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 Table of Contents  
Year : 2014  |  Volume : 1  |  Issue : 4  |  Page : 214-217

Assessment of coronary artery disease risk factors among adolescents in Kanpur, India

1 Department of Community Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
2 University Institute of Health Sciences, Chatrapati Shahu Ji Maharaj University, Kanpur, Uttar Pradesh, India
3 Department of Community Medicine, Government Medical College, Kannauj, Tirwaganj, Uttar Pradesh, India

Date of Submission03-Nov-2014
Date of Decision14-Oct-2014
Date of Acceptance12-Nov-2014
Date of Web Publication11-Dec-2014

Correspondence Address:
Samarjeet Kaur
Department of Community Medicine, GSVM Medical College, Kanpur, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-9906.146799

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Objective: To study the occurrence of coronary artery disease risk factors among adolescents attending Chatrapati Shahu Ji Maharaj University, Kanpur, India. Materials and Methods: The present study was cross-sectional in nature, conducted among students in the 1 st year of the Institute of Paramedical Sciences, Chatrapati Shahu Ji Maharaj University, Kanpur. Study participants included 185 adolescents. Among them, 94 were males, and 91 were females, between the age group of 17 and 19 years. Results: The mean systolic blood pressure (BP) of male adolescents was 123 mmHg ± 8 mmHg, which is in the prehypertensive range. Mean systolic BP and mean diastolic BP of males was significantly higher than that in females. The mean cholesterol level among males was 166.5 ± 39.0 mg/dl, which was very close to an acceptable limit for cholesterol among adolescents. There was no significant difference between the mean values of pulse rate, total cholesterol, high-density lipoprotein, and low-density lipoprotein cholesterol of males and females. Males had significantly higher mean levels of triglycerides, very-low-density lipoprotein and fasting blood sugar as compared to females. Conclusion: Mean levels of BP and serum cholesterol are on the higher side in the adolescents; therefore, they need to be targeted for lifestyle modification.

Keywords: Adolescent, coronary artery disease, risk factors

How to cite this article:
Kaur S, Katiyar P, Martolia DS, Midha T. Assessment of coronary artery disease risk factors among adolescents in Kanpur, India. J Obes Metab Res 2014;1:214-7

How to cite this URL:
Kaur S, Katiyar P, Martolia DS, Midha T. Assessment of coronary artery disease risk factors among adolescents in Kanpur, India. J Obes Metab Res [serial online] 2014 [cited 2021 Oct 16];1:214-7. Available from: https://www.jomrjournal.org/text.asp?2014/1/4/214/146799

  Introduction Top

Coronary artery disease (CAD), also known as atherosclerotic heart disease, coronary heart disease, or ischemic heart disease, is the most common type of heart disease and cause of heart attacks. CAD is caused by plaques building up along the vascular intima of the coronary arteries.The lesions narrow the arteries and reduce blood flow to the myocardium. The main symptoms of stable CAD include angina (chest pain on exertion) and decreased exercise tolerance. Unstable CAD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. The risk of CAD increases with age, smoking, high blood cholesterol, diabetes and high blood pressure (BP). CAD is more common in men and in those with close relatives with a history of CAD.

Coronary artery disease (CAD) is the leading cause of mortality in the world. [1] Every year an estimated 17 million people die due to heart attacks and strokes. CVD is responsible for 10% of Disability Adjusted Life Years lost in the low- and middle-income countries and 18% in the high-income Countries. [1]

The CAD epidemic in India has emerged as the major cause of disease-burden and deaths. The incidence of CAD in India has been reported to range from 7% to 13%. [2],[3],[4],[5] South Asian ethnicity is an independent risk factor for acute myocardial infarction (AMI), with the first AMI episode at least years earlier in being more severe, extensive and with increased complications and mortality. [6],[7],[8],[9],[10],[11] The INTERHEART study, which had only about 3.7% of patients from India, had, concluded on the similarity of risk factors for AMI in Asians with other ethnic groups. [12]

However, analysis of numerous studies revealed that the other risk factors for CAD are important for Asians. A different risk factor profile had emerged, characterized by high triglycerides, low high-density lipoprotein (HDL), glucose intolerance, insulin resistance, abdominal obesity and increased lipoprotein (a) levels. [13] Rural-urban divide was observed too in the risk factors. The additional factors were tobacco, smoking, hypertension, diabetes, psychosocial factors, low fruit and vegetable consumption, and lack of physical activity. These accounted for 89% of the cases of AMI in Indians. [13]

The emergence of risk factors is during adolescence. Hence, we focused to study the occurrence of risk factors of CAD among the adolescents in the Indian population.

  Materials and methods Top

A cross-sectional study was conducted among students in 1 st year in the Institute of Paramedical Sciences, Chatrapati Shahu ji Maharaj University, Kanpur. The study participants included 185 adolescents. Written informed consent was taken from the students as well as from their parents/guardians. There were 94 males and 91 females, of the age group 17 to19 years.

