The global trends in disease specific mortalities indicate that ischemic heart disease (IHD) is the leading cause of death in age group ≥60 years. It is also being recognized that cardiovascular diseases (CVDs) and their risk factors are emerging as primary health problems in India with all socioeconomic groups being equally vulnerable. Though the high mortality rates due to CVDs in India may have major economic repercussions, the analysis on economic impact of CVDs remains incomplete, because of inadequate coverage of these diseases in India's vital event registration and absence of surveillance systems for disease specific mortality data. The per capita expenditure on health by public sector is very low making the poor to go for costly private healthcare facilities. We discuss here the burden of CAD and its risk factors in India and need for using population and individual based prevention strategies to halt and reverse the CVD epidemic. The country will need to create data for technical and operational factors for making prevention and control of CVDs feasible. National and international multidisciplinary collaborations will be needed to address the challenge posed by CVDs.
This document discusses coronary artery disease (CAD) and its epidemiology in India. It provides three real stories about myocardial infarctions occurring in young individuals to illustrate the severity of the issue. It then presents statistics on the leading causes of death in India, showing that cardiovascular diseases are becoming more common, now accounting for over a third of deaths and occurring at younger ages compared to developed countries. The document discusses the traditional risk factors for CAD, including diabetes, hypertension, smoking, dyslipidemia, obesity, lack of exercise, and family history. It provides data on the prevalence of these risk factors in India. The document emphasizes that risk factor assessment is not prevalent in India's public health system. It concludes by describing clinical features of
What are the cardiovascular disorders?
Public Health importance
Burden of disease
Risk factors of cardiovascular disorders
Causation
Prevention strategies
Global Action Plan for the Prevention and Control of NCDs
India - National programme (NPCDCS)
1) The document discusses the rising burden of cardiovascular disease (CVD) in India, highlighting that it is occurring a decade earlier and is a leading cause of death under 70 years of age.
2) It presents data on the traditional risk factors for CVD in India, such as high rates of hypertension, diabetes, tobacco use, physical inactivity, and air pollution. These risk factors are occurring at younger ages.
3) The National Programme for Prevention and Control of Cancer, Diabetes, CVDs and Stroke (NPCDCS) aims to prevent and control non-communicable diseases through screening, early diagnosis, and management across primary healthcare centers and district hospitals in India.
- It is not wise to delay prevention and early detection of diseases like cancer, heart disease, and diabetes. Waiting until symptoms become severe or obvious to seek treatment can lead to terrible health outcomes or death.
- Many major non-communicable diseases account for over half of all deaths in India. By 2033, diseases like cancer, cardiovascular disease, and diabetes are projected to cause even more deaths than infectious diseases like HIV/AIDS.
- Early detection through regular health screenings and adopting a healthy lifestyle can help reduce risks and catch diseases in earlier, more treatable stages. Ignoring prevention and putting off treatment is a dangerous approach with serious health consequences.
Cardiovascular diseases are now the leading cause of death worldwide, responsible for over 17 million deaths in 2016. The epidemiological transition driven by industrialization and urbanization has led to lifestyle changes that promote cardiovascular risks like obesity, physical inactivity and smoking. In India, cardiovascular diseases account for 27% of all deaths, with over 2.5 million deaths in 2016. The major cardiovascular diseases - coronary heart disease, cerebrovascular disease, rheumatic heart disease and hypertension - and their risk factors are discussed. Modifiable behavioral and metabolic risk factors provide opportunities for prevention and management of cardiovascular mortality on a global scale.
This document discusses non-communicable diseases (NCDs) and was written by Dr. Anindya Debnath. It provides an introduction to NCDs, outlines their growing global magnitude, and describes some of the major NCDs affecting populations like coronary heart disease, hypertension, stroke, obesity, diabetes, accidents and injuries, malignancies, blindness, and psychiatric disorders. Risk factors for NCDs include both modifiable factors like smoking, diet, and physical activity as well as non-modifiable factors like age, sex, and genetics.
Hypertension impact during the 21 centruryJAFAR ALSAID
Hypertension is the most common cardiovascular risk factor globally, affecting around 39% of the population. By 2100, hypertension prevalence is projected to increase such that 4-6 billion people worldwide will have the condition. If preventive measures are not implemented, this will result in a tremendous disease burden from cardiovascular complications and large economic losses for nations. Urgent, unified global action is needed to control hypertension through lifestyle modification and treatment in order to reduce this impending health crisis.
This document discusses coronary heart disease (CHD), including its causes, presentations, burden, measurements, risk factors, prevention strategies, and intervention trials. It notes that CHD is caused by inadequate blood flow to the heart and is a leading cause of death. Risk factors include smoking, hypertension, high cholesterol, diabetes, genetics, physical inactivity, and alcohol consumption. Prevention strategies involve population-wide approaches like diet/lifestyle changes and controlling risk factors, identifying and counseling high-risk individuals, and secondary prevention after events. Several trials showed community programs and clinical interventions can significantly reduce CHD incidence.
This document discusses coronary artery disease (CAD) and its epidemiology in India. It provides three real stories about myocardial infarctions occurring in young individuals to illustrate the severity of the issue. It then presents statistics on the leading causes of death in India, showing that cardiovascular diseases are becoming more common, now accounting for over a third of deaths and occurring at younger ages compared to developed countries. The document discusses the traditional risk factors for CAD, including diabetes, hypertension, smoking, dyslipidemia, obesity, lack of exercise, and family history. It provides data on the prevalence of these risk factors in India. The document emphasizes that risk factor assessment is not prevalent in India's public health system. It concludes by describing clinical features of
What are the cardiovascular disorders?
Public Health importance
Burden of disease
Risk factors of cardiovascular disorders
Causation
Prevention strategies
Global Action Plan for the Prevention and Control of NCDs
India - National programme (NPCDCS)
1) The document discusses the rising burden of cardiovascular disease (CVD) in India, highlighting that it is occurring a decade earlier and is a leading cause of death under 70 years of age.
2) It presents data on the traditional risk factors for CVD in India, such as high rates of hypertension, diabetes, tobacco use, physical inactivity, and air pollution. These risk factors are occurring at younger ages.
3) The National Programme for Prevention and Control of Cancer, Diabetes, CVDs and Stroke (NPCDCS) aims to prevent and control non-communicable diseases through screening, early diagnosis, and management across primary healthcare centers and district hospitals in India.
- It is not wise to delay prevention and early detection of diseases like cancer, heart disease, and diabetes. Waiting until symptoms become severe or obvious to seek treatment can lead to terrible health outcomes or death.
- Many major non-communicable diseases account for over half of all deaths in India. By 2033, diseases like cancer, cardiovascular disease, and diabetes are projected to cause even more deaths than infectious diseases like HIV/AIDS.
- Early detection through regular health screenings and adopting a healthy lifestyle can help reduce risks and catch diseases in earlier, more treatable stages. Ignoring prevention and putting off treatment is a dangerous approach with serious health consequences.
Cardiovascular diseases are now the leading cause of death worldwide, responsible for over 17 million deaths in 2016. The epidemiological transition driven by industrialization and urbanization has led to lifestyle changes that promote cardiovascular risks like obesity, physical inactivity and smoking. In India, cardiovascular diseases account for 27% of all deaths, with over 2.5 million deaths in 2016. The major cardiovascular diseases - coronary heart disease, cerebrovascular disease, rheumatic heart disease and hypertension - and their risk factors are discussed. Modifiable behavioral and metabolic risk factors provide opportunities for prevention and management of cardiovascular mortality on a global scale.
