Prabhakaran Dorairaj

• Doctor of Medicine
• Managing Director at Centre for Chronic Disease Control

Background To estimate the prevalence of cognitive impairment in a population‐based cohort from India and assess the potential modifiable factors of cognitive impairment. Method We used the population‐representative data from the longitudinal Precision‐CARRS study from Delhi and Chennai, India. The cohort was recruited in two waves, CARRS‐1 in 201...

Background The Defense Automated Neurobehavioral Assessment (DANA) encompasses a suite of standardized neurocognitive screening tools designed for detecting various neurodegenerative diseases and subtle cognitive deficits. This study presents a pilot investigation into digital cognitive screening, utilizing an Android version of the DANA tests, con...

Background Detection of presymptomatic individuals or those with subtle cognitive changes in midlife may prevent or slow the course of Alzheimer's Disease by identifying candidates for disease‐modifying treatments. Utilizing newer delivery approaches involving digital measures shows promise for cognitive phenotyping, early detection, ease of admini...

Background In the context of the increasing number and proportion of population aged 60 years or more in India, it is imperative to understand their health needs for ensuring healthy ageing. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we identified the top ten causes of disability-adjusted li...

A substantial share of patients at risk of developing cardiovascular disease (CVD) fail to achieve control of CVD risk factors, but clinicians lack a structured approach to identify these patients. We applied machine learning to longitudinal data from two completed randomized controlled trials among 1502 individuals with diabetes in urban India and...

Background In 2019, the Global Burden of Diseases, Injuries, and Risk Factors Study attributed 0·98 million deaths to ambient air pollution in India based on potentially inappropriate exposure–response functions from countries with low air pollution levels. Instead, using data from India, we investigated long-term exposure to PM2·5 and all-cause mo...

Introduction Air pollution presents a major public health threat to India, affecting more than three quarters of the country’s population. In the current project, GEOHealth Health Effects of Selected Environmental Exposomes Across the Life CourSe–India, we aim to study the effect of environmental exposomes—fine particulate matter (PM 2.5 ), nitroge...

Background Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVD) and cardiovascular risk factors (CVRF) is critical to inform CVD prevention strategies, but limited community-level data exist from developing countries. Objective To assess the knowledge, attitudes, and practices regarding CVD and CVRF and accepta...

Background Long-term adverse consequences of the COVID-19 affect many organ systems, and this requires the identification and appropriate care of diverse symptoms. Purpose The World Heart Federation (WHF) international study describes the burden of clinical sequelae of COVID-19 up to 1 year after hospitalization, including patients from low- middl...

Background COVID-19 vaccinations have been found to be effective in reducing the severity of COVID-19 infection and in-hospital deaths; however, insufficient evidence exists about the effect of vaccination on long term morbidity and mortality after hospitalization in patients from low- and middle-income countries. Methods The global WHF COVID-19 L...

Background Telemedicine holds immense potential to revolutionise healthcare delivery, particularly in resource-limited settings and for patients with chronic diseases. Despite proven benefits and policy reforms, the use of telemedicine remains low due to several patient, technology, and system-level barriers. Assisted telemedicine employs trained h...

Cardiovascular disease (CVD) represents the largest burden of disease globally and despite the availability of strong evidence supporting cost-effective treatments for people with CVD, the implementation of these treatments remains low, especially in low-income settings. Shortages in workforce have led to focus on how to increase clinical capacity....

Background The burden of over 300 million individuals living with hypertension in India is increasing steadily. Most current guidelines recommend initial combination therapy for effective blood pressure (BP) control. However, there is no randomised evidence to inform which combinations to use in the South Asian population, who account for over one-...

Background and Objective Hypertension frequently coexists with other chronic conditions and cardiometabolic risk factors. The identification of comorbidities is key in the management of hypertensive patients. May Measurement Month (MMM) is a global initiative aimed at enhancing the detection and awareness of hypertension. This study analyzes data f...

