The Tsunami of Heart Diseases in India

World Heart Day is celebrated on 29th September every year with an aim to create awareness about the rising concerns of heart health & cardiovascular diseases. This year’s theme focuses on using our hearts to make the right decisions to provide better care and assistance to the ones suffering from heart disease. Cardiovascular diseases (CVDs) have now become the leading cause of mortality in India. A quarter of all mortalities are attributable to CVD.

Some aspects of the CVD epidemic in India are due to particular causes of concern, including its accelerated buildup, the early age of disease onset in the population, and the high case fatality rate. This blog highlights the increase in the number of cases of cardiovascular diseases in India in the past years and also the common trends contributing to the rising numbers backed by THB’s RWE data.?

Background?

Cardiovascular diseases contribute hugely to the disease burden in India, with an estimated prevalence of 54.5 million in 2016. In fact, approximately one in every four Indians dies due to CVD, as reported by the Global Burden of Disease. Evidence from recently assimilated real-world evidence (RWE) data by THB from hospitals and clinics across India demonstrates an increasing trend of CVD prevalence over the past few years.

An evident fall in the number of cases in the year 2020 can be attributed to the COVID-19 pandemic, leading to a reduction in the number of patients seeking medical aid and postponing elective heart surgeries from the safety perspective of both clinicians and beneficiaries.?

Early Onset: An Additional Burden?

Compared with the European population, CVD affects Indians a decade earlier, affecting the most productive years of a person’s life. In India, 52% of CVD deaths occur before the age of 70 years while in the West, it is lower at 23%.

Recently captured RWE data support these findings, wherein the maximum reported cases of heart diseases were present in the age group of 40-60 years (49.43%). Following this age group by close quarters was the elderly category (60-80 years).

Common Trends in Patient Presentation?

As per the RWE data, in India, the most commonly presented complaints in CVD patients are depicted in the figure below:

Based on the RWE data, ‘Angina’ is the most reported heart-related condition, noted in about 19% of the total patients with heart diseases, most reported in the age group 60-80 years. Other reported conditions include ST-elevation myocardial infarction (STEMI), heart failure, non-ST-elevation myocardial infarction (NSTEMI), arrhythmias, and congenital heart diseases (CHDs).2?

What Can Be Done to Contain the Rising Numbers??

Given the high prevalence of CVDs in India, an all-inclusive approach is vital to prevent this condition.?

Lifestyle modifications:?

• Prevention should be prioritized, considering the modifiable personalized risk factors mentioned below at every possible stage of the disease:?

Stress is also considered to be an emerging and important risk factor for CVDs.5?

• Other factors like sleeping habits, daily nutritional consumption, and physical activity also have an exceeding degree of importance in preventing CVDs.

Pharmaceutical interventions:?

• Lipid-lowering therapy: The use of drugs like statins is recommended in high-risk patients to reduce raised cholesterol levels??
• Anti-hypertensive therapy: Since each 20 mmHg rise in systolic blood pressure or a 10 mmHg rise in diastolic blood pressure doubles the risk of a cardiovascular event, controlling the blood pressure is important?
• Antihyperglycemic therapy: In patients with diabetes, serum glucose reduction has been associated with a reduction in CVD, with the lowest risk at normal blood sugars??

Concluding Statement?

The key to reducing the burden of cardiovascular disease lies in bridging the gap in patient healthcare & monitoring relevant statistics to acknowledge the link between CVD risk factors and related morbidity and mortality. Prevention should be targeted along with innovative management strategies to achieve a double hit.4 Care programs can implement effective & cost-efficient methods at the primary care level. Patients with cardiovascular disease should have access to appropriate technology and medication. Achieving these targets will require significant investment in and strengthening of health systems to make every heart healthy, happy & strong.?

References:?

1. Prabhakaran D, Jeemon P, Sharma M, et al. The changing patterns of cardiovascular diseases and their risk factors in the states of India: The Global Burden of Disease Study 1990–2016. Lancet Glob Health. 2018;6(12): e1339-e1351.?
2. Real-World Evidence- THB Proprietary Dataset.?
3. Idhrees M, Padmanabhan C, Jagadeesan K, Velayudhan B. An Indian study: Impact of COVID-19 on clinical decision-making and consensus in cardiac surgery practice across the country Indian J Thorac Cardiovasc Surg.? 2020;36(5):451-463.?
4. Prabhakaran D, Jeemon P, Roy A. Cardiovascular Diseases in India. Circulation. 2016;133(16):1605-1620.?
5. Kivim?ki M, Steptoe A. Effects of stress on the development and progression of cardiovascular disease. Nat Rev Cardiol. 2017;15(4):215-229.?
6. Fawzy AM, Lip GYH. Cardiovascular disease prevention: Risk factor modification at the heart of the matter. Lancet Reg Health West Pac. 2021; 17:100291.?
7. Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc Dis. 2017; 6:2048004016687211.?