This document discusses non-communicable diseases (NCDs) and was written by Dr. Anindya Debnath. It provides an introduction to NCDs, outlines their growing global magnitude, and describes some of the major NCDs affecting populations like coronary heart disease, hypertension, stroke, obesity, diabetes, accidents and injuries, malignancies, blindness, and psychiatric disorders. Risk factors for NCDs include both modifiable factors like smoking, diet, and physical activity as well as non-modifiable factors like age, sex, and genetics.
Hypertension impact during the 21 centruryJAFAR ALSAID
Hypertension is the most common cardiovascular risk factor globally, affecting around 39% of the population. By 2100, hypertension prevalence is projected to increase such that 4-6 billion people worldwide will have the condition. If preventive measures are not implemented, this will result in a tremendous disease burden from cardiovascular complications and large economic losses for nations. Urgent, unified global action is needed to control hypertension through lifestyle modification and treatment in order to reduce this impending health crisis.
This document discusses coronary heart disease (CHD), including its causes, presentations, burden, measurements, risk factors, prevention strategies, and intervention trials. It notes that CHD is caused by inadequate blood flow to the heart and is a leading cause of death. Risk factors include smoking, hypertension, high cholesterol, diabetes, genetics, physical inactivity, and alcohol consumption. Prevention strategies involve population-wide approaches like diet/lifestyle changes and controlling risk factors, identifying and counseling high-risk individuals, and secondary prevention after events. Several trials showed community programs and clinical interventions can significantly reduce CHD incidence.
A Study on Food Habits and Social Habits as Risk Factors among Patients Under...ijtsrd
AIM A study on food habits and social habits as risk factors among patients undergoing Percutaneous Transluminal Coronary Angioplasty PTCA OBJECTIVE To know the association of food habits and social habits as risk factors for PTCA. To observe various co morbidities among the patients To study the bio chemical parameters in patients such as heamoglobin, PVC, platelet count, bilirubin levels. To observe various social habits in the patient, such as smoking and alcohol consumption. Food consumption pattern. METHODOLOGY The sample population n = 60 of 28 80 years of age were chosen from a multi speciality hospital in Hyderabad. All the patients were of different age groups, sex, socio economic status, ethnicity with different co morbidities. A pre tested format consisting of patients profile, subjective data, objective data, biochemical data, medications and 24 hour dietary recall followed by medical nutrition therapy during the hospital stay. RESULTS Among n=60 subjects from 28 80 years of age, the detailed study identified the common risk factors with respect to cardiovascular diseases. The study showed a higher percentage of age from 28 70 years and is mostly in males. Majority of the patients are with increased BMI and are alcholics smokers. Obesity, Hypertension and Diabetes are predominant and dietary patterns recorded are mostly non vegetarians with high calorie, high fat and high protein consumption. CONCLUSION From the result it is very clear that majority of the patients studied with cardiovascular diseases belong to the age group 28 70 years and is mostly seen in males. Majority of them are accompanied with co morbidities with obesity, hypertension and diabetic. And predominantly follow a high calorie and high fat diet .Thus leading to a conclusion that consumption of high calorie and high fat food, presence of co morbidities and smoking could be the risk factors of PTCA. Mrs. Meena Kumari | Mrs. Y. V. Phani Kumari | Gwyneth Madhulika Bashapaga | Ittamala Jaya Rachel ""A Study on Food Habits and Social Habits as Risk Factors among Patients Undergoing Percatenous Transluminal Coronary Angioplasty (PTCA)"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23372.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/23372/a-study-on-food-habits-and-social-habits-as-risk-factors-among-patients-undergoing-percatenous-transluminal-coronary-angioplasty-ptca/mrs-meena-kumari
This document discusses the epidemiology of hypertension globally and nationally in India. Some key points:
- Globally, nearly 1 billion adults had hypertension in 2000, predicted to increase to 1.56 billion by 2025. Hypertension contributes to 13% of global deaths.
- In India, the prevalence of hypertension has risen from 2-15% in urban areas and 2-8% in rural areas in the late 1990s/early 2000s to approximately 25% in urban adults and 10-15% in rural adults currently.
- Cardiovascular disease is the leading cause of death in India, responsible for over 2 million deaths annually according to recent reports. There are large regional variations in cardiovascular mortality within
A Study of the Prevalence of Cardio-Vascular Diseases and Its Risk Factors (B...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Overview
This global status report on prevention and control of NCDs (2014), is framed around the nine voluntary global targets. The report provides data on the current situation, identifying bottlenecks as well as opportunities and priority actions for attaining the targets. The 2010 baseline estimates on NCD mortality and risk factors are provided so that countries can report on progress, starting in 2015. In addition, the report also provides the latest available estimates on NCD mortality (2012) and risk factors, 2010-2012.
All ministries of health need to set national NCD targets and lead the development and implementation of policies and interventions to attain them. There is no single pathway to attain NCD targets that fits all countries, as they are at different points in their progress in the prevention and control of NCDs and at different levels of socioeconomic development. However all countries can benefit from the comprehensive response to attaining the voluntary global targets presented in this report.http://www.who.int/nmh/publications/ncd-status-report-2014/en/
This study examined dyslipidemia among type 2 diabetes patients in Somalia. The study found:
- 22.5% of patients had dyslipidemia, slightly lower than other African studies.
- Risk factors for dyslipidemia included female sex, insufficient physical activity, and high BMI.
- Many patients had multiple cardiovascular risk factors like hypertension and a family history of heart disease, despite a short time since diabetes diagnosis.
- Management challenges for diabetes in Somalia include lack of funding, unreliable access to medications, and inequity in healthcare access between public and private sectors. Effective prevention and treatment strategies are needed that address Somalia's unique healthcare context.
Association Between Passive Smoking & Cardiovascular Disease Among Woman of L...Rishad Choudhury Robin
This document discusses cardiovascular disease (CVD) among women of low socioeconomic status in urban Bangladeshi communities who are exposed to passive smoking. It notes that passive smoking increases the risk of CVD by 10-30% and that over 46% of Bangladeshi women report high exposure to passive smoking. The prevalence of cigarette smoking is 21.6% in urban communities in Bangladesh, with rates over 35% among men and almost 5% among women. The document examines the risk of CVD from smoking in Bangladesh specifically.
1. Cardiovascular diseases are the leading cause of death globally, accounting for 31% of all deaths in 2016. Accurately assessing CVD risk allows for early prevention efforts.
2. The original Framingham Risk Score from 1998 predicts 10-year risk of coronary heart disease based on age, sex, cholesterol, blood pressure, smoking, and diabetes. However, it does not include other outcomes like stroke and underestimates risk in other populations.
3. Several risk calculators have been developed to address limitations of the FRS. Models like SCORE and QRISK2 predict fatal cardiovascular risk and account for additional risk factors like ethnicity and deprivation level respectively.
