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Cardio Diabetes Medicine 2017 623

Lifestyle & Noncommunicable Diseases: My ‘Formula of 80’

To Live Up To 80 Years Without A Lifestyle Disease

Dr. KK. Aggarwal

Padma Shri Awardee
National President Indian Medical Association

Noncommunicable diseases (NCDs) are a major and diet, as responsible for more than 90% of the
cause of premature and preventable deaths globally. global risk for acute heart attack viz. abnormal lip-
The World Health Organization (WHO) has identified ids, smoking, hypertension (HT), diabetes, abdominal
four main types of NCDs - cardiovascular diseases, obesity, psychosocial factors, daily consumption of
cancer, chronic respiratory diseases and diabetes - in fruits and vegetables, alcohol and regular physical
its ‘Global Status Report on NCDs 2014’. 1 activity. All these nine modifiable risk factors were
found to be similar in all regions of the world, in men
NCDs account for almost 70% of global deaths, ac- and women, the young and the old, except for the
cording to a global survey on assessing national ca- earlier age of occurrence of acute myocardial infarc-
pacity for the prevention and control of NCDs car- tion (MI) in South Asians. This is because South
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ried out in 2015 by the WHO. NCDs are no longer Asians had more risk factors at ages younger than
considered diseases of the affluent as most of the 60 years.
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deaths due to NCDs occur in low- and middle-income
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countries. Deaths due to NCDs have been projected More recently, the WHO’s ‘Global Status Report on
to increase to 52 million by the year 2030 from 38 NCDs 2014’ also identified four behavioral risk fac-
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million in 2012. Cardiovascular diseases (CVDs) ac- tors (tobacco use, unhealthy diet, physical inactivity
count for most NCD deaths that occur every year (17.7 and harmful use of alcohol) and four major metabol-
million), followed by cancers (8.8 million), respiratory ic risk factors (obesity, raised blood pressure (BP),
diseases (3.9 million) and diabetes (1.6 million). 3 raised blood sugar and raised blood total cholesterol)
that are most commonly implicated in NCDs.
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NCDs affect people of all age groups, regions and
countries. Although regarded as diseases of older The major risk factors are briefly discussed below.
age, an estimated 15 million of all deaths between
30 and 69 years of age are caused by NCDs. All the Cholesterol
four major NCDs account for more than 80% of all In the INTERHEART study, the most important risk
premature deaths due to NCDs. factor for acute MI in South Asians was dyslipidemia.
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India too is not untouched by this. Due to rapid ur- 9
banization, India is experiencing an epidemiological The dyslipidemia in South Asians is an ‘atherogenic
transition moving away from a predominantly com- dyslipidemia’ characterized by high triglycerides, low
municable or infectious to a predominantly NCD pat- levels of high-density lipoprotein cholesterol (HDL-C)
tern. Modernization, sedentary lifestyles and longev- and increased levels of more atherogenic small,
ity are the other major contributory factors for the dense low-density lipoprotein (LDL) particles even
epidemic of NCDs. NCDs account for over 60% of with comparatively normal levels of LDL-C. Also, the
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all mortality in India and almost 55% of these are pre- HDL particles are smaller, dysfunctional and proath-
mature mortality. The major factors contributing to erogenic in South Asians. Atherogenic dyslipidemia
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NCDs include inappropriate life styles, tobacco use, is typically seen in the obese, patients with metabol-
obesity, inappropriate diet, physical inactivity, alcohol ic syndrome, insulin resistance and type 2 diabetes
consumption, high blood pressure, air pollution etc.
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mellitus (T2DM) and is an important risk factor for
The landmark INTERHEART study, conducted in 52 CVD in these patients. 10,11 The higher prevalence of
countries identified nine factors, all related to lifestyle atherogenic dyslipidemia in Asian Indians has been

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