Most human populations have changed lifestyles (collectively termed as epidemiological transition) due to developments in science and technology and have moved from agrarian diets and active lives to fast foods and sedentary habits. Combined with increasing tobacco use, these changes have fueled the epidemic of obesity, diabetes, hypertension, dyslipidemia and cardiovascular diseases (CVD). Cardiovascular diseases in India cause 3 million deaths per year, accounting for 25% of all mortality. The World Health Organization predicted that deaths due to circulatory system diseases were projected to double between 1985 and 2015. Moreover, research on Indian Asians living abroad indicates a 40% higher risk of ischemic heart disease (IHD) mortality than that for Europeans.
Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart’s muscle, valves or rhythm, also are considered forms of heart disease.
Types of CVD
Heart Attack – A heart attack occurs when the blood flow to a part of the heart is blocked by a blood clot. If this clot cuts off the blood flow completely, the part of the heart muscle supplied by that artery begins to die. Most people survive their first heart attack and return to their normal lives to enjoy many more years of productive activity.
Stroke – An ischemic stroke (the most common type) happens when a blood vessel that feeds the brain gets blocked, usually from a blood clot. When the blood supply to a part of the brain is shut off, brain cells will die. The result will be the inability to carry out some of the previous functions as before like walking or talking. A hemorrhagic stroke occurs when a blood vessel within the brain bursts. The most likely cause is uncontrolled hypertension. Some effects of stroke are permanent if too many brain cells die after a stroke due to lack of blood and oxygen to the brain. These cells are never replaced. The good news is that some brain cells don’t die — they’re only temporarily out of order. Injured cells can repair themselves. Over time, as the repair takes place, some body functioning improves. Also, other brain cells may take control of those areas that were injured. In this way, strength may improve, speech may get better and memory may improve.
Heart failure – Heart Failure doesn’t mean that the heart stops beating. Heart failure, sometimes called congestive heart failure, means the heart isn’t pumping blood as well as it should. The heart keeps working, but the body’s need for blood and oxygen isn’t being met. Heart failure can get worse if it’s not treated.
Arrhythmia – This is an abnormal rhythm of the heart. There are various types of arrhythmias. The heart can beat too slowly, too fast or irregularly. Bradycardia is when the heart rate is less than 60 beats per minute. Tachycardia is when the heart rate is more than 100 beats per minute. An arrhythmia can affect how well the heart works. The heart may not be able to pump enough blood to meet the body’s needs.
Heart valve problems – When heart valves don’t open enough to allow the blood to flow through as it should, it’s called stenosis. When the heart valves don’t close properly and allow blood to leak through, it’s called regurgitation. When the valve leaflets bulge or prolapse back into the upper chamber, it’s a condition called mitral valve prolapse. When this happens, they may not close properly. This allows blood to flow backward through them.
The extent of CVD in India
In developed nations the rise in the burden of CVD occurred over several decades due to a long period of epidemiological transition (lifestyle changes in populations brought about by development). In India, perhaps because of the rapid pace of economic development, epidemiological changes have spanned a much shorter time. As a consequence, cardiovascular disease (CVD) has emerged as the leading cause of death all over India, with coronary heart disease (CHD) affecting Indians at least 5-6 years earlier than their western counterparts. Current estimates from disparate cross-sectional studies indicate the prevalence of CHD to be between 7-13 % in urban and 2-7 % in rural India. The spiraling rates of modifiable risk factors for CHD across the spectrum of rural to urban segments of our population have been demonstrated by several studies across India. In addition, migration and urbanization have resulted in an increase in the prevalence of risk factors such as diabetes and obesity. Therefore, an effective CVD prevention strategies and health system strengthening to combat CVD is needed, which should include: (i) cost-effective, innovative ways of reducing CVD risk through health policy and health system interventions; (ii) methods for ensuring integration of CVD care within health systems; (iii) health system financing strategies for individuals with CVD; (iv) best methods of applying existing knowledge for development, implementation and evaluation of CVD prevention programmes; (v) mechanistic research to identify the reasons for the younger age of onset of CVD and diabetes and their occurrence at a lower threshold of risk factors; and (vi) methods to implement health promotion measures to the population at large along with formulation and implementation of ‘HEART-friendly’ policy measures.