Global death causes & preventive strategyDeepikaHarish
The document analyzes leading causes of death globally and strategies for prevention. The top 10 causes are ischemic heart disease, stroke, COPD, lower respiratory infections, neonatal conditions, lung cancer, Alzheimer's, diarrhea, diabetes, and kidney disease. These account for over half of all deaths and are largely non-communicable diseases linked to risk factors like smoking, obesity, and lack of exercise. Most can be prevented through controlling risk factors. The document proposes a holistic healthcare framework involving population risk assessment, health monitoring, and preventive interventions to control disease progression through strategies like remote monitoring devices and digital health programs. This framework aims to decrease healthcare costs and improve outcomes.
Relationship between Vitamin D Status and Blood Pressure, Age, Physical Activ...CrimsonpublishersNTNF
Relationship between Vitamin D Status and Blood Pressure, Age, Physical Activity, and Nutritional Status in Saudi Males and Females by Tahani Aljurbua in Food Science_ Nutrition Open access Journal
Heart disease is the leading cause of death in India, with over 60 million people projected to have coronary heart disease by 2015. Mortality rates from heart disease are twice as high in India compared to the US and several times higher than some European countries. Risk factors like hypertension, diabetes and abnormal cholesterol develop at younger ages in India compared to Western countries. Diet plays a major role, as Indian diets tend to be high in saturated and trans fats. Primary prevention through controlling cholesterol levels earlier in life could help reduce India's growing heart disease burden.
Non-communicable diseases such as cancer, cardiovascular disease, and diabetes account for over 60% of deaths worldwide. Major risk factors like high blood pressure, high cholesterol, and smoking have large effects on mortality. While rates of non-communicable diseases are highest in developed nations, they are increasing in low- and middle-income countries due to urbanization and changes in lifestyle. Controlling risk factors through public health interventions could significantly reduce the growing global burden of these diseases.
Social and economic implications of noncommunicable diseases in indiaDr. Dharmendra Gahwai
India has experienced rapid economic growth over the last decade of around 7-8% per year. However, this has also led to a rising burden of non-communicable diseases (NCDs) such as heart disease, cancer and diabetes. NCDs now account for over 60% of deaths in India and place a major strain on the health system. Rising rates of risk factors like smoking, unhealthy diets and physical inactivity have contributed to the growing NCD problem. Additionally, India faces a "double burden" of both communicable and non-communicable diseases co-existing as the country undergoes an epidemiological transition.
This document provides an overview of non-communicable diseases (NCDs) presented by the Epidemiology Department Group 2 at Bahir Dar University in Ethiopia. It defines NCDs and describes their global, regional, and national distribution. It analyzes patterns of the top five NCDs (cardiovascular disease, cancer, diabetes, chronic respiratory disease, and mental illness) that account for high mortality and morbidity worldwide. It also examines the impact of NCDs on life expectancy and healthy life years lost. Some key points include: NCDs are increasing rapidly in low and middle-income countries and are responsible for over 85% of deaths globally. The largest risk factors for early death and disability are now
This document summarizes chronic non-communicable diseases. It discusses how cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases account for 80% of non-communicable disease deaths globally. It defines chronic diseases and non-communicable diseases. It also provides details on the magnitude and burden of major non-communicable diseases like diabetes, cardiovascular diseases, cancer, and stroke; discussing prevalence, mortality rates, and economic costs in India. Gaps in understanding the natural history of chronic diseases are also outlined.
This document summarizes a study examining causes of death among HIV-infected patients treated with antiretroviral therapy (ART) between 1996-2006. The study analyzed data from 13 cohorts including 39,272 patients. The main causes of death were AIDS-related (49.5% of deaths), non-AIDS malignancies (11.8%), non-AIDS infections (8.2%), and liver disease (7%). Rates of AIDS-related death were higher with lower CD4 count or higher viral load. Rates of several non-AIDS causes, like liver and respiratory disease, were higher in injection drug users. The proportion of AIDS-related deaths decreased with longer duration of ART, suggesting ART improves survival from
This document is a term paper submitted by students of the Bachelor of Public Health program at La Grande International College in Nepal on the topic of the prevalence of non-communicable diseases. It provides background information on NCDs including risk factors. Global data shows NCDs account for 60% of deaths worldwide, with 80% occurring in low- and middle-income countries. In Nepal, NCDs account for 42% of all deaths currently and are projected to cause 66.3% of deaths by 2030. The term paper analyzes NCD prevalence in Nepal and compares communicable to non-communicable disease burdens. It also examines Nepal's NCD policies and strategies.
Deaths from Renal Diseases in England, 2001 to 2008
This short report focuses on the analysis of Office for National Statistics mortality data to give insight into differences in numbers, rates and place of death from selected renal diseases.
Related resources: Chronic Kidney Disease Profiles published by the East Midlands Public Health Observatory and NHS Kidney Care and the UK Renal Registry.
The document discusses health challenges related to cardiovascular disease in India in the new century. Some key points:
- Cardiovascular disease is a growing problem in India, affecting people at younger ages than in other countries, with the average heart patient being 52 years old.
- Risk factors for cardiovascular disease in India include smoking, diabetes, hypertension, obesity, unhealthy diets, physical inactivity, stress, and genetics.
- Cardiovascular disease is also increasingly affecting women in India at younger ages, as early as their 20s and 30s, due to lifestyle changes like lack of exercise and poor diets.
- Over 70% of India's urban population is estimated to be at risk of cardiovascular
This document discusses non-communicable diseases (NCDs) such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. It notes that NCDs are the leading cause of death worldwide, responsible for 63% of all annual deaths. Four main NCDs - cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes - account for 82% of NCD deaths. The global burden of NCDs is growing, particularly in low- and middle-income countries. Risk factors include behaviors like tobacco use, unhealthy diet, and physical inactivity, as well as physiological factors like high blood pressure. The document discusses NCD burdens and risks in South and Southeast Asia specifically, including Bangladesh and Thailand. It emphasizes
Stroke INDIA epidemiology I.S.M CENTRAL CAMPUSABHISHEK
Stroke is a major health issue in India, with prevalence rates ranging from 84-262 per 100,000 people in rural areas to 334-424 per 100,000 in urban areas. The incidence of stroke is projected to rise from 89 per 100,000 people in 2005 to 98 per 100,000 people by 2030. Stroke is the third most common cause of death in India after cancer and ischemic heart disease, and is the most common cause of severe physical disability. Preventing stroke involves addressing underlying risk factors such as maintaining a healthy diet and weight, exercising regularly, avoiding smoking and alcohol consumption. Risk factors include age, sex, race, family history, and birth weight, as well as modifiable factors like hypertension,
Burden of cardiovascular diseases in Indians: Estimating trends of coronary a...Apollo Hospitals
The global trends in disease specific mortalities indicate that ischemic heart disease (IHD) is the leading cause of death in age group ≥60 years. It is also being recognized that cardiovascular diseases (CVDs) and their risk factors are emerging as primary health problems in India with all socioeconomic groups being equally vulnerable. Though the high mortality rates due to CVDs in India may have major economic repercussions, the analysis on economic impact of CVDs remains incomplete, because of inadequate coverage of these diseases in India's vital event registration and absence of surveillance systems for disease specific mortality data. The per capita expenditure on health by public sector is very low making the poor to go for costly private healthcare facilities. We discuss here the burden of CAD and its risk factors in India and need for using population and individual based prevention strategies to halt and reverse the CVD epidemic. The country will need to create data for technical and operational factors for making prevention and control of CVDs feasible. National and international multidisciplinary collaborations will be needed to address the challenge posed by CVDs.
