Prevalence of Coronary Artery Disease in Middle-Aged Adults in India: A Systematic Review Examining the Role of Family History

Systematic Review Protocol Title: Prevalence of Coronary Artery Disease in Middle-Aged Adults in India: A Systematic Review Examining the Role of Family History Authors: 1. Renjith Raj P - as Ph.D. Scholar, Saveetha Medical College, Chennai, Assistant Professor, Department of Biochemistry, MOSC Medical College, Kolenchery, Ernakulam, Kerala, India, 2. Dr. N Ananthi, Professor and Head of Department, Department of Biochemistry, Saveetha Medical College, SIMATS, Chennai, India 3. Dr. Radhakrishnan R, Scientist Grade – F 13A, Head of Department, Laboratory Medicine & Molecular Diagnostics, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India 4. Dr.Eapen Punnose, Head of Department, Department of Cardiology, MOSC Medical College, Kolenchery, Ernakulam, Kerala, India Stage of Review at time of registration: Protocol (Pre-data extraction) Background: Coronary Artery Disease (CAD) remains a major public health concern, with increasing rates of morbidity worldwide. In the Indian context, understanding the prevalence of CAD, particularly in middle-aged adults (30-60 years), is crucial for effective public health interventions. Family history of cardiovascular disease (CVD) is a well-established risk factor for CAD, suggesting a genetic predisposition and shared environmental or lifestyle factors within families. This systematic review aims to comprehensively investigate the specific role of family history in the prevalence of CAD among middle-aged adults in India. Research Question: Does the prevalence of coronary artery disease differ between middle-aged adults (defined as 30-60 years) in India with a family history of cardiovascular disease and those without such a history? Objectives: This systematic review has the following key objectives: • To systematically identify and synthesize all relevant observational studies (cross-sectional, case-control, and cohort studies) that report the prevalence of CAD in middle-aged adults in India, stratified by the presence or absence of a family history of CVD. • To quantitatively estimate the pooled prevalence of CAD in middle-aged adults with and without a family history of CVD using meta-analytic techniques, if sufficient homogeneous data are available. • To determine the magnitude of the association (e.g., odds ratio, prevalence ratio) between a family history of CVD and the prevalence of CAD in this population. • To explore potential sources of heterogeneity across included studies, such as variations in diagnostic criteria for CAD, definition of family history, age range within the middle-aged category, and geographical location within India. • To assess the methodological quality and risk of bias of the included studies. Methods: A comprehensive systematic search will be conducted across major electronic databases including PubMed/MEDLINE and Google Scholar. The search strategy will employ a combination of keywords and MeSH terms related to "coronary artery disease," "ischemic heart disease," "cardiovascular disease," "family history," "genetic predisposition," "prevalence," "epidemiology," and "India," with appropriate age-related filters. No language restrictions will be applied initially. Two independent reviewers will screen titles and abstracts, followed by full-text article assessment, based on pre-defined inclusion and exclusion criteria. Inclusion criteria comprise observational studies reporting CAD prevalence in middle-aged adults (40-60 years) in India, explicitly stratifying by family history of CVD, and using standard diagnostic criteria for CAD. Exclusion criteria include studies focusing solely on specific genetic disorders, those not clearly defining family history, case reports, case series, reviews, editorials, and studies conducted outside India or not on the middle-aged adult population. Standardized data extraction forms will be used by two independent reviewers to extract relevant information, including study design, sample size, demographics, definition of family history, diagnostic criteria for CAD, and prevalence data. Methodological quality and risk of bias will be assessed using the Newcastle-Ottawa Scale (NOS). If sufficient homogeneous data are available, a meta-analysis will be performed to estimate pooled prevalence and the association between family history and CAD prevalence. Heterogeneity will be assessed using the I² statistic and Cochran's Q test, with subgroup analyses and meta-regression to explore significant heterogeneity. A narrative synthesis will be provided for studies not suitable for meta-analysis. Publication bias will be assessed using funnel plots and Egger's test. Expected Outcomes and Significance: This systematic review is expected to provide a comprehensive and quantitative synthesis of the existing evidence regarding the association between family history of CVD and the prevalence of CAD in middle-aged adults in India. The findings will have significant implications for: • Public Health: Informing the development of targeted screening programs and preventive strategies for individuals with a positive family history of CVD in India. • Clinical Practice: Enhancing risk stratification and early identification of individuals at higher risk for CAD. • Research: Identifying gaps in the current literature and guiding future research directions in understanding the genetic and familial contributions to CAD in the Indian population.

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