Why India needs critical thinking to tackle the growing cardiovascular disease burden

A 40-year-old IT professional collapsed while exercising in the gym. Another 50-year-old popstar died due to a massive cardiac arrest. Headlines such as these are flashed every second day in India, echoing the urgent need to focus on preventing cardiac incidence before it’s too late.

India has witnessed a significant epidemiological shift during the last several decades. With increased life expectancy, comes the rise in non-communicable diseases (NCD), which are becoming a major public health problem in India. Cardiovascular diseases (CVDs) have surpassed cancer as the leading cause of death in India. Despite the widely disparate frequency of risk factors across areas, CVD is the leading cause of mortality in all parts of India. By 2030, India is expected to have the dubious distinction of having the largest number of cardiac fatalities in the world, with CVDs accounting for nearly every fourth death. CVDs strike Indians a decade sooner than their western counterparts, and about 3 million people die each year from stroke and heart attack. The surprising and unfortunate aspect is that 40% of people who have a heart attack are under the age of 55. Malnutrition, smoking and alcohol abuse, stress, obesity, sedentary lifestyle, hypertension, diabetes, hyperlipidemia, and genetic susceptibility are the key risk factors for heart disease.

In fact, did you know that people living with Type 2 Diabetes (T2D) have a higher risk of heart failure as well as a higher mortality rate?
Diabetes puts people at a higher risk of developing cardiovascular disease. Diabetics are twice as likely as non-diabetics to get heart disease.

The number of diabetes patients in India is expected to reach 69.9 million by 2025, according to a collaborative survey done by the Indian Council of Medical Research (ICMR) and the National Centre for Disease Informatics and Research (NCDIR). It is predominantly a lifestyle disease that has engulfed all age categories with a notable increase in incidence among the younger population. The situation in cities is worse than in rural regions, where the incidence of CVD is nearly twice across all socio-economic classes.

According to studies, having Type 2 diabetes or heart failure (HF) increases the likelihood of acquiring the other, and both frequently occur concurrently, worsening a patient’s health, quality of life, and care expenses. In India, presently a total of 107 million adults have been diagnosed with T2DM (Type 2 diabetes mellitus). The prevalence of adults with pre-diabetes is much higher and is estimated to be 255 million. This indicates that the increasing prevalence of HF among T2DM patients needs immediate intervention, as does the rising necessity to include cardiac screening and monitoring in diabetes care regimens.

Today, modern technology and our evolving understanding of disease give new options for personalizing therapy, reducing unnecessary expenses, and protecting those in need. Interestingly, clinicians are seen using specific biomarkers such as NT-pro-BNP for cardiac health screening. The usefulness of NT-pro-BNP in diabetic patients is critical in evaluating their overall health, allowing for the formulation of proper therapeutic management and follow-up, and it is a direct predictor of adverse outcomes and cardiovascular mortality, making this biomarker useful in the management of CVDs in T2D patients. Incorporating NT-pro-BNP, a simple blood test, to help detect and monitor heart failure as part of diabetes treatment and management is critical and essential.

Screening T2DM patients for CVD risk is a critical method for lowering mortality and CVD events and eventually reducing healthcare expenditures.

Incorporating CVD risk assessment in diabetes management must become a part of clinical protocol. Diabetes’ unrelenting growth is forcing cardiologists to re-evaluate how they treat and manage a challenging patient population.

More collaborations with government needed

In response to the ever rising burden of the cardiovascular diseases in India, the Government of India has undertaken actions in various national health programs and projects. The National Programme for the Prevention and Control of Diabetes, Cardiovascular Diseases, and Stroke (NPDCS) was established with the goal of raising awareness about the importance of having a healthy lifestyle, screening and early detection; timely, affordable, and accurate diagnosis; and rehabilitation.

Taking the “Health-in-all policies” as a new approach, the government needs to formulate public policies. Adding to this, we need active participation of various ministries and other stakeholders to emphasize on the Health-in-all approach. In the same light, there is a need for effective legislation to improve access to cardiac screening with a view to introduce prevention and early detection as an effective tool to tackle NCDs. Additionally, collaborations wherein a policy shift from curative to comprehensive approach with due emphasis on preventive care in order to make ‘healthy living’ a social norm should be facilitated. This certainly needs a multi-sectoral approach and population-based interventions. Efforts are required to collaborate with institutional bodies and national health missions to promote awareness about how we can assist in disease control.

In keeping with the same, the IVD segment can play a crucial role in utilizing innovative solutions to enable the government and private sector to introduce population-based interventions for prevention and early screening.

The last mile

To envision a world in which people with diabetes may live full and healthy lives, it is critical to advance diabetes treatment by developing an open ecosystem that integrates diabetes management products and services. Patient and physician-targeted programs to enhance awareness of various elements of diabetes treatment must be implemented at all levels of healthcare to ensure information uniformity. Partnerships between diverse stakeholders in the care process must be developed in order to properly handle the issues that diabetes care faces.

On the occasion of World Heart Day, with the theme “Use Heart for Every Heart,” let us pledge to pay attention to our hearts while also taking measures and finding solutions to minimize the burden of this global disease.



Views expressed above are the author’s own.