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Trend in prevalence of coronary artery disease and risk factors over two decades in rural Punjab
  1. Abhishek Goyal1,
  2. Praneet Kahlon2,
  3. Dinesh Jain3,
  4. R K Soni4,
  5. Rohit Gulati5,
  6. Shibba Takkar Chhabra1,
  7. Naved Aslam1,
  8. Bishav Mohan1,
  9. Inder S Anand6,
  10. Vikram Patel7,8,
  11. Gurpreet Singh Wander1
  1. 1 Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
  2. 2 Department of Medicine, Punjab Civil Medical Services, Civil Hospital, Barnala, Punjab, India
  3. 3 Department of Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
  4. 4 Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  5. 5 WVU Medicine, University Healthcare, Martinsburg, West Virginia, USA
  6. 6 University of Minnesota Medical School, VA Medical Center, Minneapolis, Minnesota, USA
  7. 7 Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
  8. 8 Sangath, Goa, India
  1. Correspondence to Dr Gurpreet Singh Wander, Department of Cardiology, Dayanand Medical College & Hospital, Unit- Hero DMC Heart Institute, Tagore Nagar, Civil Lines, Ludhiana-141001, Punjab, India; drgswander{at}


Objectives The burden of coronary artery disease (CAD) has increased in the last three decades in low-income and middle-income countries including India. CAD is responsible for 20% deaths in India. The burden of CAD has increased due to a higher prevalence of risk factors related to the changing lifestyle. We studied the change in prevalence of CAD and risk factors over 20 years in a rural area.

Methods A rural population of adults over the age of 30 years from three villages of Punjab was surveyed for the prevalence of CAD and its risk factors in 1994 and 2014 using similar research methodology. CAD was diagnosed by Epstein and clinical criteria. Blood pressure, anthropometry, ECG and biochemical analysis were carried out. The findings of two surveys were compared with a look at the change in the prevalence of CAD and its risk factors over 20 years.

Results The overall age standardised prevalence of CAD increased from 2.79% in 1994 to 4.06% (p<0.05) in 2014. There was a significant increase in the prevalence of several risk factors including sedentary lifestyle (8.2% vs 41.3%, p<0.001), hypertension (14.5% vs 26.5%, p<0.001), diabetes (4.7% vs 9.7%, p<0.001), obesity (16.6% vs 35.4, p<0.001) and hypercholesterolaemia (7% vs 9.6%, p 0.011). In contrast, cigarette smoking (8.9% vs 3%, p<0.001) and use of desi ghee (51.4% vs 28.5%, p<0.001) decreased.

Conclusions In a rural population of Punjab, the prevalence of several CAD risk factors like sedentary lifestyle, hypertension, diabetes, obesity and hypercholesterolaemia increased over 20 years. These changes in risk factors were associated with a modest increase in prevalence of CAD.

  • coronary artery disease
  • epidemiology
  • prevalence
  • risk factors
  • rural India

Statistics from


  • Contributors RG was involved in conducting the 1994 survey as a postgraduate student. PK was involved in conducting the 2014 survey as a postgraduate student. ISA guided the two surveys and helped in writing the article and in data interpretation. RKS was involved in data collection, analysis and interpretation. STC, NA and BM were involved in collection of data in 2014 survey and in the interpretation of data. AG was involved in interpretation of data for comparison of the two surveys and in interpretation and writing of the article. DJ was involved in planning of 2014 survey and in interpretation of the data. VP was involved in data analysis, interpretation and in writing the article. GSW was involved in planning, execution and analysis of the two surveys and in writing the article.

  • Funding Institutional Research Fund.

  • Competing interests None declared.

  • Ethics approval Institutional Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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