This document discusses hypertension in India. It provides statistics on the prevalence and burden of hypertension globally and within India. Some key points:
- Over a billion adults globally had hypertension in 2000, predicted to rise to 1.56 billion by 2025. Prevalence is increasing fastest in developing countries.
- In India, prevalence has risen from 2-15% in the 1990s to over 25% in urban areas and 10-15% in rural areas currently. By 2020, an estimated 159.46 per 1000 population will have hypertension.
- Hypertension awareness, treatment and control is low in India, with only around half of urban and a quarter of rural hypertensive individuals aware of their condition. Pro
A Study on Food Habits and Social Habits as Risk Factors among Patients Under...ijtsrd
AIM A study on food habits and social habits as risk factors among patients undergoing Percutaneous Transluminal Coronary Angioplasty PTCA OBJECTIVE To know the association of food habits and social habits as risk factors for PTCA. To observe various co morbidities among the patients To study the bio chemical parameters in patients such as heamoglobin, PVC, platelet count, bilirubin levels. To observe various social habits in the patient, such as smoking and alcohol consumption. Food consumption pattern. METHODOLOGY The sample population n = 60 of 28 80 years of age were chosen from a multi speciality hospital in Hyderabad. All the patients were of different age groups, sex, socio economic status, ethnicity with different co morbidities. A pre tested format consisting of patients profile, subjective data, objective data, biochemical data, medications and 24 hour dietary recall followed by medical nutrition therapy during the hospital stay. RESULTS Among n=60 subjects from 28 80 years of age, the detailed study identified the common risk factors with respect to cardiovascular diseases. The study showed a higher percentage of age from 28 70 years and is mostly in males. Majority of the patients are with increased BMI and are alcholics smokers. Obesity, Hypertension and Diabetes are predominant and dietary patterns recorded are mostly non vegetarians with high calorie, high fat and high protein consumption. CONCLUSION From the result it is very clear that majority of the patients studied with cardiovascular diseases belong to the age group 28 70 years and is mostly seen in males. Majority of them are accompanied with co morbidities with obesity, hypertension and diabetic. And predominantly follow a high calorie and high fat diet .Thus leading to a conclusion that consumption of high calorie and high fat food, presence of co morbidities and smoking could be the risk factors of PTCA. Mrs. Meena Kumari | Mrs. Y. V. Phani Kumari | Gwyneth Madhulika Bashapaga | Ittamala Jaya Rachel ""A Study on Food Habits and Social Habits as Risk Factors among Patients Undergoing Percatenous Transluminal Coronary Angioplasty (PTCA)"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23372.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/23372/a-study-on-food-habits-and-social-habits-as-risk-factors-among-patients-undergoing-percatenous-transluminal-coronary-angioplasty-ptca/mrs-meena-kumari
This document discusses the epidemiology of hypertension globally and nationally in India. Some key points:
- Globally, nearly 1 billion adults had hypertension in 2000, predicted to increase to 1.56 billion by 2025. Hypertension contributes to 13% of global deaths.
- In India, the prevalence of hypertension has risen from 2-15% in urban areas and 2-8% in rural areas in the late 1990s/early 2000s to approximately 25% in urban adults and 10-15% in rural adults currently.
- Cardiovascular disease is the leading cause of death in India, responsible for over 2 million deaths annually according to recent reports. There are large regional variations in cardiovascular mortality within
A Study of the Prevalence of Cardio-Vascular Diseases and Its Risk Factors (B...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Overview
This global status report on prevention and control of NCDs (2014), is framed around the nine voluntary global targets. The report provides data on the current situation, identifying bottlenecks as well as opportunities and priority actions for attaining the targets. The 2010 baseline estimates on NCD mortality and risk factors are provided so that countries can report on progress, starting in 2015. In addition, the report also provides the latest available estimates on NCD mortality (2012) and risk factors, 2010-2012.
All ministries of health need to set national NCD targets and lead the development and implementation of policies and interventions to attain them. There is no single pathway to attain NCD targets that fits all countries, as they are at different points in their progress in the prevention and control of NCDs and at different levels of socioeconomic development. However all countries can benefit from the comprehensive response to attaining the voluntary global targets presented in this report.http://www.who.int/nmh/publications/ncd-status-report-2014/en/
This study examined dyslipidemia among type 2 diabetes patients in Somalia. The study found:
- 22.5% of patients had dyslipidemia, slightly lower than other African studies.
- Risk factors for dyslipidemia included female sex, insufficient physical activity, and high BMI.
- Many patients had multiple cardiovascular risk factors like hypertension and a family history of heart disease, despite a short time since diabetes diagnosis.
- Management challenges for diabetes in Somalia include lack of funding, unreliable access to medications, and inequity in healthcare access between public and private sectors. Effective prevention and treatment strategies are needed that address Somalia's unique healthcare context.
Association Between Passive Smoking & Cardiovascular Disease Among Woman of L...Rishad Choudhury Robin
This document discusses cardiovascular disease (CVD) among women of low socioeconomic status in urban Bangladeshi communities who are exposed to passive smoking. It notes that passive smoking increases the risk of CVD by 10-30% and that over 46% of Bangladeshi women report high exposure to passive smoking. The prevalence of cigarette smoking is 21.6% in urban communities in Bangladesh, with rates over 35% among men and almost 5% among women. The document examines the risk of CVD from smoking in Bangladesh specifically.
1. Cardiovascular diseases are the leading cause of death globally, accounting for 31% of all deaths in 2016. Accurately assessing CVD risk allows for early prevention efforts.
2. The original Framingham Risk Score from 1998 predicts 10-year risk of coronary heart disease based on age, sex, cholesterol, blood pressure, smoking, and diabetes. However, it does not include other outcomes like stroke and underestimates risk in other populations.
3. Several risk calculators have been developed to address limitations of the FRS. Models like SCORE and QRISK2 predict fatal cardiovascular risk and account for additional risk factors like ethnicity and deprivation level respectively.
Global death causes & preventive strategyDeepikaHarish
The document analyzes leading causes of death globally and strategies for prevention. The top 10 causes are ischemic heart disease, stroke, COPD, lower respiratory infections, neonatal conditions, lung cancer, Alzheimer's, diarrhea, diabetes, and kidney disease. These account for over half of all deaths and are largely non-communicable diseases linked to risk factors like smoking, obesity, and lack of exercise. Most can be prevented through controlling risk factors. The document proposes a holistic healthcare framework involving population risk assessment, health monitoring, and preventive interventions to control disease progression through strategies like remote monitoring devices and digital health programs. This framework aims to decrease healthcare costs and improve outcomes.
Relationship between Vitamin D Status and Blood Pressure, Age, Physical Activ...CrimsonpublishersNTNF
Relationship between Vitamin D Status and Blood Pressure, Age, Physical Activity, and Nutritional Status in Saudi Males and Females by Tahani Aljurbua in Food Science_ Nutrition Open access Journal
Heart disease is the leading cause of death in India, with over 60 million people projected to have coronary heart disease by 2015. Mortality rates from heart disease are twice as high in India compared to the US and several times higher than some European countries. Risk factors like hypertension, diabetes and abnormal cholesterol develop at younger ages in India compared to Western countries. Diet plays a major role, as Indian diets tend to be high in saturated and trans fats. Primary prevention through controlling cholesterol levels earlier in life could help reduce India's growing heart disease burden.