Introduction: India has a high burden of uncontrolled hypertension (28%) with low control rates (<10%). Mean dietary sodium intake (4000mg/d) is also high, which warrants implementation of population-level sodium reduction interventions, such as using low-sodium iodized salt (LSIS). Given the low awareness about LSIS, we co-created and evaluated an...

The MNH eCohort was developed to fill gaps in maternal and newborn health (MNH) care quality measurement. In this paper, we describe the survey development process, recruitment strategy, data collection procedures, survey content and plans for analysis of the data generated by the study. We also compare the survey content to that of existing multi-...

Introduction People with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates the rate and predictors of kidney function decline among people with type 2 diabetes in South Asia. Research design and methods We analyzed dat...

Background The associations of vegetarian diets with risks for site-specific cancers have not been estimated reliably due to the low number of vegetarians in previous studies. Therefore, the Cancer Risk in Vegetarians Consortium was established. The aim is to describe and compare the baseline characteristics between non-vegetarian and vegetarian di...

In 2016–2017, Indian government set a policy target of doubling farmers’ incomes by 2022. This article investigates farmers’ perspectives on this contentious policy. Results suggest that only 18% of farmers were aware of this policy. Most farmers blamed the government’s support, high cost of cultivation and low MSP for their inability to increase t...

Background Obesity is among the leading public health threats globally. Over the last few years, visceral adiposity index (VAI), and body adiposity index (BAI), derived from anthropometric, and biochemical measures, have gained importance as a measure of obesity. However, unlike other common indices like body mass index, and waist circumference, th...

Background: The evidence for acute effects of air pollution on mortality in India is scarce, despite the extreme concentrations of air pollution observed. This is the first multi-city study in India that examines the association between short-term exposure to PM2·5 and daily mortality using causal methods that highlight the importance of locally ge...

Objective Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in India. There is no laboratory-based CVD risk data among Indians from different regions and backgrounds. This study estimated laboratory-based 10-year CVD risk across different population sub-groups. Methods Data from UDAY derived from cross-sectional surveys...

The Disadvantaged populations estimated glomerular filtration rate (eGFR) epidemiology study (DEGREE) was designed to gain insight into the burden of chronic kidney disease (CKD) of undetermined cause (CKDu) using standard protocols to estimate the general-population prevalence of low eGFR internationally. Using population-representative surveys of...

Introduction: Limited information is available on the burden of multimorbidity among diabetics in India. Methods: We conducted a cross-sectional study among 12284 adults aged ≥ 30 years, using multistage cluster random sampling, from rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on...

Introduction: India faces a huge burden of undiagnosed and uncontrolled diabetes, resulting in a significant challenge to the healthcare system. Methods: To improve linkage to the primary healthcare system and blood glucose control among diabetics, we conducted a large community-based screening and follow-up study of individuals’ ≥ 30 years led by...

Background: Current definitions of prediabetes fail to capture the heterogeneity of the type 2 diabetes (T2D) pathophysiology. We aim to identify clusters of prediabetes among South Asians and explore their associations with diabetes incidence and overall mortality. Methods: Data from individuals with prediabetes based on the ADA criteria in the CA...

Background: Characterizing heterogeneity of type 2 diabetes (T2D) is essential for precision diabetes. We investigated phenotype clusters within T2D and their associations with mortality in South Asians. Methods: In 2,639 individuals diagnosed with T2D from the CARRS cohort, we characterized T2D phenotypes by applying k-means clustering on age at d...

Background Defining lipid goals solely on low-density lipoprotein-cholesterol (LDL-C) levels in Indian population may cause misclassification due to high prevalence of hypertriglyceridemia and small dense LDL-C particles. International guidelines now recommend Apoliporotein-B (Apo-B) and non-high-density lipoprotein-cholesterol (non-HDL-C) levels a...

