World Heart Day 2020: Why India faces higher mortality from cardiovascular diseases?

Cardiovascular diseases (CVDs) are a group of conditions that affect the heart or blood vessels. These disorders are usually associated with a build-up of fatty deposits inside the arteries (atherosclerosis) and an increased risk of blood clots. Abnormal heart rhythms, or arrhythmias, Coronary artery disease (narrowing of the arteries), heart attack, heart failure, stroke, deep vein thrombosis and pulmonary embolism, vascular disease (blood vessel disease), are some of the types of cardiovascular diseases.

Together, cardiovascular diseases are the leading cause of death globally, taking an estimated 17.9 million lives each year. The highest prevalence and mortality rates of cardiovascular disease are seen in low- and middle-income countries, including India. The World Heart Foundation organizes World Heart Day on September 29 every year to increase public awareness about these diseases. So, let’s look at the common risk factors of cardiovascular diseases in India.

What causes high CVD deaths in poorer countries?

A study presented at ESC Congress 2019 in Paris, France, also concluded that cardiovascular disease is more common in poorer countries. According to the Prospective Urban Rural Epidemiology (PURE) Study data, the overall mortality rates decrease with increasing income, with 23% CVD deaths in high-income countries (HIC), 42% in middle-income countries (MIC) and 43% in low-income countries (LIC).

However, death from cancer was highest in high-income countries. Cancer mortality rates were found to be 15%, 30% and 55% for LIC, MIC and HIC, respectively. The researchers came to the conclusion after tracking over 1,62,000 individuals, aged 35-70 years, living in 21 countries across five continents, over about 9.5 years.

Hypertension, high cholesterol, and household air pollution were identified to be the most important risk factors of cardiovascular disease. These were followed by tobacco, poor diet, low education and abdominal obesity. But low education was the most important risk factor for high mortality in poorer countries, followed by tobacco, low grip strength and poor diet, which all contribute to a similar extent.

The high mortality in poorer countries is also likely due to lower quality and less health care, noted Salim Yusuf, principal investigator of the study and executive director of Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences, Canada.

Things India can do to reduce death due to cardiovascular diseases

Yusuf suggested that low-income countries should focus on reducing smoking, controlling hypertension and appropriate investments in healthcare for the prevention of CVD.

Having proper healthcare systems, availability of low-cost drugs, smoking cessation and control of BP and lipids may greatly help in CVD prevention. Moreover, the researchers emphasized training non-physician healthcare workers to focus on prevention, as they likely are more effective at helping control risk factors than physicians.

Mohan, one of the co-authors of the study, and president of Madras Diabetes Research Foundation, Chennai noted that lack of access to quality health care and insurance also plays a role in increasing CVD mortality rates in low-income countries. Better insurance and hospital standards may help low-income countries to head towards similar outcomes, as high-income countries, he said.

The HIC in the study were Canada, Saudi Arabia, Sweden and United Arab Emirates. The middle-income countries (MIC) were Argentina, Brazil, Chile, China, Columbia, Iran, Malaysia, Palestine, Philippines, Poland, Turkey and South Africa. The LIC were Bangladesh, India, Pakistan, Tanzania and Zimbabwe.