Non-communicable diseases such as cancer, cardiovascular disease, and diabetes account for over 60% of deaths worldwide. Major risk factors like high blood pressure, high cholesterol, and smoking have large effects on mortality. While rates of non-communicable diseases are highest in developed nations, they are increasing in low- and middle-income countries due to urbanization and changes in lifestyle. Controlling risk factors through public health interventions could significantly reduce the growing global burden of these diseases.
Social and economic implications of noncommunicable diseases in indiaDr. Dharmendra Gahwai
India has experienced rapid economic growth over the last decade of around 7-8% per year. However, this has also led to a rising burden of non-communicable diseases (NCDs) such as heart disease, cancer and diabetes. NCDs now account for over 60% of deaths in India and place a major strain on the health system. Rising rates of risk factors like smoking, unhealthy diets and physical inactivity have contributed to the growing NCD problem. Additionally, India faces a "double burden" of both communicable and non-communicable diseases co-existing as the country undergoes an epidemiological transition.
This document provides an overview of non-communicable diseases (NCDs) presented by the Epidemiology Department Group 2 at Bahir Dar University in Ethiopia. It defines NCDs and describes their global, regional, and national distribution. It analyzes patterns of the top five NCDs (cardiovascular disease, cancer, diabetes, chronic respiratory disease, and mental illness) that account for high mortality and morbidity worldwide. It also examines the impact of NCDs on life expectancy and healthy life years lost. Some key points include: NCDs are increasing rapidly in low and middle-income countries and are responsible for over 85% of deaths globally. The largest risk factors for early death and disability are now
This document summarizes chronic non-communicable diseases. It discusses how cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases account for 80% of non-communicable disease deaths globally. It defines chronic diseases and non-communicable diseases. It also provides details on the magnitude and burden of major non-communicable diseases like diabetes, cardiovascular diseases, cancer, and stroke; discussing prevalence, mortality rates, and economic costs in India. Gaps in understanding the natural history of chronic diseases are also outlined.
This document summarizes a study examining causes of death among HIV-infected patients treated with antiretroviral therapy (ART) between 1996-2006. The study analyzed data from 13 cohorts including 39,272 patients. The main causes of death were AIDS-related (49.5% of deaths), non-AIDS malignancies (11.8%), non-AIDS infections (8.2%), and liver disease (7%). Rates of AIDS-related death were higher with lower CD4 count or higher viral load. Rates of several non-AIDS causes, like liver and respiratory disease, were higher in injection drug users. The proportion of AIDS-related deaths decreased with longer duration of ART, suggesting ART improves survival from
This document is a term paper submitted by students of the Bachelor of Public Health program at La Grande International College in Nepal on the topic of the prevalence of non-communicable diseases. It provides background information on NCDs including risk factors. Global data shows NCDs account for 60% of deaths worldwide, with 80% occurring in low- and middle-income countries. In Nepal, NCDs account for 42% of all deaths currently and are projected to cause 66.3% of deaths by 2030. The term paper analyzes NCD prevalence in Nepal and compares communicable to non-communicable disease burdens. It also examines Nepal's NCD policies and strategies.
Deaths from Renal Diseases in England, 2001 to 2008
This short report focuses on the analysis of Office for National Statistics mortality data to give insight into differences in numbers, rates and place of death from selected renal diseases.
Related resources: Chronic Kidney Disease Profiles published by the East Midlands Public Health Observatory and NHS Kidney Care and the UK Renal Registry.
The document discusses health challenges related to cardiovascular disease in India in the new century. Some key points:
- Cardiovascular disease is a growing problem in India, affecting people at younger ages than in other countries, with the average heart patient being 52 years old.
- Risk factors for cardiovascular disease in India include smoking, diabetes, hypertension, obesity, unhealthy diets, physical inactivity, stress, and genetics.
- Cardiovascular disease is also increasingly affecting women in India at younger ages, as early as their 20s and 30s, due to lifestyle changes like lack of exercise and poor diets.
- Over 70% of India's urban population is estimated to be at risk of cardiovascular
This document discusses non-communicable diseases (NCDs) such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. It notes that NCDs are the leading cause of death worldwide, responsible for 63% of all annual deaths. Four main NCDs - cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes - account for 82% of NCD deaths. The global burden of NCDs is growing, particularly in low- and middle-income countries. Risk factors include behaviors like tobacco use, unhealthy diet, and physical inactivity, as well as physiological factors like high blood pressure. The document discusses NCD burdens and risks in South and Southeast Asia specifically, including Bangladesh and Thailand. It emphasizes
Stroke INDIA epidemiology I.S.M CENTRAL CAMPUSABHISHEK
Stroke is a major health issue in India, with prevalence rates ranging from 84-262 per 100,000 people in rural areas to 334-424 per 100,000 in urban areas. The incidence of stroke is projected to rise from 89 per 100,000 people in 2005 to 98 per 100,000 people by 2030. Stroke is the third most common cause of death in India after cancer and ischemic heart disease, and is the most common cause of severe physical disability. Preventing stroke involves addressing underlying risk factors such as maintaining a healthy diet and weight, exercising regularly, avoiding smoking and alcohol consumption. Risk factors include age, sex, race, family history, and birth weight, as well as modifiable factors like hypertension,
Burden of cardiovascular diseases in Indians: Estimating trends of coronary a...Apollo Hospitals
The global trends in disease specific mortalities indicate that ischemic heart disease (IHD) is the leading cause of death in age group ≥60 years. It is also being recognized that cardiovascular diseases (CVDs) and their risk factors are emerging as primary health problems in India with all socioeconomic groups being equally vulnerable. Though the high mortality rates due to CVDs in India may have major economic repercussions, the analysis on economic impact of CVDs remains incomplete, because of inadequate coverage of these diseases in India's vital event registration and absence of surveillance systems for disease specific mortality data. The per capita expenditure on health by public sector is very low making the poor to go for costly private healthcare facilities. We discuss here the burden of CAD and its risk factors in India and need for using population and individual based prevention strategies to halt and reverse the CVD epidemic. The country will need to create data for technical and operational factors for making prevention and control of CVDs feasible. National and international multidisciplinary collaborations will be needed to address the challenge posed by CVDs.
This document discusses hypertension in India. It provides statistics on the prevalence and burden of hypertension globally and within India. Some key points:
- Over a billion adults globally had hypertension in 2000, predicted to rise to 1.56 billion by 2025. Prevalence is increasing fastest in developing countries.
- In India, prevalence has risen from 2-15% in the 1990s to over 25% in urban areas and 10-15% in rural areas currently. By 2020, an estimated 159.46 per 1000 population will have hypertension.
- Hypertension awareness, treatment and control is low in India, with only around half of urban and a quarter of rural hypertensive individuals aware of their condition. Pro
The document discusses the growing burden of non-communicable diseases (NCDs) in India. It notes that NCDs now account for over 60% of deaths in India and this proportion is projected to increase further. The major NCDs affecting India are cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. The rising burden is linked to lifestyle changes like increasing tobacco use, unhealthy diets, physical inactivity, and urbanization. Managing NCDs poses challenges for India's healthcare system due to the country's large population and diversity.