The standard mercury sphygmomanometer was used for recording BP, in the left arm, in a sitting position. The body weight (BW) was measured, to the nearest 0.5 kg, using Krup's weighing machine. The height (Ht) was measured, to the nearest 0.5 cm, with the subject in an erect position against a vertical surface, and with the head positioned so that the top of the external auditory meatus was level with the inferior margin of the bony orbit. A hardboard was put vertical to the wall, just above the head and height marked on the wall and measured with a measuring tape. The waist circumference (WC) was measured, at the level of the umbilicus, with the subject in the erect position, breathing silently. BMI was calculated as Kg/m 2 . All students were interviewed and examined carefully. All the clinical chemistry on the fasting blood samples was studied on the next day at the laboratory in the Department of Biochemistry of the University, Kanpur, for lipid profile, blood sugar etc., by standard methods.

Statistical analysis

The data was compiled using Microsoft Excel, Microsoft Corporation, Washington and analyzed using SPSS 17.0 SPSS Inc.Chicago. Chi-square test was used to analyze the difference between discrete variables. Fischer's exact test was used when the expected values were <5. Student's t-test was used to analyze the difference between continuous variables. Two-tailed p < 0.05 was considered significant.

  Results Top

Among 94 males and 91 females, the average age of males was 18.9 ± 2.3 years and that of females was 18.1 ± 3.1 years. There was no statistically significant difference between males and females for the type of family, socioeconomic status, religion, tobacco, and alcohol consumption [Table 1]. However, the level of physical activity was significantly different, with more females (45.1%) being sedentary as compared to males (27.7%). Also, more females were vegetarian (74.7%) as compared to males (52.1%).
Table 1: Distribution of bio-social characteristics and personal habits of adolescents

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The median weight of study subjects was 54 kg, and median height was 160 cm. Median BMI was 21.1 kg/m 2 [Table 2]. Median level of HDL cholesterol was 40 mg/dl and low-density lipoprotein (LDL) cholesterol 97 mg/dl. Median fasting blood glucose (FBG) was 92 mg/dl.
Table 2: Distribution of subjects according to quartiles

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There was no statistically significant difference between the mean values of pulse rate, total cholesterol, HDL and LDL cholesterol of males and females [Table 3]. However, BW, Ht and WC were significantly different. Mean systolic BP of males (123 ± 8 mmHg) was significantly higher than females (119 mmHg ± 12 mmHg). Mean diastolic BP of males (81 mmHg ± 5 mmHg) was also higher than females (79 ± 6 mmHg). Males had significantly higher mean levels of serum triglycerides and very-low-density lipoprotein as compared to females. Mean fasting blood sugar levels were higher in males (92.3 mg/dl ± 12.4 mg/dl) as compared to females (87.9 mg/dl ± 14.8 mg/dl).
Table 3: Cardiovascular risk factors in adolescents

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  Discussion Top

Earlier studies have demonstrated that most children with normal weight for height and healthy have risk factor levels associated with the absence of heart disease. The absence of smoking, diabetes, physical activity, LDL cholesterol (<110 mg/dL), and < 120/80 mm Hg) protected the subjects. [14] However, by adolescence, the earliest lesions of atherosclerosis-fatty streaks and raised lesions emerge in the coronary arteries and the abdominal aorta. The severity is related to the coexistence of the major cardiovascular risk factors. Most commonly, the associated risk disturbances are mild: borderline hypertension, mild dyslipidemia, insulin resistance, overweight, physical inactivity, and initiation of tobacco use. [14]

In the present study, it was observed that the majority of the females had a sedentary lifestyle which is a major risk factor for CVD. Although the percentages of adolescents who consumed tobacco and alcohol reported as small, there is a chance that many adolescents concealed the facts. Most of the males were consuming a mixed diet with low intake of fruits.

The BMI for Asians is set at 23 kg/m 2 and 28 kg/m 2 for overweight and obesity respectively. The mean BMI of adolescents in the study was already 22.0 kg/m 2 ± 3.5 kg/m 2 among males and 20.8 ± 4.2 kg/m 2 among females. These values are near to 23 kg/m 2 , which is the adult value at age 18 years for Indian boys and girls. [15] Overweight and obesity are associated with diabetes, hypertension and CVDs, therefore, a BMI value nearing the overweight category in adolescence is a matter of concern.

The mean systolic BP of male adolescents was 123 mmHg ± 8 mmHg, which is in the prehypertensive range, [15] which may later progress to hypertension. The mean diastolic BP of male adolescents was 81 ± 5 mmHg, which was also in the prehypertensive range and could lead to hypertension. The mean systolic and diastolic BPs of female adolescents were 119 mmHg ± 12 mmHg and 79 ± 6 mmHg respectively which were also borderline for prehypertension. [16] Since hypertension is the entry point for the several noncommunicable diseases, prehypertension in adolescents needs to be taken seriously. More extensive and longitudinal studies are needed.

