186 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 17, NO. 4, 2004 ABSTRACT Background. There is a paucity of data on the relative importance of various traditional risk factors for coronary artery disease among rural Indians. We conducted a prospective case–control study to deter- mine the risk factors for acute myocardial infarction in a rural population of central India. Methods.We recruited 111 consecutive patients admitted toourhospitalwithafirstepisodeofacutemyocardialinfarction and222age-andsex-matchedcontrols.Demographics,anthro- pometric measures, lipids, blood glucose, smoking and other lifestyle factors were compared among cases and controls. Multivariate analyses were used to identify the risk factors independentlyassociatedwithacutemyocardialinfarction. Results.Elevated fasting blood glucose (odds ratio [OR] 8.9; 95% confidence interval [CI] 4.5, 17.9), abnormal waist– hip ratio (OR 3.0; 95% CI 1.7, 5.4) and income (OR 4.0 and 5.9forthehigh-andmiddle-incomecategories,comparedtothe lowest category) were independently associated with the first episodeofacutemyocardialinfarction.Abnormaltriglycerides (OR 1.7; 95% CI 0.9, 3.1) and current smoking (OR 1.9; 95% CI 0.9, 4.0) were risk factors but were not statistically significant. Conclusion. Reduction in blood glucose levels and truncal obesity may be important in controlling the burden of coronary artery disease in rural Indians. Natl Med J India 2004;17:189–94 INTRODUCTION India is in epidemiological transition. 1,2 In addition to the burden of endemic infections, the emerging threat of non-communicable diseases is a matter for concern. 1 Studies have shown a rising prevalence of diabetes 3 and hypertension 4 in urban communities. The prevalence of coronary artery disease (CAD) has increased from 40 per 1000 in 1968 to nearly 110 per 1000 in 2001. 5 Death rates from CAD are expected to overtake those due to infectious diseases by 2010. 2 The epidemiology of non-communicable diseases in South Asians is characterized by a higher burden Risk factors for acute myocardial infarction in a rural population of central India: A hospital-based case–control study SAMIR S. PATIL, RAJNISH JOSHI, GAUTAM GUPTA, M. V. R. REDDY, MADHUKAR PAI, S. P. KALANTRI of CAD and diabetes, earlier occurrence and greater severity of CAD, excess mortality that is only partly explained by conven- tional risk factors and a higher prevalence of syndrome X. 1,6 Almost 75% of the Indian population lives in rural areas. Most studies on CAD and non-communicable diseases have been conducted in urban populations. A few rural studies suggested that CAD was not a major problem in rural commu- nities. 7–9 A cross-sectional survey in a rural population at Sevagram in central India (2433 subjects; 1338 men) in 1988 reported the lowest prevalence of CAD in India: 14.8 per 1000. 8 Similarly, in a rural population of Thiruvananthapuram district, Kerala, of the 1253 individuals screened for CAD, 36 per 1000 were detected to have electrocardiographic (ECG) changes suggestive of CAD. 9 However, recent hospital-based admis- sion data (unpublished) from our institution suggest that CAD has become more common. About 150 patients with a first episode of acute myocardial infarction (AMI) and thrice as many subjects with angina are admitted to our teaching hospital every year compared to 30 patients in 1980. Published research from India has largely focused on iden- tifying risk factors for CAD in urban populations. 10–12 Accurate determination of the risk factors for CAD in rural populations will enable planning of population-based screening and inter- vention strategies for the prevention of CAD in rural India. We aimed to find out the risk factors for AMI in patients admitted to our hospital. METHODS Location The Mahatma Gandhi Institute of Medical Sciences, Sevagram is a 648-bedded teaching institution in rural central India with 325 000 patient visits and about 5500 patient admissions to the medicine wards per year. Nearly 150 patients with AMI are admitted every year. Cases All consecutive patients with AMI admitted to our critical care unit between December 2001 and April 2003 were included in the study. AMI was diagnosed if patients fulfilled 2 of 3 criteria: typical ischaemic chest pain, raised concentrations of creatinine kinase-MB in the serum, and typical ECG findings including development of pathological Q waves. 13 Patients were excluded if they had a past history of myocardial infarction or presented more than 24 hours after the onset of symptoms. Written informed consent was obtained from all patients eligible for inclusion in the study. Controls Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha 442102, Maharashtra, India SAMIR S. PATIL, RAJNISH JOSHI, S. P. KALANTRI Department of Medicine GAUTAM GUPTA, M. V. R. REDDY Department of Biochemistry University of California at Berkeley, 140 Warren Hall, Berkeley CA 94720, USA MADHUKAR PAI Division of Epidemiology Correspondence to S. P. KALANTRI; sp_kalantri@rediffmail.com © The National Medical Journal of India 2004 Original Articles