Current status of health and burden of diseaseManiDhingra1
The document provides an overview of the current health status and disease burden in India. It discusses that communicable diseases account for around half of India's disease burden, with HIV, tuberculosis, malaria, and dengue posing significant problems. Non-communicable diseases like cardiovascular disease, diabetes, and cancer also contribute to 63% of all deaths in India. The document further summarizes methods for measuring disease burden, like disability-adjusted life years (DALYs) and quality-adjusted life years (QALYs), and examines the impacts of disease burden on personal, social, and national levels.
This document provides an outline and overview of public health solutions for the prevention and control of non-communicable diseases (NCDs) globally and in Nepal. It discusses the growing global burden of NCDs, risk factors, initiatives taken, and the disproportionate impact on the poorest billion. For Nepal, it notes that NCDs account for over 60% of deaths and outlines guiding principles, current public health programs, challenges, and recommended solutions to address the NCD burden, including expanding essential services and strengthening primary care initiatives.
The document provides an overview of ischemic heart disease (IHD), the leading cause of death globally. It discusses IHD in detail, including its symptoms, risk factors, global and national burden, economic costs, and approaches for prevention and control. Key points are: IHD accounts for over 9 million deaths annually worldwide; prevalence is highest in Eastern Europe but increasing in Western countries; Nepal faces a growing IHD burden responsible for 16.4% of deaths; and prevention relies on controlling major risk factors like smoking, diet, activity levels, and treating conditions like diabetes and hypertension.
1. Non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, diabetes and chronic respiratory diseases account for a large burden of disease in Nepal. NCDs represent over 80% of outpatient cases and over 88% of inpatient cases based on national data.
2. Risk factors for NCDs such as tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity are highly prevalent in Nepal. Surveys show over one-third of the population uses tobacco and over one-quarter consumes alcohol harmfully.
3. While Nepal has drafted an NCD policy and strategy, urgent action is needed to implement prevention and control efforts for NCDs given their growing burden
Effect of Modifiable factors on Systolic Blood Pressure (SBP) in Elderly Popu...AI Publications
Hypertension (HTN) is a major public health problem in all age group but isolated systolic hypertension (ISH) is the commonest form of hypertension in elderly population and it is a better predictor of cardiovascular morbidity and mortality compared to diastolic blood pressure. Aim of the present study is to evaluate the effectiveness of modifiable factors on systolic blood pressure (SBP) in elderly population on systolic blood pressure in elderly patients. This prospective observational study was conducted on the patient attending OPD & IPD of HAHC Hospital, Jamia Hamdard, New Delhi. All the elderly hypertensive with elevated systolic BP were included in the study, after explaining the details about the study and taking written consent data were recorded on a proforma. The patients were followed every regularly and the effect of drugs on SBP were assessed and recoded at monthly interval. Data were analysed by using IBM SPSSv20. This study documented that among the 220 hypertensive patients who completed the study 51% were female. The maximum numbers of patients were from of age group of 56 to 65 years (44.54%). This study also shows that 40.90% patients were tobacco user. Morbidity and mortality are increased by elderly hypertension. The number of elderly hypertension patients will increase for practitioners as the US aging population rises. Most ISH in elderly hypertension. Most difficult to treat. Evidence is quite strong for treating ISH. SBP management must come before DBP reduction. Clinical studies demonstrate that lowering SBP lowers cardiovascular and renal disease more than keeping SBP uncontrolled. Prioritizing elderly SBP management is necessary.
Global burden of disease & International Health RegulationSujata Mohapatra
The document discusses global burden of disease and key concepts in global health. It summarizes that global burden of disease assessments measure years of life lost to premature mortality and disability worldwide. The leading causes of mortality globally are ischemic heart disease, stroke, lower respiratory infections and COPD, while the highest disease burdens come from lower respiratory infections, diarrheal diseases, depression and ischemic heart disease. Noncommunicable diseases like cardiovascular disease are responsible for most deaths globally.
Ncd non communicable diseases presentationMohan Bastola
The document summarizes information on non-communicable diseases (NCDs) presented by a group of students. It discusses the global and national scenarios of major NCDs such as cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, chronic kidney disease, and COPD. The leading causes and risk factors of these diseases are also presented along with strategies for prevention at different levels from primordial to tertiary prevention. The document contains information on disease burden, trends, and risk factors specific to Nepal.
India Must Learn to Live with CoronavirusAnil Chawla
This document discusses coronavirus (Covid-19) mortality rates in India by comparing Covid-19 deaths to other causes of death in India. Some key points:
1) As of April 9th, 2020, there were approximately 6,000 confirmed Covid-19 cases and 200 deaths in India, compared to over 1.5 million global cases and 84,000 deaths.
2) In India in 2017, communicable diseases caused over 6,900 deaths per day, while non-communicable diseases caused over 4,500 deaths per day.
3) The author argues that given India's high mortality rates from other causes like suicide, drowning, and snake bites, Covid-19 should
This document discusses non-communicable diseases (NCDs) and provides information on their global burden, definitions, surveillance, risk factors, and social and economic implications. It notes that NCDs caused 36 million deaths globally in 2008, with 80% of NCD deaths occurring in low- and middle-income countries. In India specifically, NCDs account for 53% of total deaths and their economic costs are substantial. The four main NCDs are cardiovascular diseases, cancer, chronic respiratory disease, and diabetes. Surveillance of NCDs and their risk factors is important for planning prevention and control programs.
The Future of Cardiology (2018 – 2030): Advanced Treatments to Combat the Global Advance of Cardiovascular Diseases. I presented this at Conference Series Cardiology Conference 2017 in Philadelphia, Pennsylvania on 09/01/2017. I first look the the number of people globally affected by cardiovascular diseases. Then I look at the cumulative "lost productivity" globally as a result of people suffering from cardiovascular diseases. Following that, I look at the total costs of treating cardiovascular diseases globally. Then I present the reasons why cardiovascular diseases are rising so rapidly throughout the world - lifestyle/clinical. Then I look at the rates of smoking throughout the world; one of the main culprits of cardiovascular diseases (CVDs). The next slides look at the "Gold Standard" of care for coronary artery diseases (CAD), congestive heart failure (CHF), and aortic valve disease. I also present what is driving industry consolidation and associated major transactions. I then provide some perspective on the future of interventional cardiology. And finally, I provide some insight into "evolving technologies" for cardiovascular care and interventional cardiovascular care. It was a lengthy presentation, but I feel, all critical. This is a very complex field. It takes at least 12 continuous years of education and training to become an interventional or non-interventional cardiologist (4 years pre-med, 3 years medical school, 3 years medical residency, 2 years fellowship (where a cardiologist selects and trains on their cardiovascular specialties)). Some authorities are even calling for post-fellowship training for procedures like transcatheter aortic valve implantation (TAVI) and pacemaker/ICD implantation.
