Fetal Origins of Coronary Heart Disease and Hypertension and Its Relevance to India: Review of Evidence from the Mysore Studies

Reduced growth in utero has been associated with an increased risk of coronary heart disease and hypertension. The rising rates of coronary heart disease in India are not explained by the prevalence of risk factors such as high blood pressure, hypercholesterolaemia, smoking or obesity. The fetal origins hypothesis may therefore be particularly relevant to India. Studies conducted at the Holdsworth Memorial Hospital, Mysore show that poor fetal growth is associated with an increased risk of adult coronary heart disease. However, the association is not mediated by hypertension, left ventricular mass or arterial compliance. This suggests that the way in which the intrauterine environment influences coronary heart disease differs between Indian and Western populations. The fact that the Mysore men and women are insulin resistant, and that coronary heart disease and its risk factors have been linked to features of the insulin resistance syndrome lead to the speculation that insulin resistance may be partially responsible.