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Introduction: Data are limited evaluating the association of socioeconomic position and cardiovascular disease risk factors in rural India, an area facing rapid economic changes. Hypothesis: We hypothesized that socioeconomic position is associated with the prevalence of abnormal cardiovascular disease risk factors in rural India. Methods: From 2013-2014, we performed multi-stage, representative, community-based sampling of the rural Solan district of Himachal Pradesh in India as part of a prospective, longitudinal cohort study enrolling 40,017 participants. We collected data on demographics, medical history, anthropometry, blood pressure, and laboratory studies. Using factor analysis for mixed data, we constructed a socioeconomic position index incorporating education, occupation, income, and household assets for each individual. We used multivariable logistic regression models adjusted for age and sex to evaluate the association between quintiles of the socioeconomic position index and cardiovascular disease risk factors. Results: Participants’ mean (SD) age was 42.7 (15.9) years, and 57% were women. Fifteen percent of participants were illiterate (n = 6081) and 24% were employed (n = 9502). The mean (SD) BMI was 22.3 (4.1) kg/m 2 . The mean (SD) systolic and diastolic blood pressures were 139.6 (21.8) mmHg and 84.3 (11.4) mmHg, respectively. After adjustment, individuals in the highest quintile of socioeconomic position index had 2.19 (95% CI 2.01, 2.38) higher odds of being overweight, 3.43 (95% CI 2.91, 4.04) higher odds of being obese, 2.45 (95% CI 2.16, 2.78) higher odds of having hypertension, and 1.62 (95% CI 1.44, 1.82) higher odds of having diabetes mellitus (Figure). Conclusion: We observed a direct, stepwise association between socioeconomic position and prevalence of abnormal cardiovascular risk factors in rural India. Primordial prevention strategies are needed for rural Indians, including those who experience increases in socioeconomic position, to improve cardiovascular health.

Background— In rural areas in China and India, the cardiovascular disease burden is high but economic and healthcare resources are limited. This study (the Simplified Cardiovascular Management Study [SimCard]) aims to develop and evaluate a simplified cardiovascular management program delivered by community health workers with the aid of a smartphone-based electronic decision support system. Methods and Results— The SimCard study was a yearlong cluster-randomized, controlled trial conducted in 47 villages (27 in China and 20 in India). Recruited for the study were 2086 individuals with high cardiovascular risk (aged ≥40 years with self-reported history of coronary heart disease, stroke, diabetes mellitus, and/or measured systolic blood pressure ≥160 mm Hg). Participants in the intervention villages were managed by community health workers through an Android-powered app on a monthly basis focusing on 2 medication use and 2 lifestyle modifications. In comparison with the control group, the intervention group had a 25.5% ( P P P =0.04). However, no significant changes were observed in the lifestyle factors. The intervention was culturally tailored, and country-specific results revealed important differences between the regions. Conclusions— The results indicate that the simplified cardiovascular management program improved quality of primary care and clinical outcomes in resource-poor settings in China and India. Larger trials in more places are needed to ascertain the potential impacts on mortality and morbidity outcomes. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01503814.