Cardiovascular disease burden in India

During this millennium the epidemic of cardiovascular disease is involving developing nations of Asia and is rapidly becoming the leading cause of death in most of the countries.
By 2020 cardiovascular disease will surpass infectious diseases as the world’s leading cause of mortality.
Factors contributing to this phenomenon are
 Availability of better medical care thus leading to increase in life span
 Changing social milieu and economic growth leading to life style changes
 A large majority of the countries have a population that is poor and without sufficient access to health care, coupled with inadequate social support systems. This leads to increase in burden of patients of congenital and rheumatic heart disease.
Magnitude of problem
 In 2005 cardiovascular diseases caused 17.5 million (30%) / 58 million deaths world wide.
 By the year 2010, 60% of the world's patients with heart disease will be in India.
 In India about 50% of CHD-related deaths occur in people younger than 70 years compared with only 22% in west.
 In India there is a fully developed epidemic of cardiovascular diseases.
 Mortality from infectious diseases decreased from 22% to 16% in recent times while mortality from cardiovascular diseases has increased from 21% to 25%.
 Mean age for Coronary heart disease occurrence in India is : 56.6±12 years (men) ; 61.8±10 years(women)
 In developed countries the average age of presentation is higher: 66.0±5 years.
 The reason for this difference in age of presentation of same disease is exactly not known, and the answer to this question may lie in genes which we inherit. May be in future we would be able to define the cause for young age of onset of disease in Indians.
 Also occurrence of coronary heart disease in young adults is a matter of great concern. There is long life ahead and patients are left with varying degree of disabilities. Some times in India we see that the patient was the sole income source for the family.
 Having a heart attack at 30 years of age in a person who is the only earning member of the family would cripple the entire family. Who will look after the family if the patient does not survives? Who will bear the expenses of the treatment of heart attack for this patient? What if the patient survives but is left will chronic heart failure due to massive heart attack (myocardial infarction). Who will bear the expenses for his life long treatment of heart failure?
 Why do some young patients suffer from such disease even if they do not have any of the risk factors (so called major coronary risk factors- smoking, diabetes, high blood pressure, high cholesterol).
 Just imagine a situation when you are a doctor sitting in emergency and a 27 years old male presents with acute severe heart attack (myocardial infarction) and is in shock. He has never smoked, not a diabetic, not a hypertensive and does not have high cholesterol? How difficult it would be for you, to explain to his family members, why such a disease happened to this patient.
 In patients presenting with acute myocardial infarction (heart attack), opening up the occluded coronary artery is the treatment of choice. But this procedure called as coronary angioplasty would cost some where around 1-2 lakh rupees.
 So many poor patients in India are not affording the optimal treatment.
 India desperately need a solution to this problem- either reducing the cost of the stent, or making policy for medicare compulsory for all? Still searching for a solution!!!
 Another unanswered question is the relative protection of young females from coronary artery disease. The reason lies in the difference in hormones between males and females or there is something else??
How common in coronary artery disease in India
 Prevalence of CAD in India- from 1.04 in Delhi in 1962 to 12.65 in Trivandrum in 1995. Recent trials show prevalence around 10%
 Low in rural areas from 1 to 7%




 Prevalence has increased
Two-fold in rural areas (2.06% in the 1970s to 4.14% in the 2000s)
Nine-fold in urban areas (1.04% in the early 1960s to 9.45% in the mid 2000s).
 Highest prevalence reported from metropolitan Delhi and Chennai. This clearly shows the importance of socioeconomic factors associated with CHD epidemic in India.
 The economic burden of CHD in India is about Rs. 200 billion. The total economy of India annually (GDP) is about Rs. 25000 billion. Thus the burden of CHD in India is about 0.8% of the GDP.
 Smoking or tobacco use, hypertension, diabetes and cholesterol levels are significantly greater in subjects with CHD.
 High LDL cholesterol (bad cholesterol) and triglycerides, and low HDL cholesterol (good cholesterol) are also important.




Well-known coronary risk factors—
 High cholesterol
 Smoking
 Hypertension
 Diabetes
 High waist –hip ratio
 Psychosocial factors
 Low fruit and vegetable consumption
 Lack of physical activity

 Inverse association between fruit and vegetable intake and CAD risk.
 Use of mustard oil, which is rich in linolenic acid, is associated with a lower risk than use of sunflower oil.
 High smoking and tobacco use was reported among men and women in northeastern and northern Indian states while a low prevalence was observed in Punjab and Maharashtra.
 The habit of smoking is more prevalent in rural subjects (30–60%) than in the urban population (10–30%).
 Although smoking is low among women, use of non-smoked tobacco is high.
 Hypertension directly or indirectly contributes to 57% of all stroke deaths and 24% of all coronary heart disease deaths in India.
 Hypertension is a controllable disease and a 2mmHg population-wide decrease in BP can prevent 151,000 stroke and 153,000 coronary heart disease deaths in India.
 But the problem is that only 1/3 of patients are diagnosed as hypertensive, out of this on1/3 is having adequate control of their blood pressure. Remaining are either unaware that their blood pressure is high or the pressure is poorly controlled.
 India leads the world with largest number of diabetic subjects earning the dubious distinction of being termed the “diabetes capital of the world”
 Cardiovascular disease is the prevailing noncommunicable cause of death and disability in India and will become the prevailing overall cause of mortality among the inhabitants of South Asia in the next 20 yr.
 The current epidemic and imminent growth are due to the huge burden of CVD risk factors, largely driven by urbanization.
 What to do? How to escape? Some useful tips!!!
 Do not smoke. Quit immediately if you are smoking. No tobacco in any form.
 Get your blood pressure regularly checked and take proper medications if it is high.
 Get your blood sugar and blood cholesterol level checked once in every 2-3 years. If the results are abnormal take proper medications.
 Adopt a healthy life style:
 Eat fruits/ vegetables. No non veg food
 Avoid fried food and processed foods
 Daily brisk walk for atleast 45 min
 Avoid stress (use yoga, meditation)
 Avoid late night parties, early to bed and early to rise.
May be in coming time we may be better able to define the cause of the disease and able to generate some rationale solution for our people.