Fatal and Nonfatal Cardiovascular Disease and the Use of Therapies for Secondary Prevention in a Rural Region of India

Abstract

Background— The rate of cardiovascular disease is widely considered to be increasing throughout India. Precise and reliable data on fatal and nonfatal cardiovascular disease, however, are few, and little is known about the use of preventive therapies. This is particularly true for rural regions. Methods and Results— Data were collected from 53 villages in the Godavari region of Andhra Pradesh. Mortality data were obtained from a verbal autopsy-based mortality surveillance system during a 12-month period in 2003 to 2004. The prevalence of nonfatal cardiovascular disease and the use of preventive therapies were estimated from a stratified random sample of 4535 adults (≥30 years of age) in 2005. Cardiovascular disease was the leading cause of mortality, accounting for at least 32% of all deaths. The average age at cardiovascular death was 65 years, and 51% of all cardiovascular deaths occurred in patients <70 years of age. Among adults, the prevalence of coronary heart disease was estimated to be 4.8% (95% CI, 4.1 to 5.5), and the prevalence of cerebrovascular disease was estimated at 2.0% (95% CI, 1.5 to 2.4). Among individuals with either diagnosis, 14% (95% CI, 10 to 18) reported taking aspirin, 41% (95% CI, 36 to 47) took a blood pressure-lowering medication, and 5% (95% CI, 3 to 7) reported using a cholesterol-lowering medication. Conclusion— This region has a large disease burden attributable to cardiovascular disease with significant underuse of proven, low-cost preventive medications.

High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries

“…Previous multinational comparisons have relied on subnational surveys conducted around selected urban areas and may have overestimated true intervention coverage. [36][37][38][39] Our results are in line with prior estimates from country-level surveys in Mexico and Germany. 40,41 This analysis has several limitations.…”

The Rural Andhra Pradesh Cardiovascular Prevention Study (RAPCAPS)

“…Whether that one positive finding was a real effect or simply reflects chance is not clear. We also observed that for every component of the primary knowledge outcome, the ability of respondents to answer correctly was very high and much higher than we recorded in a similar survey conducted in the same area a few years earlier (10). It is possible that the knowledge levels increased in both intervention and control villages due to a study effect or that health promotion programs for diabetes and hypertension that were implemented in the area in the meantime had significant positive effects on the knowledge of the population.…”

Trends in Coronary Heart Disease Epidemiology in India

“…13,[24][25][26][27][28][29][30][31][32][33][34][35] Prevalence of CHD was lower in rural locations at 0.5%-2%. [36][37][38][39][40][41][42][43][44][45] National Family Health Surveys (NFHS) are nationwide surveys of multiple social and health factors. 53 The initial surveys, NFHS-1 and NFHS-2, focused on maternal and child health and the burden of communicable diseases.…”