Background Diabetes control is poor globally and leads to burdensome microvascular and macrovascular complications. We aimed to assess post hoc between-group differences in sustained risk factor control and macrovascular and microvascular endpoints at 6.5 years in the Center for cArdiovascular Risk Reduction in South Asia (CARRS) randomized trial....

Aims The aim of this study was to evaluate the effects of yoga-based cardiac rehabilitation (Yoga-CaRe) on the endothelial system, oxidative stress, and inflammatory markers in patients with acute myocardial infarction (MI). Methods A sub-study was conducted in two clinical sites of the Yoga-CaRe trial (a multicenter randomized controlled trial)....

Objectives To explore associations between type and number of abnormal glucose values on antenatal oral glucose tolerance test (OGTT) with postpartum diabetes in South Asian women diagnosed with gestational diabetes (GDM) using International Association of the Diabetes and Pregnancy Study Groups criteria. Methods This post‐hoc evaluation of the Li...

Objective To evaluate adult (>18 years) hypertension awareness, treatment, control, and comorbidities using three years of May Measurement Month (MMM) data (2017-2019). Design and method Up to three sitting blood pressure (BP) readings as well as lifestyle and comorbidity data (self-reported diabetes, myocardial infarction, stroke and overweight/o...

Introduction Associations between markers of impaired kidney function and adverse outcomes among South Asians is understudied and could differ from existing data derived mostly from North American or European cohorts. Methods We conducted a prospective analysis of 9797 participants from the ongoing cardiometabolic risk reduction study in South Asi...

Background COVID-19 cardiovascular research from Africa is limited. This study describes cardiovascular risk factors, manifestations, and outcomes of patients hospitalised with COVID-19 in the African region, with an overarching goal to investigate whether important differences exist between African and other populations, which may inform health po...

Background: The Asian Indian Beta Cell function (ABCs) in Infants Study examined the associations of maternal weight on infant pancreatic beta cell function across 7 months postpartum. Methods: Pregnant women aged 18–35 years were recruited in Hyderabad, India. Women were classified by first trimester weight as underweight (UW), BMI < 18.5 kg/m2; n...

Background Exposure to ambient PM 2.5 is known to affect lipid metabolism through systemic inflammation and oxidative stress. Evidence from developing countries, such as India with high levels of ambient PM 2.5 and distinct lipid profiles, is sparse. Methods Longitudinal nonlinear mixed-effects analysis was conducted on >10,000 participants of Cen...

Fixed-dose combination (FDC) therapy, also known as polypill therapy, targets risk factors for atherosclerotic cardiovascular disease (ASCVD) and has been proposed as a strategy to reduce global ASCVD burden. Here we conducted a systematic search for relevant studies from 2016–2022 to assess the effects of FDC therapy for prevention of ASCVD. The s...

OBJECTIVE To describe the natural history of diabetes in Indians. RESEARCH DESIGN AND METHODS Data are from participants older than 20 years in the Centre for Cardiometabolic Risk Reduction in South Asia longitudinal study. Glycemic states were defined per American Diabetes Association criteria. Markov models were used to estimate annual transitio...

Background: In India, several state governments are implementing or considering home-based hypertension screening programs to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programs in India. Methods: Using six waves of population-representativ...

High resolution assessment of historical levels is essential for assessing the health effects of ambient air pollution in the large Indian population. The diversity of geography, weather patterns and progressive urbanization, combined with a sparse ground monitoring network makes it challenging to accurately capture the spatiotemporal patterns of a...

To study the association of pro-inflammatory markers with incident diabetes in India. We did a nested case–control study within the CARRS (Centre for Ardiometabolic Risk Reduction in South Asia) cohort. Of the 5739 diabetes-free individuals at the baseline, 216 participants with incident diabetes and 432 age-, gender- and city-matched controls at 2...

Background Heatwaves are expected to increase with climate change, posing a significant threat to population health. In India, with the world’s largest population, heatwaves occur annually but have not been comprehensively studied. Accordingly, we evaluated the association between heatwaves and all-cause mortality and quantifying the attributable m...