The mean cholesterol level among males was 166.5 mg/dl ± 39.0 mg/dl which was very close to an acceptable limit for cholesterol among male adolescents (<168 mg/dl for males). [17] This is a risk factor for CVD and necessitates the need for further studies in adolescents. Development of specific programs for preventive cardiology is needed for adolescents. The higher cholesterol levels in adolescent males as compared to females are also a cause for concern. There is an increased risk of CVD in males in comparison with females in early and middle years of life. The mean cholesterol level among females was 157.2 mg/dl ± 26.5 mg/dl which was less than the acceptable limit for cholesterol among female adolescents (<176 mg/dl for females). In our study, the mean value of triglycerides among males was 152.7 ± 45.1 mg/dl and that among females was 120.4 mg/dl ± 38.2 mg/dl. These values are far above the acceptable limits of triglycerides for adolescents (<88 mg/dl-males and <85 mg/dl-females. [17] Acceptable levels for LDL are <109 mg/dl in males and <110 mg/dl in females whereas the mean levels in the present study were 97.4 mg/dl ± 27.0 mg/dl and 95.4 mg/dl ± 20.0 mg/dl respectively. [17] LDL is the major contributor to atherosclerosis and the mean values nearing borderline limits is a fact to be concerned about. Mean level of FBG was 92.3 mg/dl ± 12.0 mg/dl in males and 87.9 ± 14.8 mg/dl in females, which are also nearing the cut-off of 100 mg/dl for impaired glucose tolerance. [18],[19]

  Conclusion Top

The present study brings to light the fact that adolescents already have a mildly deranged metabolic profile which can be corrected by lifestyle modification. Regular screening of adolescents and health education may lead to an improved metabolic picture and prevent the cardiovascular morbidity and mortality later in the adulthood. Preventive cardiology program also is the need of the hour, and adolescents may be the right target to reduce the CAD epidemic in India.

  References Top

Available from: http://www.who.int/cardiovascular_diseases/resources/atlas/en/. [Last accessed on 2014 Jul 04].  Back to cited text no. 1
Chadha SL, Radhakrishnan S, Ramachandran K, Kaul U, Gopinath N. Epidemiological study of coronary heart disease in urban population of Delhi. Indian J Med Res 1990;92:424-30.  Back to cited text no. 2
Gupta R, Prakash H, Majumdar S, Sharma S, Gupta VP. Prevalence of coronary heart disease and coronary risk factors in an urban population of Rajasthan. Indian Heart J 1995;47:331-8.  Back to cited text no. 3
Singh RB, Sharma JP, Rastogi V, Raghuvanshi RS, Moshiri M, Verma SP, et al. Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India. Eur Heart J 1997;18:1728-35.  Back to cited text no. 4
Mohan V, Deepa R, Rani SS, Premalatha G, Chennai Urban Population Study (CUPS No. 5). Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No 5). J Am Coll Cardiol 2001;38:682-7.  Back to cited text no. 5
Gupta R, Gupta VP, Sarna M, Bhatnagar S, Thanvi J, Sharma V, et al. Prevalence of coronary heart disease and risk factors in an urban Indian population: Jaipur Heart Watch-2. Indian Heart J 2002;54:59-66.  Back to cited text no. 6
Kumar R, Singh MC, Singh MC, Ahlawat SK, Thakur JS, Srivastava A, et al. Urbanization and coronary heart disease: A study of urban-rural differences in northern India. Indian Heart J 2006;58:126-30.  Back to cited text no. 7
Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: Thoughts on pathogenesis, prevention, and therapy. coronary artery disease in Asian Indians (CADI) study. Clin Cardiol 1995;18:131-5.  Back to cited text no. 8
Wilkinson P, Sayer J, Laji K, Grundy C, Marchant B, Kopelman P, et al. Comparison of case fatality in south Asian and white patients after acute myocardial infarction: Observational study. BMJ 1996;312:1330-3.  Back to cited text no. 9
Wild S, McKeigue P. Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92. BMJ 1997;314:705-10.  Back to cited text no. 10
Reddy KS. Cardiovascular diseases in India. World Health Stat Q 1993;46:101-7.  Back to cited text no. 11
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004;364:937-52.  Back to cited text no. 12
Gupta R. Recent trends in coronary heart disease epidemiology in India. Indian Heart J 2008;60:B4-18.  Back to cited text no. 13
Gidding SS. Cardiovascular risk factors in adolescents. Curr Treat Options Cardiovasc Med 2006;8:269-75.  Back to cited text no. 14
Khadilkar VV, Khadilkar AV, Borade AB, Chiplonkar SA. Body mass index cut-offs for screening for childhood overweight and obesity in Indian children. Indian Pediatr 2012;49:29-34.  Back to cited text no. 15
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003;289:2560-72.  Back to cited text no. 16
Daniels SR, Greer FR, Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics 2008;122:198-208.  Back to cited text no. 17
American Diabetes Association Recommendations. Available from: https://www.amc.edu/pathology_labservices/addenda/addenda_documents/Americandiabetesassociationrecommendations2.pdf. [Last accessed on 2014 Jul 04].  Back to cited text no. 18
Williams DE, Cadwell BL, Cheng YJ, Cowie CC, Gregg EW, Geiss LS, et al. Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999-2000. Pediatrics 2005;116:1122-6.  Back to cited text no. 19


  [Table 1], [Table 2], [Table 3]


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