Prevalence of Dyslipidemia in Urban and Rural India: The ICMR–INDIAB Study

Citation: Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A, et al. (2014) Prevalence of Dyslipidemia in Urban and Rural India: The ICMR–INDIAB Study. PLoS ONE 9(5): e96808. doi:10.1371/journal.pone.0096808
Published: May 9, 2014

Aim: To study the pattern and prevalence of dyslipidemia in a large representative sample of four selected regions in India.
Methods: Phase I of the Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study was conducted in a representative population of three states of India (Tamil Nadu, Maharashtra and Jharkhand) and one Union Territory (Chandigarh), and covered a population of 213 million people using stratified multistage sampling design to recruit individuals ≥20 years of age. All the study subjects (n = 16,607) underwent anthropometric measurements and oral glucose tolerance tests were done using capillary blood (except in self-reported diabetes). In addition, in every 5th subject (n = 2042), a fasting venous sample was collected and assayed for lipids. Dyslipidemia was diagnosed using National Cholesterol Education Programme (NCEP) guidelines.
Results: Of the subjects studied, 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists with the highest rates of hypercholesterolemia observed in Tamilnadu (18.3%), highest rates of hypertriglyceridemia in Chandigarh (38.6%), highest rates of low HDL-C in Jharkhand (76.8%) and highest rates of high LDL-C in Tamilnadu (15.8%). Except for low HDL-C and in the state of Maharashtra, in all other states, urban residents had the highest prevalence of lipid abnormalities compared to rural residents. Low HDL-C was the most common lipid abnormality (72.3%) in all the four regions studied; in 44.9% of subjects, it was present as an isolated abnormality. Common significant risk factors for dyslipidemia included obesity, diabetes, and dysglycemia.
Conclusion: The prevalence of dyslipidemia is very high in India, which calls for urgent lifestyle intervention strategies to prevent and manage this important cardiovascular risk factor.


Cardiovascular disease (CVD) is the leading cause of death worldwide, and mortality due to CVD is higher in low- and middle-income countries [1], [2]. In India, there has been an alarming increase in the prevalence of CVD over the past two decades so much so that accounts for 24% of all deaths among adults aged 25–69 years [3]. Asian Indians have been found to develop CVD at a younger age than other populations [4]. The likely causes for the increase in the CVD rates include lifestyle changes associated with urbanization and the epidemiologic and nutritional transitions that accompany economic development [5]. Dyslipidemia has been closely linked to the pathophysiology of CVD and is a key independent modifiable risk factor for cardiovascular disease [6], [7]. While Asian Indians are known to have a unique pattern of dyslipidemia with lower HDL cholesterol, increased triglyceride levels and higher proportion of small dense LDL cholesterol, there have been no large scale representative studies on dyslipidemia to assess the magnitude of the problem in India. The estimation of the prevalence of dyslipidemia will ensure proper planning of health care resources for both primary and secondary prevention of CVDs. This article will report on the lipid patterns and prevalence of lipid abnormalities of the Indian population studied in Phase I of the Indian Council of Medical Research India Diabetes Study (ICMR-INDIAB study), involving three states and one union territory (UT), representing the north, south, east and west of the country.


The methodology of the ICMR-INDIAB study has been published separately [8], [9]. Briefly, this is a cross-sectional survey involving adults aged 20 years and above (age range: 20–90 years). The study plans to survey all the 28 states in India, the two Union Territories (UT) of Chandigarh and Puducherry and the National Capital Territory (NCT) of Delhi in a phased manner. Phase I of the ICMR-INDIAB study was conducted from November 2008 to April 2010, and included three states randomly selected to represent the south (Tamilnadu), west (Maharashtra), and east (Jharkhand) of India and one union territory (UT) representing northern India (Chandigarh). These four states have a population of 213 million, which is roughly 1/8 of India's total population of 1.2 billion people. In INDIAB-NE, the 8 north eastern states namely Sikkim, Assam, Meghalaya, Tripura, Mizoram, Manipur, Nagaland and Arunachal Pradesh are being sampled and ...

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