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| ORIGINAL RESEARCH |
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| Year : 2016 | Volume
: 5
| Issue : 1 | Page : 70-75 |
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Prevalence of hypercholesterolaemia among adults aged over 30 years in a rural area of north Kerala, India: a cross-sectional study
Ottapura Prabhakaran Aslesh1, Anandabhavan Kumaran Jayasree2, Usha Karunakaran2, Anidil Kizhakinakath Venugopalan2, Binoo Divakaran2, Thekkel Raghavannair Mayamol2, Charappilli Bhaskaran Sunil2, Kizhakkedathu Joseph Minimol2, Kannankai Shalini2, Ganesh Bhagyanath Mallar2, Thazhathe Peedika Mubarack Sani2
1 Thrissur Government Medical College, Thrissur, Kerala, India
2 Department of Community Medicine, Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India
| Date of Web Publication | 18-May-2017 |
Correspondence Address:
Ottapura Prabhakaran Aslesh
Thrissur Government Medical College, MG Kavu, Thrissur, Kerala 680596
India
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DOI: 10.4103/2224-3151.206557 PMID: 28604401 
Background: Cardiovascular disease is a leading cause of death in India. In order to reduce the burden of the disease, it is important to know the level of modifiable risk factors in the population. The aim of this study was to estimate the prevalence of hypercholesterolaemia and associated factors among the population aged over 30 years in a rural area in north Kerala, India.
Methods: A cross-sectional study was carried out to find the prevalence of hypercholesterolaemia among 533 residents of Kulappuram village. The fasting blood glucose level, total serum cholesterol level, blood pressure and body mass index of the residents were also assessed. The significance of association of hypercholesterolaemia with age, sex, body mass index and blood pressure was tested using the chi-squared test. Logistic regression was carried out to estimate the adjusted odds ratios (OR).
Results: The prevalence of hypercholesterolaemia was 63.8%. It was more prevalent in women (adjusted OR: 1.56; 95% confidence interval [CI]: 1.07-2.27), in those with body mass index in the range 23.0-24.9 kg/m2 (adjusted OR: 1.78; 95% CI: 1.04-3.02) and in those with blood pressure >140/90 mmHg (adjusted OR: 1.62; 95% CI: 1.1-2.38).
Conclusion: The prevalence of hypercholesterolaemia is high in the study population. Keywords: hypercholesterolaemia, India, prevalence, rural
How to cite this article:
Aslesh OP, Jayasree AK, Karunakaran U, Venugopalan AK, Divakaran B, Mayamol TR, Sunil CB, Minimol KJ, Shalini K, Mallar GB, Sani TP. Prevalence of hypercholesterolaemia among adults aged over 30 years in a rural area of north Kerala, India: a cross-sectional study. WHO South-East Asia J Public Health 2016;5:70-5 |
How to cite this URL:
Aslesh OP, Jayasree AK, Karunakaran U, Venugopalan AK, Divakaran B, Mayamol TR, Sunil CB, Minimol KJ, Shalini K, Mallar GB, Sani TP. Prevalence of hypercholesterolaemia among adults aged over 30 years in a rural area of north Kerala, India: a cross-sectional study. WHO South-East Asia J Public Health [serial online] 2016 [cited 2019 Jul 19];5:70-5. Available from: http://www.who-seajph.org/text.asp?2016/5/1/70/206557 |
| Background | |  |
Cardiovascular disease is the leading cause of morbidity and mortality among the population of India. It contributes to nearly one quarter of the deaths in the working age group of 25–65 years in the country.[1],[2] The average age of onset of cardiovascular disease is found to be lower among Indians when compared to other populations.[3] A rise in the prevalence of cardiovascular disease has been attributed to changes in lifestyle and dietary practices in the country.[4]
The total serum cholesterol level is considered to be an important modifiable risk factor for cardiovascular disease.[5] Studies from different parts of India show that the prevalence of hypercholesterolaemia is high among Indians.[6],[7],[8] Surveillance of cardiovascular risk factors conducted by the Indian Council of Medical Research (ICMR) in different Indian states showed that the urban Indian population has a higher prevalence of hypercholesterolaemia than the rural population.[9] Considerable differences in the prevalence of hypercholesterolaemia were observed among rural populations in different Indian states, with Kerala reporting the highest prevalence.[9] Kerala is one state in India with a high burden of cardiovascular disease,[10] but there is no significant difference in the prevalence of cardiovascular risk factors in the urban and rural populations in Kerala.[11] A possible explanation for this might be the fact that the state is undergoing rapid urban transformation, with increasing numbers of the population in rural areas engaging in non-agricultural occcupations.[12]
In order to formulate plans to reduce the morbidity associated with cardiovascular disease, it is important to assess the level of risk factors in the population. Hence, this study was carried out to estimate the prevalence of hypercholesterolaemia among the population aged over 30 years in Kulappuram village, Kannur district in Kerala and to study the relationship between hypercholesterolaemia and age, sex, body mass index (BMI), fasting blood glucose and blood pressure.
