Population Study of Urban, Rural, and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study: Rationale, Study Design, and Baseline Characteristics of PURSE-HIS

Abstract

We designed and implemented the PURSE-HIS (Population Study of Urban, Rural and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study) to understand the prevalence and progression of subclinical and overt endovascular disease (EVD) and its risk factors in urban, semiurban, and rural communities in South India. The study is also designed to generate clinical evidence for effective, affordable, and sustainable community-specific intervention strategies to control risks factors for EVD. As of June 2012, 8,080 (urban: 2,221; semiurban: 2,821; rural: 3,038) participants >20 years of age were recruited using 2-stage cluster sampling. Baseline measurements included standard cardiovascular disease risk factors, sociodemographic factors, lifestyle habits, psychosocial factors, and nutritional assessment. Fasting blood samples were assayed for putative biochemical risk factors and urine samples for microalbuminuria. All nondiabetic participants underwent oral glucose tolerance test with blood and urine samples collected every 30 min for 2 h. Additional baseline measurements included flow-mediated brachial artery endothelial vasodilation, assessment of carotid intimal medial wall thickness using ultrasonography, screening for peripheral vascular disease using ankle and brachial blood pressures, hemodynamic screening using a high-fidelity applanation tonometry to measure central blood pressure parameters, and aortic pulse wave velocity. To assess prevalence of coronary artery disease, all participants underwent surface electrocardiography and documentation of ventricular wall motion abnormality and function using echocardiography imaging. To detect subclinical lesions, all eligible participants completed an exercise treadmill test. Prospectively, the study will assess progression of subclinical and overt EVD, including risk factor-outcome relation differences across communities. The study will also evaluate community-specific EVD prevention using traditional Indian system of medicine versus recognized allopathic (mainstream) systems of medicine.

Associations between Greenness, Impervious Surface Area, and Nighttime Lights on Biomarkers of Vascular Aging in Chennai, India

“…Details on the PURSE-HIS study design and population have been published elsewhere ( Thanikachalam et al 2015 ); here, we provide a brief overview of the PURSE-HIS Chennai population. The urban-area subjects were drawn from Chennai, the capital city, and the semiurban- and rural-area subjects were selected from the Thiruvallur and Kanchipuram districts, respectively, in the state of Tamil Nadu, India.…”

Sodium Intake, Blood Pressure, and Dietary Sources of Sodium in an Adult South Indian Population

“…The detailed methodology of PURSE-HIS is published elsewhere. 19 As of June 2012, 8080 (urban: 2221; semi-urban: 2821; rural: 3038) participants >20 years of age were recruited by 2-stage cluster sampling using the 2001 India census database. In this current analysis, because both semiurban and urban populations were very similar in their risk profile, they were combined and identified as semi-urban/urban population.…”

“…Fasting blood specimens were collected and assayed for various putative cardiovascular biochemical risk factors. 19 All nondiabetic participants were given 75 g of glucose dissolved in 250 to 300 mL water and an oral glucose tolerance test was conducted. Blood and urine specimens were collected every 30 minutes for up to 2 hours.…”

Epidemiologic studies targeting primary cardiovascular disease prevention in South Asia

“… Controls: Frequency matched controls from outpatient settings and visitors to hospitals. Population Study of Urban, Rural, and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study (PURSE-HIS) 29 , 30 , 31 , 32 , 33 , 34 India: Chennai Thiruvallur Kanchipuram Cross-sectional + Prospective Cohort; 8080 Cross sectional: Estimate the prevalence of risk factors, biomarkers, subclinical endovascular disease and overt endovascular disease. 2 stage cluster sampling.…”

“…The PURSE-HIS was initiated in 2007 to study endovascular disease in urban, semiurban, and rural communities in South India. 29 The cross-sectional component of the study estimated the prevalence of risk factors, biomarkers, subclinical endovascular disease and overt endovascular disease. The prospective cohort component of the study is aimed at understanding the impact of holistic interventions on risk factors and the course of disease.…”