Cardiovascular diseases in India - An Overview

    
     India is awakening to a heart-centred way of life. It seems promising. But the growing number of deaths due to cardiovascular diseases show that we still have a long way to go. In India, 140 in 1 lakh people die of heart attack. At least 10% of people above 30 years in urban areas and 5% in rural areas have blocked arteries, says the Indian Medical Association. Cardiovascular disease is the cause of death in 26.3% males and 22.5% females in the age group of 25-69yrs. There are families where no male member celebrated his 50th birthday. 
     Experts point out that many of these could have been preventable deaths. Indians have smaller calibrated arteries and we are 3 times more prone to heart attack than Europeans and Americans. Another reason for the rise in the number of cardiac patients in the country is that the concept of early detection doesn't exist here. 
     Earlier it was assumed that women are not vulnerable to heart attacks, but the incidence of heart diseases among women is on the rise now. Heart attacks in women can be more fatal than in men. 
     According to the World Health Report 2002, cardiovascular diseases (CVD) will be the largest cause of death and disability in India by 2020.
     Much of this enormous burden is already evident in urban as well as semi-urban and slum dwellings across India, where increasing lifespan and rapid acquisition of adverse lifestyles related to demographic transition are thought to have contributed to rising prevalence of chronic disease determinants like smoking, physical inactivity, improper diet, stress etc. and their ensuing outcomes such as obesity, hypertension, and type 2 diabetes. 
     This accelerated epidemiological transition has resulted in urban Indians experiencing heart attacks, strokes and type 2 diabetes at least a decade earlier than the western population, with nearly a fifth of hospital-based patients being less than 40 years of age. This has significant implications for the national productivity.

 RURAL SCENARIO

     There is also an increasing trend for reversal in the socio-economic gradient for CVD (as already manifest in developed nations), with the poor and disadvantaged having an equal,sometimes higher, burden of CVD and its risk factors. Added to this is the lack of awareness and understanding regarding CVD, resulting in a large proportion (one-third to a half or more) of those with risk factors like hypertension and diabetes remaining undetected and even a lesser fraction achieving adequate control.
     Similarly, compliance and adherence to therapies among those with established vascular disease is poor, exposing them to a very high risk of future vascular events including sudden death.
     While infectious and malnutrition-related illnesses continue to be a major problem, in many parts of India the additional burden of CVD will severely strain an overstretched, ill-prepared and resource constrained health infrastructure. In this scenario, control of CVD will require a comprehensive prevention programme comprising policies and measures for promoting awareness and healthy lifestyles in the general population as well as strategies for cost-effective identification and treatment of high-risk individuals. 
     Integrated prevention programmes incorporating health promotion, surveillance and risk reduction instruments prevent premature death and avert diversion of resources to expensive and technology-intensive treatment for established vascular disease, and have been successful in developed as well as developing country settings (e.g. Finland and Mauritius). Whether such programs are successful depends on many factors, but mainly on the background burden of CVD and its risk factors.
     To contain the increasing burden of Non-Communicable Diseases, Ministry of Health and Family welfare, Government of India, has launched the National Programme on Prevention and Control of Diabetes, Cardiovascular diseases and Stroke (NPDCS). 
     Below are two references which shows the role of cardiovascular diseases and how serious it is really becoming, concerning the overall health and productivity of our country. It self-explains the seriousness of the issue:

Top 10 causes of mortality

Mortality from major communicable and non-communicable diseases, 2030

   
     In the coming articles I will be briefly outlining a list of  10 commandments for cardiac health given by 10 cardiac specialists from across the country, which was originally publised in The Week, Health Supplement, dated June 16 2013. 

REFERENCES

1. Health, The Week, June 16, 2013
2. INDIA CARDIOVASCULAR DISEASES AND ITS RISK PROFILE
   (Prevalence, Current Capacity and Epidemiological Leads in CVD Programmes)
3. Cardiovascular diseases in India - Challenges and way ahead, Deloitte & Assocham, International Heart Protection Summit, September 2011