| Methods | | |
The study was carried out in Kulappuram village, which comes under Cheruthazham Panchayat in Kannur district, Kerala. The village has a total of 520 houses and 2206 residents. The local nongovernmental organization, Kulappuram Vayanashala, in association with the Department of Community Medicine, Pariyaram Medical College is running a health-promotion initiative in the area, “the model health village project”. Various health-education and screening activities are carried out through the project. For the project, the village is divided into 20 clusters based on geography.
As a part of the health-promotion and screening campaign, a series of screening camps were organized in Kulapppuram village by Kulappuram Vayanashala, in association with the Department of Community Medicine, Pariyaram Medical College, to screen for diabetes, hypertension and hypercholesterolaemia. For the campaign, volunteers conducted house visits to identify persons aged 30 years or more and encouraged them to attend the screening camp for investigation. A total of five screening camps were conducted, with one camp for four clusters. Screening was done between December 2011 and January 2012.
In the screening camp, blood samples were collected after 10–12 h of overnight fasting. The fasting levels of blood glucose and total serum cholesterol were analysed using a standard automated procedure (Beckman Coulter AU400 autoanalyser, 2009). Blood glucose was estimated by end-point method, using the hexokinase glucose-6-phosphate dehydrogenese method, and serum cholesterol was estimated using the CHOP-PAP (cholesterol oxidase/peroxidase, phenol, 4-aminoantipyrine) method. Blood pressure measurement was carried out on the right arm of seated subjects, using a mercury sphygmomanometer (Diamond 2009, precision 2 mmHg). The height of the participants was measured (to the nearest millimetre) using a stadiometer (Seca 213) while they were standing erect without footwear and with their head positioned such that the external auditary meatus was level with the inferior margin of the orbit. Weight was measured (to the nearest 0.5 kg) using a mechanical weighing scale (Krups, 2009) while subjects were standing unsupported without footwear or heavy clothing. The results of the screening were entered into a screening record and a copy was given to the participants through the community volunteers. The participants with a fasting blood glucose >125 mg/dL and fasting serum cholesterol >199 mg/dL were referred for a free physician consultation at Pariyaram Medical College.
For the current study, the data in the screening records were reviewed to estimate the prevalence of hypercholesterolaemia among the participants who had attended the screening camp. Clearance for analysis of the records was obtained from the ethics committee of the Academy of Medical Sciences, Pariyaram. The data were entered using EpiDataversion 3.1 software and analysed using EpiInfo7.1.1.14 (Centers for Disease Control and Prevention, Atlanta, United States of America). A total serum cholesterol level of ≥200 mg/dL was considered as hypercholesterolaemia. The significance of association of hypercholesterolaemia with age, sex, BMI and blood pressure was tested using the chi-squared test. Logistic regression was carried out to estimate the adjusted odds ratio (OR).
| Results | | |
In the study area, all the 1070 person aged above 30 years were contacted by home visit and encouraged to attend screening by the volunteers. Of these, 533 attended the screening programme. [Table 1] shows the general characteristics of the study participants. Women constituted 61.9% of the total sample. BMI was ≥25 kg/m2 in 32.6% of the participants and ranged between 23 kg/m2 and 24.9 kg/m2 in 18.2% of the participants. The fasting blood glucose was >126 mg/dL in 9.2% and was in the range 110–126 mg/dL in 7.9% of the participants. Blood pressure of <140/90 mmHg was seen in only 46% of the study participants.
The proportion of participants with hypercholesterolaemia (total cholesterol level ≥200 mg/dL) was 63.8%. The total cholesterol level ranged between 200 mg/dL and 239 mg/dL in 44.7% and was above 240 mg/dL in 19.1% of the study participants. [Table 2] shows that the prevalence of hypercholesterolaemia was similar across different age groups and was higher in women (67.6%) than men (57.6%; P = 0.02). It was also more prevalent in those who had a BMI ≥25 kg/m2 (69%) and in those with BMI in the range 23-24.9 kg/m2 (71.1%) when compared to normal (18-22.9 kg/m2; 59%). No statistically significant relationship was found between fasting blood glucose level and hypercholesterolaemia. | Table 2: Prevalence of hypercholesterolaemia in different groups based on demography, anthropometry, fasting blood glucose and blood pressure (n = 533 )
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Hypercholesterolaemia was seen more in those who had either systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg (68.8%) when compared with those who had blood pressure <140/90 mmHg (58%) (P < 0.001). Among those who had diastolic blood pressure in the range 90–99 mmHg and those with diastolic blood pressure ≥100 mmHg, the prevalence of hypercholesterolaemia was 71.1% and 69.2% respectively. This was found to be significantly higher than in those with diastolic blood pressure <80 mmHg (51.3%) (P = 0.008).
