The high prevalence rate of hypertension, mostly among young and middle aged adult men and women has convinced the majority into adopting a normalized attitude towards disease progression. However, lifestyle and nutrition transition, linked to prosperity has unbelievably set India into the forefront of mind-boggling cardiac disease trends. Interventions at the national and individual levels are obligatory to curb cascading consequences of cardiac disease and complications arising from co-morbid conditions.
Disturbing Cardiac Disease Trends for India
According to global market research data published by Research and Markets, trends in cardiovascular surgery in Brazil, Russia, India, China, South Africa (BRICS) up to 2017 indicated incredible market growth opportunities for cardiac medical equipment suppliers and manufacturers. Their findings were based on trends in population growth, heart disease prevalence and inequities in access to cardiovascular medical care. India topped the list just after China, reinstating persistent loopholes in healthcare delivery on the cardiovascular front.
Epidemiological studies carried out by the University of California in San Francisco suggested that urban middle class was more prone to rising levels of CAD prevalence in a developing country like India. Secular trends in their twenty year long study showed a rise in BMI, decrease in smoking and systolic BP and no significant change in central adiposity, hypercholesterolemia, and diabetes. It was interesting to note that literacy levels were inversely proportional to trends in “systolic BP, glucose, HDL cholesterol and BMI”
The WHO Global Status report on non communicable diseases in 2010[] focusing on the combined burden of cardiovascular disease, cancer, diabetes and lung disease, stated that nearly 80% of deaths due to cardiovascular disease occurred in low and middle income countries. According to report findings, CVD accounted for 17 million (48%) deaths from NCDs in 2008.
Cardiovascular disease has been rampant as the leading killer in India, accounting for the largest number of deaths, nearly 29% back in 2005[]. Disease data has presented cumulative statistical trends consistently, year after year.
When experts in New Delhi analyzed disease burden in September last year on the occasion of World Heart Day, estimates revealed an overall increase of 34.5 million in heart disease population from 2000 to 2015. The year 2020 is expected to put India into the forefront of global heart disease. Around 19% deaths are expected from the killer illness and its comorbidities alone.
Causes of Disease Progression
Genetic predisposition and biological makeup account for causes related to triggers for CAD development. However, high blood pressure is often the precursor to a stroke, coronary artery disease or chronic heart disease among young and middle aged men and women. High blood pressure could result from certain medications including birth control pills, diet pills or certain amphetamines and antihistamines.
Disease burden created by stress, high carbohydrate diet resulting in overweight and obesity, smoking and alcohol not only raises morbidity and mortality ratios, but also threatens the existence of a healthy economy given the rising costs of healthcare involved.
Myocardial Infarction, directly associated with heart disease accounts for significant mortality rates among young men and women. Egred, Viswanathan and Davis[] have identified up to four causal agents for myocardial infarction in men and women under the age of forty five. Their review, motivated by the costs, psychological impact and significant morbidity related to the condition, suggests the application of secondary preventive measures to curtail mortality in the long run.
Low density lipoprotein cholesterol which is known to cause plaque formation in arterial blood vessels is a major contributing factor for hypertension. The prevalence of dyslipidaemia among males between 31 and 40 years was identified early. One such study was carried out in 2006 in Mumbai[]. Close to 9000 members participated in the Health check-up program at P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India. Researchers advocated increased physical activity and adoption of healthy diet besides clinical interventions for proper management of dyslipidaemia.
Clinical Insights for Disease Management
Researchers at the Fortis-Escorts Hospital in Jaipur emphasize on the use of lifestyle and dietary interventions to reduce the risk of cardiovascular failure, besides just drug related therapy. Gupta and Gupta in their paper on Strategies for initial management of hypertension[] recommend the use of dihydropyridine calcium channel blockers (CCB), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARB) as opposed to beta-blockers or diuretics, based on international guidelines.
Anwer et al, at the Meerut Institute of Engineering and Technology, New Delhi identified that CAD in the diabetes backdrop had significant implications for drug prescription and use. In their research on “Hypertension management in diabetic patients”[], the need for a “lower goal blood pressure” and “multiple antihypertensive drugs” was identified for increased efficacy in controlling the double dimensional spectrum of diabetes and hypertension.
