Cardiovascular diseases (CVD) pose a significant threat in India, claiming a substantial number of lives and causing considerable disability. In 2019, non-communicable diseases (NCDs) accounted for 65% of all deaths in the country, with over 25% attributed to CVDs and related factors like diabetes. Recent data from the Global Burden of Diseases Collaboration, as published in the Journal of the American College of Cardiology, further highlights an alarming trend, age-standardized mortality rates from CVDs in South Asia, including India, have been rising, ranging from 248.6 to 350.9 per 100,000 individuals in 2021.
Ischemic heart disease, ischemic stroke, and intracerebral hemorrhage stand out as leading causes of death within this category. Compared globally, India sees 1.6 times higher age-standardized DALY rates for ischemic heart disease and 2.4 times higher rates for rheumatic heart disease. Notably, Indians experience CVD about a decade earlier than people of European descent. Nearly two-thirds (62%) of all CVD deaths among Indians occur prematurely.
Studies like INTERHEART and PURE underscore these disparities, revealing that Indians face higher rates of major cardiovascular events and mortality, despite having lower overall risk factor burdens compared to high-income countries (The Lancet). This burden is felt acutely among individuals aged 30–50, with states like Kerala, Punjab, and Tamil Nadu reporting the highest CVD rates within the country (NLM). Alarmingly, half of all heart attacks in Indian men occur before age 50, with a quarter striking before age 40 — an indication of the disease’s early onset and severe impact. This trend extends to Indian women, who also face disproportionately high mortality rates from cardiac diseases (Indian Heart Association).
Why is CVD in India a matter of concern?
India faces a critical challenge with cardiovascular diseases (CVDs). Despite having less than 20% of the world’s population, India accounts for around 60% of the global heart disease burden. Heart disease is the leading cause of death in the country, creating a silent epidemic for the people under the age of 50.
A 2023 study by the Indian Council of Medical Research (ICMR) revealed that 10.1 crore Indians have diabetes. India, the largest contributor to the non-communicable disease (NCD) burden in the region, also grapples with high rates of hypertension, obesity, and dyslipidemia. These conditions, along with smoking and metabolic syndrome, significantly increase the risk of CVD.
The rise in CVDs in India is not due to a single factor but a complex mix of determinants. Population-level changes in urban and rural areas such as shifts in diet, lifestyle, and environmental factors contribute to this increase. Additionally, inherent biological risks, influenced by early life conditions, also play a role.
Six major transitions underpin these changes
1. Epidemiological: Shifts in disease patterns.
2. Demographic: Changes in population structure.
3. Nutritional: Dietary habits evolution.
4. Environmental: Urbanization and pollution.
5. Social-cultural: Lifestyle and behavioral changes.
6. Economic: Growing middle class and associated lifestyle changes.
Urban vs Rural Risk Factors for Indians Aged 30–50
Urban residents, as highlighted in the Lancet Report, have higher BMI, waist circumference, and blood pressure compared to their rural counterparts. Their glycaemic and lipid profiles are also notably higher, which significantly increases their risk for cardiovascular diseases (CVD). Additionally, here are some other factors contributing to CVD risk :
1. Diet: Urban diets are often high in unhealthy fats, processed foods, and added sugars, while lacking in fiber and fresh produce. This dietary pattern contributes to weight gain, hypertension, and unfavorable cholesterol levels.
2. Less Physical Activity: City residents typically lead more sedentary lives due to desk-bound jobs and reliance on motorized transport. This lack of physical activity raises the risk of obesity and heart disease.
3. Stress: The fast-paced urban lifestyle can lead to chronic stress, which is associated with elevated blood pressure and other health complications.
The Indian migration study reveals that rural migrants to urban areas quickly adopt urban risk factor levels within a decade, compared to their siblings who remain in rural settings. However, rural areas also present significant challenges in terms of CVD risk factors, these includes:
1. Unbalanced Diet: Diets in rural areas often include high-fat and carbohydrate-rich foods, along with frequent consumption of fried foods. These dietary habits contribute to metabolic disorders and cardiovascular risk.
2. Demanding Physical Activity: While rural residents tend to engage in more physical labor, such activities may not suffice to counterbalance unhealthy dietary practices and prevent obesity and related cardiovascular issues.
3. Limited Access to Healthcare: Rural communities often face limited access to healthcare facilities and specialists, impacting timely diagnosis and treatment of cardiovascular conditions.
Furthermore, smoking, tobacco and alcohol use heighten CVD risk. Recent data from a February 2023 Parliamentary report revealed tobacco consumption at 32.8% and alcohol use at 15.9%. These figures underscore the significant impact of these habits on cardiovascular health among Indians aged 18–69.
Healthcare in Urban and Rural Areas
Healthcare facilities in India are undergoing continuous improvement, with the establishment of 707 District NCD Clinics, 193 Cardiac Care Units, and 5541 Community Health Center NCD Clinics under NPCDCS (Lok Sabha, February 2023). However, limited awareness among rural populations about CVD symptoms and limited health facilities and specialists, coupled with irregular health check-ups, contribute to persistent risks of chronic CVD. In urban areas, despite greater availability of healthcare services, the fast-paced lifestyle often hinders regular health monitoring and consultations.
Identifying urban and rural risk factors among individuals aged 30–50 is crucial in combating cardiovascular diseases effectively. Incorporating preventive measures such as adopting a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while minimizing saturated fats, trans fats, added sugars, and salt benefits both urban and rural communities. Including lentils, pulses, and seasonal vegetables in daily meals promotes heart health.
Engaging in regular, moderate exercise suitable for individual fitness levels supports maintaining a healthy weight. Managing stress through activities like yoga, meditation, or nature walks and quitting smoking, alcohol, and tobacco are also beneficial practices. Regular health check-ups to monitor blood pressure, cholesterol, and blood sugar levels are essential for early detection and management of cardiovascular conditions. Platforms like Heartnet India offer convenient online consultations with expert physicians, bridging healthcare accessibility gaps. Expert consultations through online platforms aids in early detection and treatments for cardiac care, potentially preventing the onset of CVD.
Sources : American College of Cardiology (Global Burden of Diseases Collaboration) World Heart Federation Indian Heart Association The Lancet Digital Sansad National Library of Medicine Press Information Bureau
