Determinants of urban–rural differences in cardiovascular risk factors in middle-aged women in India: A cross-sectional study ☆ Ravindra M. Pandey a, ⁎, Rajeev Gupta b , Anoop Misra c , Puneet Misra a , Vasundhara Singh a , Aachu Agrawal b , Sanjit Dey d , Shobha Rao e , V. Usha Menon f , N. Kamalamma g , K.P. Vasantha Devi g , K. Revathi h , Vinita Sharma i a All India Institute of Medical Sciences, New Delhi, India b Monilek Hospital and Research Centre & Fortis Escorts Hospital, Jaipur, India c Fortis Rajan Dhall Hospital, New Delhi & National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India d University of Calcutta, Kolkata, India e Agharkar Institute, Pune, India f Amritha Institute of Medical Sciences, Kochi, India g Gandhigram Rural Institute, Gandhigram, Dindigul, India h Pondicherry Science Forum, Pondicherry, India i Department of Science and Technology, New Delhi, India abstract article info Article history: Received 9 August 2010 Received in revised form 7 March 2011 Accepted 3 June 2011 Available online 30 August 2011 Keywords: Low income countries Cardiovascular diseases Coronary risk factors Hypertension Diabetes Obesity Objectives: Cardiovascular diseases (CVD) are the most important cause of death amongst middle-aged Indian women. To determine prevalence of CVD risk factors and their determinants we performed a nationwide study. Methods: Population based studies amongst women 35–70 years were performed in four urban and five rural locations in India. Location based stratified sampling was performed and we enrolled 4624 (rural 2616, urban 2008) of eligible 8000 women (58%). Demographic details, medical history, diet, physical activity and anthropometry were recorded using standardised techniques. Blood haemoglobin, glucose and total cholesterol were determined. Risk factors were diagnosed using current guidelines. Descriptive statistics are reported. Stepwise multivariate logistic regression was performed to identify determinants of urban–rural differences. Results: In urban women mean body mass index (BMI), waist circumference, waist–hip ratio (WHR), systolic BP, haemoglobin, fasting glucose and cholesterol were significantly greater (p b 0.01). Age-adjusted prevalence of risk factors (%) in urban vs rural was of obesity BMI ≥25 kg/m 2 (45.6 vs 22.5), truncal obesity WHR N 0.9 (44.3 vs 13.0), hypertension (37.5 vs 29.3), hypercholesterolemia ≥200 mg/dl (27.7 vs 13.5), and diabetes (15.1 vs 4.3) greater whilst any tobacco use (19.6 vs 41.6) or smoking lower. Significant determinants of urban–rural differences were greater income and literacy, dietary fats, low physical activity, obesity and truncal obesity (p b 0.01). Conclusions: Greater prevalence of CVD risk factors in urban middle-aged women is explained by greater income and literacy, dietary fat, low physical activity and obesity. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Cardiovascular diseases (CVD) are the number one cause of death in women in economically developed countries and coronary heart disease (CHD) is the most important [1,2]. This is due to high prevalence of multiple cardiovascular risk factors — smoking, diabetes, hypertension and dyslipidemia [3]. Million Death Study in India reported that CVD is the most important cause of death in International Journal of Cardiology 163 (2013) 157–162 ☆ Authors' contributions: RMP conceptualised and designed the study, obtained funding, trained the investigators, supervised data collection and management, performed the statistical analyses, and provided critical comments to the manuscript. RG was involved in study conceptualisation, funding, data collection and statistical analyses and wrote the first draft of the manuscript. AM was involved in study conceptualisation, funding, statistical analyses and jointly wrote the first draft of the manuscript. PM was involved in study conceptualisation, funding, data collection and management and provided critical inputs for manuscript. VS was involved in training of investigators, supervision of the study and data collection. SJ, SR, VUM, NK, KPVD and KR were all involved in study design, obtaining funding, supervision of data collection and management, and provided critical comments to the manuscript. AA was involved in the data collection, data management, performed the initial statistical analyses and provided critical comments to the manuscript. VS was involved in study conceptualisation, funding and study supervision. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. ⁎ Corresponding author at: Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. E-mail address: rmpandey@gmail.com (R.M. Pandey). 0167-5273/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2011.06.008 Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard