood1,2,
  2. Jill Pell3,
  3. Anushka Patel1,2,
  4. Bruce Neal1,2,
  5. P Krishnam Raju4,5,
  6. Clara K Chow1,2
  1. 1The George Institute for Global Health, Sydney, Australia
  2. 2Sydney Medical School, Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia
  3. 3BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  4. 4The George Institute India, Hyderabad, India
  5. 5Department of Cardiology, CARE Hospital and CARE Foundation, Hyderabad, India
  1. Correspondence to Dr Clara K Chow, The George Institute for Global Health, Level 10, King George V Building, PO Box M201, 83-117 Missenden Road, Camperdown, NSW 2050 Australia; cchow{at}


Objectives To determine levels of cardiovascular disease (CVD) prevention and to model the potential impact of improved prevention strategies for a large rural Indian region.

Design A cross-sectional study with modelling of coronary heart disease (CHD) events over 10 years.

Setting Rural Andhra Pradesh, India.

Participants A stratified random sample of 1079 adults 30 years and older.

Main outcome measures Proportion on medical and behavioural treatments for prevention of CVD; estimated number of CHD events using a locally recalibrated Framingham risk equation.

Results Among the 3.5% (95% CI 2.1% to 4.9%) with existing CVD, 49.3% (95% CI 28.8% to 69.8%) were on blood pressure (BP)-lowering medication, 4.7% (95% CI 0 to 10.4%) were on cholesterol-lowering medication, 24.6% (95% CI 9% to 40.3%) had increased exercise and 26.9% (95% CI 2.6% to 51.1%) attempted to quit smoking. Among the 7.6% (95% CI 6.2% to 8.9%) with a high global CHD risk (>20% over 10 years), 29.5% (95% CI 19.5 to 39.5%) were on BP-lowering medication, 2.8% (95% CI 0 to 6.7%) were on cholesterol-lowering medication, 19.4% (95% CI 10.9% to 28%) had increased exercise and 24.8% (95% CI 15.8% to 33.8%) attempted to quit smoking. If confirmed drug therapies were provided to all individuals at high risk there would be a 28% reduction in cardiovascular events over 10 years at an approximate annual treatment cost of US$533 per event avoided.

Conclusions There are serious deficiencies in CVD prevention in rural areas of India. Addressing these with simple confirmed drug treatments could produce a large reduction in the future cardiovascular burden in India.

  • Epidemiology
  • public health

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  • Funding This work was supported by the Byrraju Foundation and the George Institute for Global Health. The authors did not receive any specific financial support with respect to the writing or development of this manuscript. CKC is supported by a fellowship cofounded by the National Heart and Medical Research Council of Australia, the National Heart Foundation of Australia and the Sydney University Chapman fellowship. BN and AP were supported by fellowships from the National Heart Foundation of Australia while doing this work. This work was also supported by a NHMRC grant (358395).

  • Competing interests All authors have completed the unified competing interest form at (available on request from the corresponding author) and declare that AW, JP, AP, BN, KJ and CKC have support from the George Institute for the submitted work; AW, JP, AP, BN, KJ and CKC have no relationships with companies that might have an interest in the submitted work in the previous 3 years; their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and AW, JP, AP, BN, PKR and CKC have no non-financial interests that may be relevant to the submitted work.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committees of the CARE Hospital (Hyderabad, India) and the University of Sydney, Australia.

  • Provenance and peer review Not commissioned; externally peer reviewed.