Heart Disease in Indians

What is Killing Indians

• Heart Disease is the leading cause of death• The health and family welfare ministry has

projected that India will have more than 60 million people with coronary heart diseases by 2015

• Mortality rates for heart disease are twice that of USA and three to five times that of some European Countries

Heart Disease Incidence in India• 32 million people with disease of the arteries

supplying blood to the heart (Coronary Artery Disease – CAD)

• 52% of cardiovascular disease deaths occur under 70 years

• 10% of heart attacks under 40 years

INDIA

USA

Proportion of all CVD Deaths 2000-30Working Age Group (35-64 Yrs)

Predicting CAD in Indians

• As disease occurs at a young age conventional risk scores are not applicable to us

• Also preventive health check-ups are not a regular feature as people spend out of their pocket

• Hence most people are not aware of their risk factors

Indians are Food centric

• In all celebrations which are common in India food consumed is rich in saturated fats, Trans fats and sugar

• Ghee and butter in North India and coconut oil in South India are more likely to lead to blockage in heart arteries (atherogenic)

• Reheating oil which is common in India for deep frying results in production of trans fats which are more atherogenic

INTERHEART Study• We are not genetically predisposed to heart

disease at a young age as compared to the western population

• The same nine risk factors are present in us.• However the risk factors develop at a

younger age

Prevalence of Risk Factors in Urban and Rural India

• Prevalence of Hypertension is 25-40% in urban areas and 10-15% in rural areas

• And that of Diabetes Mellitus is 10-15% and 3-5% respectively

• Abnormal Cholesterol is seen in 20-35% of people

• Abnormality of lipids (Dyslipidaemia) appears to be the commonest factor for heart attack

Most common and modifiable risk factor is Cholesterol

• World wide approx. 50% of CAD is due to high cholesterol

• Cholesterol lowering with statins shown to be beneficial in primary and secondary prevention

Primary Prevention in Indians

• It is time for a paradigm shift in the LDL-C dictum

• lower the better to • earlier and lower the better