Coronary artery disease has assumed epidemic proportions in India. Over 80% of deaths and 85% of disability from cardiovascular disease (CVD) occur in low- and middle-income countries. The Indian subcontinent is home to 20% of the world’s population and may be one of the regions with the highest burden of CVD in the world.
The absence of reliable mortality data for the Indian subcontinent has necessitated basing estimates of the CVD burden on the cross-sectional studies that have been previously described. In 2003, the prevalence of CHD in India was estimated to be 3-4% in rural areas and 8-10% in urban areas with a total of 29.8 million affected according to population-based cross-sectional surveys. The estimate is comparable to the figure of 31.8 million affected, derived from extrapolations of the Global Burden of Diseases study. However, these are still likely underestimates as they do not account for those with silent myocardial infarction or otherwise asymptomatic CHD. In 1990 there were an estimated 1.17 million deaths from CHD in India, and the number is expected to almost double to 2.03 million by 2010. In addition to the high rate of CHD mortality in the Indian subcontinent, CHD manifests almost 10 years earlier on average in this region compared with the rest of the world resulting in a substantial number of CHD deaths occurring in the working age group.
In Western countries where CVD is considered a disease of the aged 23% of CVD deaths occur below the age of 70 This compares with 52% of CVD deaths occurring among people under 70 years of age in India. As a result, the Indian subcontinent suffers from a tremendous loss of productive working years due to CVD deaths An estimated 9.2 million productive years of life were lost in India in 2000, with an expected increase to 17.9 million years in 2030. The health and economic implications of this staggering rise in early CVD deaths in South Asian countries are profound and warrant prompt attention from governing bodies and the policy makers of these countries. The huge burden of CVD in the Indian subcontinent is the consequence of the large population and the high prevalence of CVD risk factors.
Urbanization is characterized by a marked increase in the intake of energy-dense foods, a decrease in physical activity, and a heightened level of psychosocial stress, all of which promote the development of dysglycemia, hypertension, and dyslipidemia.
The Indian subcontinent has a higher prevalence of diabetes mellitus than any other region in the world, and 2-3 times the reported prevalence in Western countries. In India alone, an estimated 19.3 million people had diabetes in 1995, and this is expected to almost triple to 57.2 million in 2025. The Indian Council of Medical Research estimates that the prevalence of diabetes is 3.8% in rural areas, compared with 11.8% in urban areas.
Hypertension is even more prevalent (20-40% among urban and 12-17% among rural adults, affecting an estimated 118 million inhabitant in India in 2000.)
In 2002, a national survey of tobacco use reported that the Indian subcontinent, is second only to China in both the production and consumption of tobacco products, There is an alarming 56% rate of tobacco use amond Indian men age 12-60 years. A new wave of smoking among India’s youth forebodes serious future public health consequences for the Indian subcontinent.
The Indian Council of Medical Research (ICMR) surveillance project reported a prevalence of dyslipidemia (defined as a ratio of total to HDL cholesterol > 45) of 37.5% among adults aged 15-64 years, with an even higher prevalence of dyslipidemia (62%) among young male industrial workers. |
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