It is interesting to note that people between the ages 35-65 years form the at risk population. Sharma and Ganguly from the Indian Council of Medical Research, New Delhi have explored the causes of premature coronary artery disease[] among Indians. Researchers suggest focus on risk factors and relevant clinical guidelines, checking unhealthy nutrition and improving access to healthcare, especially among women, who seem to have been pushed into the neglected segment.
CAD and Indian women have been the focus of a number of studies earlier as well. The AIIMS study by Dave et al[] for example suggested that diabetes, menopause and cholesterol were risk factors among women presenting a number of clinical forms of CAD.
According to Chow and Patel[], outcomes in cardiovascular health of women are notably inferior to those in men, especially within the strata of lower socioeconomic status and education level. The diversity in Indian population could be a significant factor contributing towards information deficit in prevention and care mechanisms of cardiovascular disease in India.
Finally, Setia et al[] by shifting focus on families rather than individuals, have acknowledged the importance of diagnosing Familial Hypercholesterolemia, and its early identification. Whole family focus could result in better health outcomes, specifically life expectancy. Researchers suggest the use of DNA testing and cholesterol assay to achieve required results.
However, besides a role played by the genetic component involved in disease condition transition and development, heart disease is manageable in terms of preventing it and alleviating the overall impact on life quality.
The Road Ahead
The World Health Organization country office for India in its 2011 summit on non-communicable diseases organized in New Delhi, identified cardiovascular disease as a dominant cause of mortality in rural as well as urban areas. Indian Health Minister, Shri Ghulam Nabi Azad, along with WHO representative Nata Menabde and potential stakeholders in Indian Healthcare rolled out an outline for “universal coverage, prevention and control of NCDs” to be rolled out during the 12th plan period, covering 640 districts. Concentration on Indian health policy framework in favor of better prevention and management of non-communicable diseases, alongside cross-sectorial support were significant in realizing their overall aims.
National and global research continually reiterates the importance of lifestyle and dietary interventions in controlling heart related chronic diseases. Given these research insights, it is high time for the large proportion of CAD diagnosed individuals to adopt healthy choices for catalyzing accomplishment of national initiatives and global collaboration attempts. This is true especially considering the fact that based on current trends in CVD progression, nearly seven out of ten CVD deaths are forecasted by the year 2020[].
[] M Egred, G Viswanathan, G K Davis. “Myocardial infarction in young adults”. Postgrad Med J 2005;81:741–745. doi: 10.1136/pgmj.2004.027532
[] Sawant AM, Shetty D, Mankeshwar R, Ashavaid TF. “Prevalence of dyslipidemia in young adult Indian population.” The Journal of the Association of Physicians of India.. 2008 Feb;56:99-102.
[] Rajeev Gupta and Soneil Guptha. “Strategies for initial management of hypertension”. The Indian Journal of Medical Research. 2010 November; 132(5): 531–542.
[] Anwer Z, Sharma RK, Garg VK, Kumar N, Kumari A. “Hypertension management in diabetic patients”. European review for medical and pharmacological sciences.. 2011 Nov;15(11):1256-63.
[] Meenakshi Sharma, Nirmal Kumar Ganguly. “Premature Coronary Artery Disease in Indians and its Associated Risk Factors” Vascular Health Risk Management. 2005 September; 1(3): 217–225.
[] Dave TH, Wasir HS, Prabhakaran D, Dev V, Das G, Rajani M, Venugopal P, Tandon R. “Profile of coronary artery disease in Indian women: correlation of clinical, non invasive and coronary angiographic findings”. Indian Heart Journal. 1991 Jan-Feb;43(1):25-9.
[] Chow CK, Patel AA. Cardiovascular healthcare for women in India. Heart. 2012 Jan 3.
[] N. Setia, I. C. Verma, B. Khan, and A. Arora. “Premature Coronary Artery Disease and Familial Hypercholesterolemia: Need for Early Diagnosis and Cascade Screening in the Indian Population”. Cardiology Research and Practice Volume 2012 (2012), Article ID 658526, 4 pages doi:10.1155/2012/658526
[] Khor GL. “Cardiovascular epidemiology in Asia-Pacific region”. Asia Pacific Journal of Clinical Nutrition 2001;10:76–80.
About the Author
Safia Fatima Mohiuddin is a Technical Writer in the Healthcare, Bioinformatics and Information Technology domains. Chronic Disease, specifically non communicable diseases accounting for epidemic proportions on a global scale is one of her primary interests. Safia blends scientific and health data to derive potential insights targeted at population health.
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