The age of man-made diseases
The Rising Epidemic of Heart Diseases: A Perspective
In the year 2012, more than 75% of 17.5 million deaths globally due to heart diseases (cardiovascular diseases, CVD) occurred in developing countries.
This increase is driven by industrialization, urbanization, and related lifestyle changes and is called “epidemiological transition”.
This transition affected the developed world, including countries of Europe and North America, in the early 20th century and spread to developing countries 50 years later.
Epidemiological transition is divided into 4 stages:
- age of famines, when deaths are primarily due to communicable/ infectious diseases (deaths or mortality from CVD <10%);
- age of reducing communicable diseases, when deaths due to famines reduce rapidly (CVD mortality: 10%-35%);
- age of man-made diseases, when deaths due to diseases caused by poor lifestyle increase rapidly (CVD mortality: 35%-65%);
- age of delayed degenerative diseases, when man somehow manages to outlive himself with all the medical advances while suffering from degenerative diseases such as cancer (CVD mortality >40%)
In terms of our Epidemiological transition, we are currently somewhere between Stage 3 & Stage 4, where a huge percentage of us suffer with one or more of man-made diseases such as hypertension, diabetes and lipid abnormalities, even while we look forward to elongate the unhealthy lifestyle by few more years. And the result is this: an ever deteriorating quality of life with a massive global burden of diseases.
The CVD Burden of India
According to the World Health Organization (WHO), the South Asian region has one of the highest cardiovascular mortality rates in the world, of which Bangladesh is the lowest (179/100,000 in men and 153/100,000 among women) and India / Pakistan are the highest (349/100,000 among men in India and 294/100,000 in women in Pakistan — as compared to Indian women CVD mortality rate of 265/100,000). These rates are >2–3 times greater than in the United States, where rates are 170/100,000 in men and 108/100,000 in women.
In comparison with the people of European ancestry, CVD affects Indians at least a decade earlier and in their most productive midlife years. For example, in Western populations only 23% of CVD deaths occur before the age of 70 years; in India, this number is 52%. WHO has estimated that, with the current burden of CVD, India lost $237 billion from the loss of productivity and spending on health care over a 10-year period (2005–2015). An estimated 9.2 million productive years of life were lost in India in 2000 alone, with an expected increase to 17.9 million years in 2030 (almost ten times the projected loss of productive life in the United States).
Of the 10.5 million deaths annual deaths in India in the period 2010–2013, the overall CVD related mortality of 23% varies from <10% in rural locations in less developed states to >35% in more developed urban locations.
Additionally, geographic distribution of CVD mortality in India indicates that in less developed regions, such as the eastern and northeastern states with low Human Development indices, there is lower proportionate mortality compared with better developed states in southern and western regions (Fig. 1).
There is a linear relationship of increasing proportionate CVD mortality with regional Human Development Index, which confirms the presence of the epidemiological transition introduced earlier.
Risk Factors
Case-control studies have reported that important risk factors for coronary heart disease (CHD) in India are smoking, diabetes, hypertension, abdominal obesity (waist-to-hip ratio), dyslipidemias (abnormal amount of lipids e.g., triglycerides, cholesterol in the blood), psychosocial stress, low fruits and vegetables intake along with high saturated fats and carbs, and physical inactivity.
Factors such as tobacco use and hypertension in urban settings are consistently associated with lower levels of education and income. Another study of age-specific trends in cardiovascular risk factors among the adolescent and young reveals that cardiovascular risk factors increase exponentially with age once Indians reach the 30- to 39-year age group.
An important change in risk factor dynamics in India is a more rapid increase in CVD risk factors in rural and slum populations compared with urban populations. Smoking and non-smoked tobacco continues to increase in rural and less literate populations, while it is beginning to decline in more educated urban populations. The epidemic of sedentariness has penetrated rural households with rapidly increasing use of labor-saving technologies. Dietary habits have undergone a huge change with greater consumption of fats, saturated fats, trans fats, and processed foods. Calorie-dense fast foods (comfort foods) are easily available and both Indian-style and Western-style fast foods are being consumed widely.
There is an urban-rural convergence in hypertension prevalence in India. Review of hypertension epidemiology studies over the last 20 years (1995–2015) indicates that while its prevalence continues to remain as high as 28%-32% in urban populations, in rural populations it has increased from 10%-12% in 1990s to 22%-25% presently. These are surrogates for increasing abdominal obesity and other cardio-metabolic risk factors among the rural populations in India. This portends a further escalation of CHD epidemic in India.
The Need of the Hour
With the turn of the century, cardiovascular diseases (CVDs) have become the leading cause of mortality in India. Research has indicated that return on investment of interventions to promote healthy living and to prevent and manage CHD in India is cost effective when individuals decide to take a timely action.
Healthy eating with consumption of fresh fruits and vegetables, daily exercise, smoking/tobacco cessation coupled with stress-free environment and regular check-ups for early detection and prevention can ward off heart disease risks.
To address patients’ cardiac rehabilitation in long term, which is almost nonexistent in India currently, a systematic health program advising on low cost methods and traditional approaches like yoga and meditation (a disciplined method of controlling body and mind) can be effective.
Lifestyle changes like these need individual-focused structured programs that promote extensive communication driving awareness, behavioral changes, discipline and results in the long term. The Indian subcontinent is home to a heterogeneous population for which a “one size fits all” policy approach to addressing the CVD burden is likely to be insufficient. Different manifestations of CVD can be observed not only between urban and rural populations, but also in between poor and wealthy households that live side by side in the same neighborhood, making run-off-the-mill health management programs a challenge to implement effectively.
Innovative methods need to be developed and tested in Indian settings to overcome these challenges. Several such initiatives are currently being tested in India; one example is the evaluation of an intervention strategy using innovative mobile health software applications. This mobile based platform can collect a patient’s health profile, provide decision support for clinical care, and act as a monitoring and feedback tool for use in primary care settings. It has the potential to improve the efficiency of the health system in managing CVD on scalable levels.
The Conclusion
The only thing worse than finding out that one may have heart disease is… NOT finding about it at all! By not taking our lifestyle seriously, we may not just end up abusing our chances to a healthy and happy life but also that of whole set of generations that lie ahead of us. We can share with our children only what we have ourselves, and good health is definitely one of them. It is now upto us to rise as responsible citizens of India, equip ourselves adequately and take adequate action to win over this battle of the heart before it’s too late.
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References:
The heard disease led mortality in India has been shown using data from the Registrar General of India (RGI), the World Health Organization (WHO) report on non-communicable diseases (NCDs), and the Global Burden of Diseases, Injuries, and Risk Factors (GBD) study reports.
