title: Prevalence of coronary artery disease and its risk factors in Kerala, South India: a community-based cross-sectional study.
abstract: BACKGROUND
  There are no recent data on prevalence of coronary artery disease (CAD) in Indians. The last community based study from Kerala, the most advanced Indian state in epidemiological transition, was in 1993 that reported 1.4% definite CAD prevalence. We studied the prevalence of CAD and its risk factors among adults in Kerala.
  
  
  METHODS
  In a community-based cross sectional study, we selected 5167 adults (mean age 51 years, men 40.1%) using a multistage cluster sampling method. Information on socio-demographics, smoking, alcohol use, physical activity, dietary habits and personal history of hypertension, diabetes, and CAD was collected using a structured interview schedule. Anthropometry, blood pressure, electrocardiogram, and biochemical investigations were done using standard protocols. CAD and its risk factors were defined using standard criteria. Comparisons of age adjusted prevalence were done using two tailed proportion tests.
  
  
  RESULTS
  The overall age-adjusted prevalence of definite CAD was 3.5%: men 4.8%, women 2.6% (p < 0.001). Prevalence of any CAD was 12.5%: men 9.8%, women 14.3% (p < 0.001). There was no difference in definite CAD between urban and rural population. Physical inactivity was reported by 17.5 and 18% reported family history of CAD. Other CAD risk factors detected in the study were: overweight or obese 59%, abdominal obesity 57%, hypertension 28%, diabetes 15%, high total cholesterol 52% and low level of high density lipoprotein cholesterol 39%. Current smoking was reported only be men (28%).
  
  
  CONCLUSIONS
  The prevalence of definite CAD in Kerala increased nearly three times since 1993 without any difference in urban and rural areas. Most risk factors of CAD were highly prevalent in the state. Both population and individual level approaches are warranted to address the high level of CAD risk factors to reduce the increasing prevalence of CAD in this population.
authors.affiliation: Govt. Medical College, Kozhikode, Kerala, India. dr.mn.krishnan@gmail.com.
authors.forename: M N
authors.initials: MN
authors.lastname: Krishnan
authors.affiliation: Mother Hospital, Thrissur, Kerala, India. geevarzachariah@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Zachariah
authors.affiliation: Pushpagiri Hospital, Tiruvalla, Kottayam, Kerala, India. venugopalknair@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Venugopal
authors.affiliation: Westfort High-tech Hospital, Thrissur, Kerala, India. drmohanan@gmail.com.
authors.forename: P P
authors.initials: PP
authors.lastname: Mohanan
authors.affiliation: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. drharikrishnan@hotmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Harikrishnan
authors.affiliation: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. drsanjayganesh@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Sanjay
authors.affiliation: Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India. ljey@cmcvellore.ac.in.
authors.forename: L
authors.initials: L
authors.lastname: Jeyaseelan
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Medical College, P.O. 695011, Thiruvananthapuram, Kerala, India. kavumpurathu@yahoo.com.
authors.forename: K R
authors.initials: KR
authors.lastname: Thankappan
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D000886:Anthropometry; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004032:Diet; D050171:Dyslipidemias / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology; D056128:Obesity, Abdominal / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult