World Heart Day: May the force be with your HEART

Abstract

Cardiovascular diseases (CVDs) remain the single leading cause of deaths worldwide, and India is no exception. It was projected that 17.5 million people died from CVDs in 2012, which is one-third of all global deaths, and of these deaths, 7.4 million were due to coronary heart disease alone.1 Over 3 million of these deaths were premature, i.e., before the age of 60 and, ironically, could have largely been prevented. Further, over 75% of CVD deaths take place in developing countries. Out of the 16 million deaths due to noncommunicable diseases (NCDs) in people less than the age of 70 years, 82% occur in developing countries and 37% are caused by CVDs. 2In India, the Registrar General's Report states that CVDs are the foremost cause of mortality, with almost every fourth death in the country being attributable to CVD.3 In fact, the Global Burden of Disease (GBD) Study found that the agestandardized CVD death rate in India of 272 per 100,000 population is significantly higher than the global average of 235 per 100,000 population. 4 A particularly alarming feature of the Indian scenario is the relatively early age of onset and the high case fatality rate. It is estimated that by the year 2020, nearly 3 million Indians will die due to coronary heart disease, and a high number of these deaths are expected to occur in the age group of 30-69 years. 5 Currently, CVD deaths in Indians are seen at least a decade earlier than those in developed countries. The GBD Study also observed that over 50% of deaths due to CVDs in India are seen below the age of 70 years, as compared to 23% in developed countries, directly affecting the most productive age groups, with profound adverse impact on the country's economy. 5 Risk factors alleviation or tertiary careThe leading cause for the increasing burden of CVDs is the rising prevalence of risk factors for CVD, such as hypertension, diabetes, overweight or obesity, physical inactivity, and tobacco use. Major health gains can be made in this hitherto fore ignored area through basic public health strategies focusing on lifestyles, diet, and the environment. Despite adequate knowledge on the risk factors for CVDs, which have been demonstrated in case-control INTER-HEART and INTER-STROKE studies, there have been hardly any prospective studies that have analyzed the association of risk factors with CVD incidence in India. 6Public health services in developing countries are already overstretched due to the double burden of communicable and NCDs. Already scarce and overburdened state resources need to be often diverted to cope with the increasing demands of heart disease, diabetes, and other NCDs. At the same time, healthcare systems in these countries are hampered by a model based on high-technology hospitals that provide expensive tertiary care to a limited population who can afford it, while consuming large amounts of resources. It is estimated that some countries may spend more than 50% of their health budgets on tertiary care services, thus rendering a significant proportion of people w...