Non communicable disease and risk factorsRabin Dani
The document discusses non-communicable diseases (NCDs) such as heart disease, diabetes, cancer, and chronic lung disease. It notes that NCDs cause over 70% of deaths globally and are increasing in low and middle income countries. Key risk factors for NCDs include tobacco use, alcohol consumption, unhealthy diet, physical inactivity, obesity, high blood pressure, and high blood glucose. The status of NCDs in Nepal is described, with over 50% of deaths caused by cardiovascular or respiratory disease, cancer or diabetes. World Health Organization global targets for reducing NCD deaths and risk factors by 2025 are also presented.
This document provides a brief overview of India's healthcare system and macro environment. It discusses key topics such as:
- The burden of disease in India, including communicable diseases and non-communicable diseases. NCDs are projected to account for over half of India's disease burden by 2025.
- Healthcare market size, which has grown significantly but remains fragmented. Private sector delivery dominates the market.
- Health infrastructure challenges, such as shortages of hospital beds, doctors, and other medical professionals compared to international benchmarks.
- Specialist shortages, with estimates that only 700 gastroenterology surgeons serve India's population of over 1 billion people.
In summary, the document outlines
A Descriptive Study to Assess the Knowledge and Practices Regarding COPD Prev...ijtsrd
A descriptive study to assess the knowledge and practices regarding COPD prevention and management among staff nurses in selected hospital of district Patiala. The global burden of disease study reports a prevalence of 251 million cases globally in 2016. Globally, it is estimated that 3.17 million deaths were caused by the disease in 2015 that is, 5 of all deaths globally in that year . COPD is an important cause of mortality and morbidity in our country and all over the world. Prevalence of COPD is being anticipated to increase due to continuing risk factors and aging of society. Although, COPD is a disease involving the respiratory medicine experts, its symptoms and diagnostic criteria should also be known by the primary healthcare providers considering its economic burden.The study is non experimental descriptive method and data was collected through convenient sampling technique i.e self structured questionnaire and check list. The analysis was done through ANNOVA analysis test. Practices like hand washing, proper medication, knowledge regarding medicines, oxygen therapies, diagnostic tests spirometry , pulmonary rehabilitation, infection control techniques, non invasive ventilation, inhalation techniques, and therapeutic outcomes regarding COPD prevention and management will be average among staff nurses. Lovekirat Singh | Dr. Priyanka Chaudhary | Mrs Raman Deep Kaur "A Descriptive Study to Assess the Knowledge and Practices Regarding COPD Prevention and Management among Staff Nurses in Selected Hospital of District Patiala" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47623.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/47623/a-descriptive-study-to-assess-the-knowledge-and-practices-regarding-copd-prevention-and-management-among-staff-nurses-in-selected-hospital-of-district-patiala/lovekirat-singh
This study aimed to determine the prevalence of cardiovascular diseases among diabetes patients attending Kampala International University Teaching Hospital. The study found a cardiovascular disease prevalence of 54.1% among the 98 diabetes patients. Hypertension was the most common complication at 53%, followed by diabetic retinopathy at 14%. Poor blood sugar monitoring and control was also observed. The study concludes that the cardiovascular disease prevalence among diabetes patients is high, calling for improved diabetes management and care.
Dr vijay pneumococcal disease prevention in older adults 2020vkatbcd
The document provides details about Dr. Vijay K. Agrawal including his credentials and positions held. It also includes two disclosure statements indicating that Dr. Agrawal does not have any financial interests or arrangements that could be perceived as a conflict of interest. The rest of the document appears to be a slide presentation on pneumococcal disease.
This document discusses lifestyle-related diseases and their impact on the kidneys. It begins by noting the large global and national impact of non-communicable diseases (NCDs) like hypertension, diabetes, obesity, and smoking, which are the leading causes of kidney disease. The document then discusses factors that can cause progression of chronic kidney disease (CKD) like proteinuria and podocyte injury. It also outlines how conditions like diabetes and hypertension can specifically damage the kidneys and lead to CKD. The high costs of renal replacement therapy in India are also noted.
Article Type: Editorial
Title: Changing and Challenging Scenario of Burden of Disease
Year: 2022; Volume: 2; Issue: 1; Page No: 3 – 4
Author: Dr. P.K. Govindarajan
10.55349/ijmsnr.20222134
Affiliation: Professor, Department of Community Medicine, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry (UT), India.
Email ID: drpkgr@gmail.com
Article Summary:
Submitted : 15-February-2022
Revised : 27-February-2022
Accepted : 15-March-2022
Published : 31-March-2022
Similar to Burden of cardiovascular diseases in Indians: Estimating trends of coronary artery disease and using low cost risk screening tools (20)
Movement disorders: A complication of chronic hyperglycemia? A case reportApollo Hospitals
A 77-year-old man presented with bilateral choreic movements that had developed over the past month. He had a history of poorly controlled type 2 diabetes. At admission, he was found to have severe hyperglycemia without ketosis. A CT scan showed hyperdensity in the putamen and lenticular nucleus. Treatment with insulin, haloperidol, and glycemic control led to regression of the choreic movements within 4 days. Chorea secondary to nonketotic hyperglycemia is a rare complication of uncontrolled diabetes that is usually reversible with normalization of blood glucose levels and neuroleptic treatment. The pathophysiology is thought to involve metabolic disturbances from hyperglycemia impairing neurotransmission in basal ganglia structures and
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
This case report describes the successful treatment of an acardiac twin (TRAP sequence) via intra-fetal laser ablation of the umbilical vessels. The patient was a 26 year old pregnant woman at 18 weeks gestation with twins, one normal (Twin A) and one acardiac (Twin B). By 26 weeks, Twin A showed signs of cardiac failure so laser ablation was performed to interrupt blood flow from Twin B to A. This minimally invasive procedure used an Nd: YAG laser to coagulate the vessels under ultrasound guidance. The pregnancy continued successfully, with Twin A delivered via c-section at 35 weeks in good condition. This report demonstrates that intra-fetal laser ablation can safely
Improved Patient Satisfaction At Apollo – A Case StudyApollo Hospitals
1) Indraprastha Apollo Hospital utilized patient satisfaction surveys called Voice of Customer (VOC) tools to identify ways to improve various hospital departments and services.
2) Factors that contributed to an increasing trend in VOC scores over 1.5 years included leadership commitment to quality improvement, improved efficiency, superior clinical care, soft skills enhancement for staff, and improved patient information and complaint resolution.