Logistic regression analysis (see [Table 3]) showed that the odds of having hypercholesterolaemia were higher in women than in men (adjusted OR: 1.56; 95% confidence interval [CI]: 1.07-2.27). Also, a significant association was seen with a BMI in the range 23.0-24.9 kg/m2 (adjusted OR: 1.78; 95% CI: 1.04-3.02) and blood pressure ≥140/90 mmHg (adjusted OR: 1.62; 95% CI: 1.1-2.38). | Table 3: Factors associated with hypercholesterolaemia in the study sample (n = 533)
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| Discussion | | |
Hypercholesterolaemia was found in 63.8% of the participants of this study. Studies carried out in rural populations of other Indian states in the past decade have reported prevalences of hypercholesterolaemia in the range of 12-30%.[6],[13],[14],[15] The prevalence in the study sample was found to be more than double that reported in other rural Indian populations.[6],[13],[14],[15] The prevalence was also higher than that in the urban Indian population, which has been reported to range between 19% and 44%.[6],[14],[15],[16],[17] However, the result was similar to the findings of studies conducted in rural population in central and southern Kerala, which report a prevalence between 37% and 57%.[8],[11] The prevalence of hypercholesterolaemia in the study sample was more than the global average of 39% reported by the World Health Organization.[18]
Hypercholesterolaemia was found to be more prevalent in women, in those with high BMI (23.5-24.9 kg/m2) and in those with blood pressure ≥140/90 mmHg. A similar association with female sex, high BMI and hypertension was seen in the ICMR-INDIAB (India Diabetes) study.[6] In the present study, the prevalence of hypercholesterolaemia was similar in different age groups; this is in sharp contrast to other studies, which report an increase in prevalence with advanced age. In the present study, even the young age group of 30–39 years had a prevalence of 54%. A similar result (49%) was found in participants aged 25–35 years in a study in Kerala by Thankappan et al. in 2009.[11]
It is important to consider the factors that can explain the high burden of hypercholesterolaemia in the study population. Low physical activity and high intake of saturated fat and red meat are some of the factors that are traditionally attributed to hypercholesterolaemia.[19] The ICMR noncommunicable diseases risk factor survey in Kerala showed that more than 95% of households in Kerala are using oils like coconut oil or palm oil, which have a saturated fatty acid content of more than 90%. The use of oils that are rich in saturated fats is low in all other states in which surveys have been carried out. The daily consumption of food items that are rich in saturated fats and cholesterol, like fried foods, red meat and eggs is also high in the state.[20] The level of physical activity was found to be low in 75% of the population aged over 15 years in the state.[20] A study conducted in the same area showed that a low level of physical activity was seen among 66% of the population aged over 15 years.[21]
The study has certain limitations. Individuals who were eligible for the study were identified by home visits and were encouraged to attend a screening camp organized in their vicinity. As the response rate was only 50%, this process may have resulted in an over-estimation of prevalence. However, a prevalence of 32% is seen even when it is estimated by using the total population aged over 30 years as the denominator (340/1070). This is still higher than that seen in studies from north India. Also, the study only assessed the prevalence of hypercholesterolaemia, which is only one form of dyslipidaemia. Measurements of the levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides are needed to ascertain the true extent of dyslipidaemia in the population. Another limitation is that the study did not assess the presence of behavioural risk factors in cardiovascular disease, such as physical activity, misuse of alcohol, diet and central obesity.
| Conclusion | | |
The study concludes that the prevalence of hyper-cholesterolaemia is high in this study population in rural Kerala. In order to reduce the burden of cardiovascular diseases, efforts need to be made to reduce the prevalence of modifiable risk factors like hypercholesterolaemia. Practices like diet modification and recreational physical activity should be encouraged to achieve this aim. As a high prevalence of hypercholesterolaemia was seen even in younger age groups, early screening should be carried out.
| Acknowledgements | | |
We are grateful to J Sunil Kumar and volunteers of Kulappuram Vayanashala for their valuable contributions in the conduct of the study.
Source of Support: Nil.
Conflict of Interest: None declared.
Authorship: OPA analysed the data and wrote the draft manuscript. AKJ and TPMS designed the study and revised the manuscript. AKJ, KU, AKV, DB, TRM, CBS, KJM, KS, GBM and TPMS assisted in data collection and revised the manuscript.
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[Table 1], [Table 2], [Table 3]
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