Miscellania

MISCELLANIA

HEART DISEASE IN INDIANS.

IS THE RISK OF HEART DISEASES HIGH AMONG INDIANS?

Yes and no. Studies among emigrant Indians (South Asians) have shown that persons who migrate to foreign countries, specifically, Trinidad, Singapore and Britain have higher mortality from coronary heart disease as compared to native populations. In Britain it has been reported that South Asian men have 1.2 to 1.3 times higher risk of dying from coronary heart disease as compared to British Caucasians. South Asian women have 1.5 to 1.6 times increased risk than their white counterparts. Similar observations have been made in Singapore where Indians show an increased of dying from coronary heart disease as compared to native Malays and the Chinese (McKeigue et al. Journal of Clinical Epidemiology, 1989).

However there are caveats. It is not clearly understood whether this increased mortality is due to high prevalence of coronary risk factors, higher incidence of coronary heart disease or higher incidence of acute myocardial infarction. Studies in Britain have shown that South Asians neglect their disease, ignore the symptoms, present late to the hospital after onset of acute myocardial infarction and hence the mortality is greater (Leicester). Studies have also shown that among South Asians the highest risks are present in Bangladeshis, followed by Pakistanis and the least risk is among Indians. This study showed that risk factors among Indians were not significantly different from British Whites (Bhopal et al, British Medical Journal, 1999).

In India, however we do not have sufficient mortality data, therefore the mortality statistics are not comparable (Reddy et al. Circulation 1998). Prevalence studies in India have shown a consistent increase in coronary heart disease prevalence from 1960's. Studies show that coronary heart disease prevalence in adult Indian urban populations increased from 3.5% in 1960's to 9.5% in 1990's. In rural areas it increased from 2% in 1970's to 4% at present (Gupta et al. Indian Heart Journal 1996). These prevalence rates are much lower than reported from British Regional Heart Study. This study used criteria used by Indian coronary heart disease prevalence studies and reported a rate of 15%, much higher than the Indian studies (Shaper et al. British Medical Journal, 1981). More studies are needed to clarify the issue. Increased government funding in this field is urgently needed.

ARE SMOKING, HIGH BLOOD PRESSURE, SEDENTARY LIFESTYLE AND NON-VEGETARIAN DIET RISK FACTORS FOR DEVELOPING HEART DISEASE?

The World Health Organisation (WHO, 1985) has categorically stated that cardiovascular diseases are now the most common causes of death worldwide. Epidemiological transition, with increasing life-expectancy and demographic shifts in population age-profile, combined with lifestyle related increases in the levels of cardiovascular risk factors is accelerating the coronary heart disease epidemic in India. World Health Organisation has also suggested that primordial prevention of coronary heart disease rests on three main pillars. These are:

::	Smoking cessation and tobacco control
::	Changes in dietary habits. Healthy nutrition
::	Regular non-occupational physical activity and increased occupational physical activity.

The Cardiological Society of India has included a fourth dimension to primordial prevention by including control of mental stress among the population by yoga and stress management techniques. Population control measures have been recommended by the World Health Organisation and Cardiological Society of India as the most cost-effective tool for coronary heart disease prevention. The World Health Organisation has suggested the following changes in attitudes, behaviour and social values for primordial prevention of coronary heart disease.

::	There should be encouragement of positive health behaviour, prevention of adopting risk behaviour, elimination of established risk behaviour, and promotion of the concept of health as a social value.
::	Established principles and practices of health and general education should be included in a public health program.
::	Healthy behaviour should be made socially acceptable and should be encouraged by improved community facilities.
::	Close co-operation between the health and teaching professions at all levels is necessary.
::	Health education should emphasize the satisfaction and joy of a healthy life.
::	Special target groups should be kept in mind, including children and adolescents, the family unit, the under-privileged and other high-risk groups.
::	Mass media should play a major role in a health education program. This requires a close collaboration between health personnel and media representatives.

Primordial prevention is concerned with control of smoking, and improvement in eating and exercise habits. It begins in childhood when health risk behaviour begins. Parents, teachers and peer groups are important in imparting health education to children. In Indian urban adolescent school children there is a high prevalence of obesity, hypertension, hypercholesterolaemia, and high fat diet. The need to promote dietary discretion and physically active lifestyles in children is important for primordial prevention. All adults should know their blood pressure and blood cholesterol levels, should not smoke, should be careful about their salt and fat intake, and should engage in at least moderate physical exercise and relaxation techniques. Medical practitioners should incorporate the advances in medical research in day-to-day care of patients with cardiovascular diseases.

WHAT HAS BEEN DONE IN INDIA TO THWART THIS EPIDEMIC?

Coronary heart disease is a major disease in India and has taken deep roots. This is a cause for concern. Studies from Europe and North America that the disease can be prevented by using both population-based and high-risk control measures. Population based measures entail educating the public regarding prevention guidelines. Multiple national bodies in India have published guidelines regarding population measures to be used in prevention and control of heart disease, hypertension, diabetes. These guidelines are published by a national consensus among experts and are freely available. Specifically, guidelines for prevention of coronary heart disease have been published by Cardiological Society of India (2000) and guidelines for prevention and control of hypertension have been published by the Association of Physicians of India and Hypertension Society of India (2001). Similar guidelines are available from the World Health Organisation as WHO publications and also by scientific societies of North America and Europe.

In these countries these guidelines have a tacit governmental support and press and media highlights parts of these guidelines from time to time in an effort at public education. Government of India is committed to form a taskforce to oversee that these guidelines are widely disseminated among the general public and practising doctors.

Available Volumes

EDITOR IN CHIEF

Dr. Rajeev Gupta
(MD PhD FACC)

HON. EDITOR

Dr. Soneil Guptha
(MD FACC FESC)

Editorial Board

Available Volumes

USEFUL LINKS