Background: A heavy burden of cardiometabolic conditions on low- and middle-income countries like India that are rapidly undergoing urbanization remains unaddressed. Indians are known to have high levels of triglycerides and low levels of HDL-C along with moderately higher levels of LDL-C. The genome-wide findings from Western populations need to b...

High prevalence of Vitamin D deficiency has been reported among selective population, but its population prevalence from representative adult population is lacking in India. The aim of this study was to estimate the prevalence and identify the correlates of Vitamin D deficiency among urban and rural areas of the National Capital Region (NCR) of Del...

Background: The associations of vegetarian diets with risks for site-specific cancers have not been estimated reliably due to the low number of vegetarians in previous studies. Therefore, the Cancer Risk in Vegetarians Consortium was established. Objective: To describe and compare the baseline characteristics between non-vegetarian and vegetarian d...

Background Retention of participants is a challenge in community-based longitudinal cohort studies. We aim to evaluate the factors associated with loss to follow-up and estimate attrition bias. Methods Data are from an ongoing cohort study, Center for cArdiometabolic Risk Reduction in South Asia (CARRS) in India (Delhi and Chennai). Multinomial lo...

There is a growing recognition that the profound environmental changes that have occurred over the past century pose threats to human health. Many of these environmental factors, including air pollution, noise pollution, as well as exposure to metals such as arsenic, cadmium, lead and other metals, are particularly detrimental to the cardiovascular...

Dietary sodium intake is high among adults in India. Use of low sodium iodized salt (LSIS) can help reduce sodium intake. However, contextually relevant and culturally appropriate interventions to promote LSIS uptake in India have not been developed and implemented. We carried out formative research to inform an intervention to promote uptake of LS...

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bi...

Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries a...

Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey—a novel population survey conducted in 15 low-income, middle-income, and high-income countries—we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half...

Despite major efforts to achieve universal health coverage (UHC), progress has lagged in many African and Asian countries. A key strategy pursued by many countries is the use of health insurance to increase access and affordability. However, evidence on insurance coverage and on the association between insurance and UHC is mixed. We analysed nation...

Background: Obesity is among the leading public health threats globally. Over the last few years, Visceral Adiposity Index (VAI), and Body Adiposity Index (BAI), derived from anthropometric, and biochemical measures, have gained importance as a measure of obesity. However, unlike other common indices like body mass index, and waist circumference, t...

Background Structured lifestyle change education reduces the burden of cardiometabolic diseases such as diabetes. Delivery of these programs at worksites could overcome barriers to program adoption and improve program sustainability and reach; however, tailoring to the worksite setting is essential. Methods The Integrating Diabetes Prevention in W...

Background COVID-19 pandemic presents a number of unpredictable and long-lasting challenges. Understanding the short- and long-term effects of COVID-19 infection is crucial for better planning of preventive and management strategies for future pandemics. This study aims to determine short- and long-term clinical sequelae among COVID-19 hospitalized...

Importance Hypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum—including diagnosis, treatment, and control—in India did not assess district-level variation. Local data are critical for planning, implementation, and monitoring efforts to curb the burden of hyper...

Todd Lewis and co-authors discuss development and use of the People's Voice Survey for health system assessment.

Introduction Exposure to fine particulate matter has been associated with several cardiovascular and cardiometabolic diseases. However, such evidence mostly originates from low-pollution settings or cross-sectional studies, thus necessitating evidence from regions with high air pollution levels, such as India, where the burden of non-communicable d...

Background More than 250 loci have been identified by genome-wide scans for type 2 diabetes in different populations. South Asians have a very different manifestation of the diseases and hence role of these loci need to be investigated among Indians with huge burden of cardio-metabolic disorders. Thus the present study aims to validate the recently...

