Coronary heart disease and risk factors in India – On the brink of an epidemic?

Abstract

Coronary heart disease (CHD) is a major cause of mortality and morbidity all over the world. According to a report of World Health Organization (WHO) in 2005, cardiovascular disease (CVD) caused 17.5 million (30%) of the 58 million deaths that occurred worldwide. 1 While the prevalence and mortality due to CHD is declining in the developed nations 2 the same cannot be held true for developing countries. There has been an alarming increase over the past two decades in the prevalence of CHD and cardiovascular mortality in India and other south Asian countries. India is going through an epidemiologic transition whereby the burden of communicable diseases have declined slowly, but that of non-communicable diseases (NCD) has risen rapidly, thus leading to a dual burden. There has been a 4-fold rise of CHD prevalence in India during the past 40 years. Current estimates from epidemiologic studies from various parts of the country indicate a prevalence of CHD to be between 7% and 13% in urban 3e5 and 2% and 7% in rural 6,7 populations. Epidemiologic studies have shown that there are at present over 30 million cases of CHD in this country. A study by Gajalakshmi et al during 1995e1997 showed that CVD deaths are the highest (38.6%) in urban Chennai. 8 Similar data are published by Joshi et al from Andhra Pradesh. 9 The Global Burden of Diseases Study reported that the disabilityadjusted life years lost by CHD in India during 1990 was 5.6 million in men and 4.5 million in women; the projected figures for 2020 were 14.4 million and 7.7 million in men and women respectively. 10 The burgeoning burden of CHD in India can be explained by the alarming rise in the prevalence of coronary risk factors like diabetes, hypertension, atherogenic dyslipidemia, smoking, central obesity and physical inactivity. Rapid urbanization and change in lifestyle that occurred during the past two decades have led to the growing burden of coronary risk factors in India. Previous studies conducted in migrant Indians were misinterpreted to indicate that conventional risk factors do not account for the high prevalence and premature occurrence of CHD among Indians 11 ; they were thought to be genetically preordained to develop the disease. However, the large INTERHEART study which recruited significant number of Indian subjects found that the conventional risk factors accounted for most of the CHD burden. 12 The INTERHEART study was a large cross-sectional study of around 30,000 participants from 52 countries representing every inhabited continent. The specific aim was to assess the strength of association between various risk factors to myocardial infarction and to ascertain if this varies with geographic regions, age, sex or ethnicity. The secondary objective was to estimate the Population Attributable Risk (PAR) for risk factors and their combinations in the overall population and in various subgroups. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apoli...

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