MUMBAI: Indians who are educated, have higher household wealth and boast of urban addresses are more prone to cardiovascular disease (CVD), a study done by researchers of the Public Health Foundation of India and Harvard TH Chan School of Public Health has revealed. Also, Indian males have a higher risk than females.The study also found that wealthier people living in rural areas had the same risk as their urban counterparts, said its Delhi-based author Dr Ashish Awasthi of PHFI. Indians are pre-disposed to cardiac diseases, with heart attacks being the leading cause of deaths (almost 18% of all deaths). The study, published in PLOS Medicine , looked at health data of almost 8 lakh Indians from two big household surveys (Annual Health Survey round 2 and District Hevel Household and Facility Survey-round 4) that was carried out between 2012 and 2014."We looked at adults aged between 30 and 74 years across India, and found that the average 10-year risk of a fatal or nonfatal CVD event varied widely among states in India. If it was 13.2% in Jharkhand, it was 19.5% in Kerala,'' said Awasthi. Both Maharashtra and Delhi have an overall risk of around 15%.The Harvard study claims to have mapped India's heart disease, with states in south India, north and the northeast emerging as the worst. It found that smoking was more prevalent in poorer households and rural areas, whereas body mass index, high blood glucose, and systolic blood pressure were associated with household wealth and urban location.The study's main author Dr Pascal Geldsetzer from Harvard T H Chan School of Public Health told TOI , "While those with more education had higher CVD risk on average, the associations were stronger for household wealth quintile (a measure of poverty) and urban/rural with those with higher household wealth and in urban areas having higher CVD risk."Dr Geldsetzer said more educated and wealthier Indians were less likely to smoke, which reduces CVD risk. "But wealthier Indians were more likely to have a higher body mass index (that is, weight given their height), higher blood pressure, and more likely to have diabetes," he added. The reasons could range from include high calorie diet, higher salt and sugar intake and poorer physical activity.Dr Prafulla Kerkar, who heads the cardiology department of KEM Hospital in Parel, said, "This seems to be the largest study done. It shows India is undergoing an epidemiological transition as urbanization is growing along with sedentary-ism." He added the poor are at the highest risk because they don't have awareness about the disease and are diagnosed at an advanced stage.This study demonstrates the need for research on diabetes and hypertension prevention and management in India. It also highlights the urgent need for elimination of artificial transfat and sodium reduction as well as reducing tobacco use.