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Cardio Diabetes Medicine 2017 63

CVD in India

Dr. Ramasami Nandakumar

Singapore.

INTRODUCTION : Partially hydrogenated vegetable oils with high trans
fat content contribute to a significant proportion of
Cardiovascular diseases (CVDs) have now become total fat intake in Indians.
the leading cause of mortality in India. A quarter of
all mortality is attributable to CVD. Ischemic heart Also in India, the average blood pressure has in-
disease and stroke are the predominant causes creased in the past 2 decades, whereas in most
and are responsible for >80% of CVD deaths. CVD Western nations it has declined.
has emerged as the leading cause of death in all In the urban areas of India, the prevalence of diabe-
parts of India, including poorer states and rural ar- tes mellitus has almost doubled in the past 20 years,
eas. The Global Burden of Disease study estimate of from 9% to 17%, and in rural areas it has nearly qua-
age-standardized CVD death rate of 272per 100 000 drupled, from 2% to 9%.47. In 2013, the International
population in India is higher than the global average Diabetes Federation estimated that 65.1 million peo-
of 235 per 100 000 population.
ple in India had diabetes mellitus, a high proportion
Currently, in India, life expectancy has increased of whom were adults of working age. Diabetes melli-
from 58.3 to 65.2 years, resulting in the ageing of tus continues to have a positive social gradient (with
the population during the same period. Consequent- a higher burden among the rich and well educated).
ly, the NCD burden has increased rapidly in India. In
comparison with the people of European ancestry, Differences in CVD between Asians and
CVD affects Indians at least a decade earlier and in European populations:
their most productive midlife years. (23 vs 52%).
Studies among Indian migrants in various parts of
The progression of the epidemic is characterized by the world have documented an increased suscep-
the reversal of socioeconomic tibility to CHD in comparison to the native popula-
tion studied. In Britain, comparisons of age adjusted
gradients; tobacco use and low fruit and vegetable
intake have become more prevalent among those mortality statistics have shown a 40–60 per cent ex-
from lower socioeconomic backgrounds. In addition, cess in South Asian migrants (comprising Indian) in
individuals from lower socioeconomic backgrounds comparison to the population of England and Wales.
frequently do not receive optimal therapy, leading to Danaraj et al, in their seminal article in 1959, report-
poorer outcome. ed higher age-standardized mortality among Indians
living in Singapore (even among individuals between
30 and 49 years of age) in comparison with other
Multiple factors contribute to the rise of the populations.
CVD epidemic in India.
In the United Kingdom, the prevalence of diabetes in
Tobacco use is increasing rapidly among young indi- South Asians approaches 15% to 20% and suggests
viduals (20–35 years) in India with a steeper rate of an interaction between genetic predisposition and
increase among those with lower education
environmental influences, the so-called “thrifty gene”
The rate of consumption of fruit and vegetables is hypothesis. In a contemporary, community-based
low in India. study of Asian Indian immigrants in the Atlanta, Ga,

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