There are several risk factors for heart diseases: age, gender, tobacco use, physical inactivity, excessive alcohol consumption, unhealthy diet, obesity, family history of cardiovascular disease, raised blood pressure (hypertension), raised blood sugar (diabetes mellitus), raised blood cholesterol (hyperlipidemia), psychosocial factors, poverty and low educational status, and air pollution. While the individual contribution of each risk factor varies between different communities or ethnic groups the overall contribution of these risk factors is very consistent. Some of these risk factors, such as age, gender or family history, are immutable; however, many important cardiovascular risk factors are modifiable by lifestyle change, social change, drug treatment and prevention of hypertension, hyperlipidemia, and diabetes.
The Indian Heart Watch (IHW) study assessed the prevalence of different “lifestyle” and biological CVD risk factors across the country – and results presented for the first time at the World Congress of Cardiology organized by the World Heart Federation, show that these risk factors are now at higher levels in India than in developed countries and regions such as the USA and Western Europe. Seventy-nine % of men and 83 % of women were found to be physically inactive, while 51 % of men and 48 % of women were found to have high fat diets. Some 60 % of men and 57 % of women were found to have a low intake of fruit and vegetables, while 12 % of men and 0.5 % of women smoke.
Moreover, the prevalence of biological and metabolic risk factors was also found to be high. Overweight and obesity was reported in 41 % of men and 45 % of women. High blood pressure was reported in 33 % of men and 30 % of women, while high cholesterol was found in one-quarter of all men and women. Diabetes (and or metabolic syndrome) was also reported in 34 % of men and 37 % of women.
The results of this study showed that even among literate middle-class urban Indians, there is a low awareness and control rates of these risk factors. Of the approximately one-third of study participants found to have hypertension, only about half (57 %) were aware of their high blood pressure, only 40 % were on treatment and only 25 % had adequate control. This is in contrast to more than 75 % awareness in most high and middle-income countries, where more than 50–60 % of people with high blood pressure are controlled. This overwhelming CVD incidence data should prompt the government to develop public health strategies that will change lifestyles, if these risk factors are to be controlled. Improving urban planning and overall living conditions are critical to the curb the CVD epidemic in India. Government efforts have to include improvements in basic amenities, healthcare facilities and, perhaps most importantly, education that will enable people to take responsibility for their own actions.
In addition, Asian Indians are more likely to have high levels of lipoprotein (a), a variant of low-density lipoprotein (LDL) cholesterol, also called bad cholesterol, and a risk factor. Indians are also genetically predisposed to develop Metabolic Syndrome, or Syndrome X, a metabolic condition associated with doubling the risk for cardiovascular diseases. Gene mutations are the leading reason for cardiomyopathy, a cardiovascular disease involving damage to the myocardium, the heart muscles, lessening the heart’s ability to pump blood. Cardiomyopathy can trigger sudden cardiac death.
Treatment/Prevention of CVD
Medical care is essential once heart disease is diagnosed, with the goals of stabilizing the condition immediately, controlling symptoms over the long term, and providing a cure when possible. Many forms of heart disease can be prevented or treated with healthy lifestyle choices. Prevention of atherosclerosis is achieved by decreasing risk factors through healthy eating, exercise, avoidance of tobacco smoke and limiting alcohol intake. Treating high blood pressure and diabetes is also beneficial.
Irrespective of genetics, lifestyle changes can prevent and stave off further brain and heart attacks and the ensuing damage. Smokers can cut their risk of having a heart incident to the level of non-smokers within 15 years of quitting. Making the right food choices helps to offset Syndrome X-even if it was inherited-and, conversely, Syndrome X can be acquired by a faulty diet. It helps to limit calorie intake from fats, to eliminate trans-fatty acids and to switch from saturated to unsaturated fats, say WHO guidelines. Limiting the consumption of free sugars and salt, eating whole grains, nuts and antioxidant-rich fresh fruits and vegetables daily is recommended. Regular aerobic exercise cuts the risk of heart disease by 30%, according to the World Heart Federation.
Currently practiced measures to prevent cardiovascular disease include:
- A low-fat, high-fiber diet including whole grains and fruit and vegetables
- Tobacco cessation and avoidance of second-hand smoke
- Limit alcohol consumption to the recommended daily limits
- Lower blood pressures, if elevated
- Decrease non-HDL cholesterol
- Decrease body fat if overweight or obese
- Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week)
- Reduce sugar consumptions
- Decrease psychosocial stress