PURE is a multinational, multicentred study guided and coordinated by McMaster University, Canada. The baseline study of this project was from March 2003 till 2007 and recruited 5650 subjects from fifteen locations in Thiruvananthapuram district both rural and urban. The study population comprises people between age group of 35-70 years. The first three year follow up of this study was completed and the second round follow up is going.