Adiposity has gradually become a global public threat over the years with drastic increase in the attributable deaths and disability adjusted life years (DALYs). Given an increased metabolic risk among Asians as compared to Europeans for any given body mass index (BMI) and considering the differences in genetic architecture between them, the presen...

Background Low levels of docosahexaenoic acid (DHA) or high n-6: n-3 ratio in pregnant women is associated with poor fetal growth velocity and suboptimal neurodevelopment. However, there is lack of data on levels of important n-6 and n-3 fatty acids at different time points during pregnancy and lactation from India. Data on how much DHA is transfer...

Background: In India, around 77 million people are at high risk of developing type 2 diabetes mellitus (T2DM). Yoga interventions can be effective in preventing T2DM. We conducted a feasibility randomized controlled trial (RCT) in India, and the intervention was the Yoga Programme for T2DM Prevention (YOGA-DP). This study aimed to identify and exp...

Background: Environmentally sustainable diets are represented in the EAT-Lancet recommendations developed by the Lancet Commission on Planetary Health in 2019. Very few studies have compared Indian diets with the EAT-Lancet recommendations. The present study performed such a comparison using primary dietary consumption data from adults in north an...

Aim: To study, the incidence and risk factors for postpartum diabetes (DM), in women with gestational diabetes mellitus (GDM) from South Asia (Bangladesh, India and Sri Lanka), followed for nearly two years after delivery. Methods: Women with prior GDM diagnosed using IADPSG criteria were invited at 19 centres across Bangladesh, India and Sri La...

Background & objectives: Heart failure (HF) is emerging as a major health problem in India. The profile of HF in India is divergent from elsewhere in the world. While cardiologists must equip themselves with the requisite clinical management tools, scientists and health policymakers would need epidemiological data on HF and information on the reso...

Background Asian Indians are at higher risk of cardiometabolic disease compared to other ethnic groups, and the age of onset is typically younger. Cardiac structure and function are poorly characterized in this ethnic group. In this study, we describe image-acquisition methods and the reproducibility of measurements and detailed echocardiography ch...

Background: Delivery of proven structured lifestyle change education for reducing the burden of cardiometabolic diseases such as diabetes at worksites could overcome barriers to program adoption and improve sustainability and reach of these programs; however, tailoring to the worksite setting is essential. Methods: The Integrating Diabetes Preventi...

Purpose: To assess prevalence of key lifestyle behaviours including maintaining a body mass index (BMI) <25Kg/m2, engaging in physical activity for ≥150 min/week, consuming >5 servings of fruits & vegetables daily, & no tobacco use among diabetics, pre-diabetics, & nondiabetics. Methods: We conducted a large population-based survey among 12284 part...

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Providing quality cardiovascular disease (CVD) care in low resource setting requires understanding of priority and effective interventions. This study aimed to identify and prioritize evidence-based quality improvement strategies for CVD care in India using a modified two-round Delphi process in which, we asked 46 experts (clinicians, researchers,...

Background Hypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum in India – including diagnosis, treatment, and control – did not assess district level variation. Local data are critical for planning, implementation, and monitoring efforts to curb hypertension bu...

Background: Cardiovascular diseases (CVDs) are the leading cause of death in most low- and middle-income countries (LMICs). CVDs and their metabolic risk factors have historically been concentrated among urban residents with higher socioeconomic status (SES) in LMICs such as India. However, as India develops, it is unclear whether these socioecono...

Introduction: Measures to address the COVID-19 pandemic in India included a ban on the sale and use of tobacco products during 2020 when stay at home guidance (lockdown) was in place. In this study we examined the extent of reduction in frequency of tobacco consumption across all products. Methods: Telephone survey was conducted between July and...

Introduction: Many Indians are at high risk of type 2 diabetes mellitus (T2DM). The blood glucose level can be improved through a healthy lifestyle (such as physical activity and a healthy diet). Yoga can help in T2DM prevention, being a culturally appropriate approach to improving lifestyle. We developed the Yoga Programme for T2DM Prevention (YO...