3) Through consistent efforts such as staff training, improved processes, and addressing issues identified in VOC surveys, Apollo Hospitals achieved higher than target patient satisfaction scores, creating loyal patients with memorable hospital experiences.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
A 34-year-old woman presented with accidental ingestion of mercury that was used in her household to preserve grains. She experienced abdominal radiopaque shadows on X-ray that cleared after two days. Mercury poisoning can result from inhalation, ingestion, or absorption and affects the neurological, gastrointestinal, and renal systems. Diagnosis involves determining exposure history and elevated mercury levels in blood and urine. Supportive treatment includes removal of contaminated materials, irrigation, activated charcoal, chelation agents, and hemodialysis in severe cases.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
This case report describes a 24-year-old man who presented with fever, rash, abdominal pain, and vomiting. He had been taking carbamazepine for seizures. His symptoms and lab results met the criteria for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as drug hypersensitivity syndrome. DRESS is caused by certain drugs and is characterized by fever, rash, eosinophilia, and involvement of internal organs like the liver or lungs. Carbamazepine was withdrawn and steroids were started, leading to improvement. The report reviews the characteristics, diagnosis, and treatment of DRESS, noting it is important to identify the causative drug and avoid re-
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
This document describes two cases of unusual manifestations of dengue fever. Case 1 is a 40-year-old man who presented with fever, headache, body aches, and a rash who developed hepatitis, thrombocytopenia, and respiratory distress from dengue hemorrhagic fever. Case 2 is a 24-year-old man who presented with fever and was found to have an intraocular hemorrhage, retinal detachment, ARDS, myocarditis, and hepatitis, also from dengue hemorrhagic fever. The document then reviews atypical neurological and gastrointestinal manifestations that have been reported with dengue infection.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
This document discusses pediatric liver transplantation. It begins by stating that pediatric liver transplantation is now an established treatment for end-stage liver failure from various causes, with excellent results due to improved immunosuppressive regimens, surgical techniques, and intensive care. It then discusses the historical development of liver transplantation, including the first attempts in the 1960s and key innovations like cyclosporine in the 1980s. The most common indications for pediatric liver transplantation are discussed as extrahepatic biliary atresia and acute liver failure. The document provides an overview of the pre-transplant evaluation process and post-transplant medical management and immunosuppression. It notes that living-related transplantation has helped address the shortage of donor l
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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Burden of cardiovascular diseases in Indians: Estimating trends of coronary artery disease and using low cost risk screening tools
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3. world population.1,2 World Health Organization (WHO) has
projected 55 million NCD related deaths by 2030.3 Around 80%
of all deaths in 2008 were due to NCDs in developing countries,
with 48% of these occurring in individuals below 70 years of
age.3 As per World Economic Forum and Harvard School of
Public Health's collaborative report, an increase in NCD
related years of life lost (YLLs) due to premature mortalities
may have financial implications to the tune of US$ 30 trillion
on the global economy in the next 20 years.4 Given these
concerns, United Nations dedicated its High-Level Meeting to
NCDs in 2011 in which heads of states gave their commitment
to set up specific measures in a time bound fashion to address
NCD burden and World Health Assembly in 2012 embarked on
a global target of 25% reduction in NCD caused mortalities by
2025.5 This target will require identification and sealing of
gaps in health infrastructure and scaling up of surveillance
methods for collection of local reliable data.
The global strategy to combat NCDs demands that in
resource constrained settings, public resources may first be
concentrated against diseases with catastrophic conse-quences.
It is with an intention to keep focus of the national
agenda in India on CVD that we review in this article the
burden of cardiovascular diseases (CVD) in India with partic-ular
emphasis on coronary artery disease (CAD), risk factors
for CAD and need for shifting the focus of healthcare system
to prevention rather than treatment of sick persons alone.
2. Why reduction in cardiovascular diseases
(CVD) is the best global buy?
With 30% of the deaths worldwide, CVDs and circulatory
diseases were the topmost cause of death in 2010.1 Absolute
numbers of deaths due to individual CVDs are provided in
Table 1. Ischemic heart disease (IHD) and stroke with 7million
and 5.9 million of global deaths respectively, accounted for
one quarter of deaths with an increase in premature mortal-ities.
1,2 Though the global disability-adjusted life years
(DALYs) remained constant from 1990 to 2010, 54% of the 2.5
billion DALYs in 2010 were attributed to NCDs of which 11.8%
were due to CVDs and circulatory diseases.2 DALYS from IHD
increased by 29.2%, stroke (both hemorrhagic and ischaemic)
by 18.9% and hypertensive heart disease by 37.4%. Both gen-ders
aged 15e49 years were equally affected.1 In women, with
61.5% of deaths due to NCDs, CVD mortalities surpassed even
maternal mortalities.6 It is estimated that with a cost of nearly
US $863 billion, strategic public health allocations aimed at
reducing exposure to CVD risk factors will provide respite to
populations from a vicious ‘health poverty trap’.
3. CVD burden in India and its economic
repercussions
Mortality data gathered from vital registration system, with
medical certification of cause of death or survey with verbal
autopsy can help in assessment of health programs targeting
reduction in premature mortality from NCDs by 25%, as per
the global NCD mortality targets laid down by WHO.5 In India,
the vital event registration system under the civil law act of
1969 requires each death to be registered. Despite this, 33.1%
of deaths were not registered in 2009 with lowest registration
of less than 30% in Bihar and Arunachal Pradesh; 90% and
more in only Kerala, Punjab, Goa, Mizoram and Sikkim.7 India
will therefore need to undertake concrete steps to improve the
vital event registration system. The 2004e2005 ‘Special Survey
of Deaths’ by Registrar General of India and Centre for Global
Health Research, Toronto, observed 42% of all deaths in India
as due to NCDs with 56% in urban and 40% in rural areas.9
Another study by Mahal el al estimated 60% of the 8.1
million deaths from all causes in 2004 due to NCDs.10 CVDs
emerged as leading cause of death in both genders, all ages,
rural and urban areas.9 The projected rise in YLL due to CAD
from 7.1 million in 2004 to 17.9 million in 2030 in India, with
largest proportion of deaths being in the age group 25e69
years, requires an immediate action by all stakeholders.9,11
The Southern States appear to have the highest proportions
(25%) of deaths due to CVDs and Central region States have the
lowest (12%).9
Cross sectional epidemiological studies In India have been
carried out to find prevalence rates of coronary artery disease
(CAD) in different regions of the country at different times
with inadequate sample sizes and often using ‘convenience
sampling’. This makes it difficult to make inter-temporal and
interregional comparisons. These studies have reported an
increase in CAD prevalence in urban parts from 1% to 2% in
1960s to 10e12% in 2012 and from 0.5% to 1% to 4e5% in rural
parts.12,13 The projected rise in DALYs lost due to CAD in India
from 2000 to 2020 is 14.4 million.14 CREATE registry observed
presence of severe form of coronary atherosclerosis in young
Indians with a mean age of presentation of Acute Coronary
Syndrome (ACS) of 57.5 years.15,16 Another large registry from
Kerala, a state with health indicators close to those of devel-oped
countries, also observed lower mean age (60 years) at
presentation of ACS.17 Sixty percent of ACS patients presented
with STEMI and a good proportion of these were from poor
families, who also had higher 30 day mortalities.15 Thus In-dians
of all socioeconomic strata are facing a hostile cardio-vascular
environment and poor suffer the most due to less
likely affordability of costly in-hospital treatment or percep-tions
of the healthcare personnel.15
Table 1 e Relative mortalities due to cardiovascular and
circulatory diseases in 2012.1
Cause All age deaths
(million)
Percentage
Rheumatic heart disease 0.3 1.9%
Ischemic heart disease 7.0 44.9%
Cerebro vascular diseases (Stroke) 5.9 37.8%
Hypertensive heart disease 0.9 5.8%
Cardiomyopathy and myocarditis 0.4 2.6%
Atrial fibrillation and flutter 0.1 0.6%
Aortic aneurysm 0.2 1.3%
Peripheral vascular disease 0.05 0.3%
Endocarditis 0.05 0.3%
Other cardiovascular
0.7 4.5%
and circulatory diseases
Total 15.6
a pol l o m e d i c i n e 1 1 ( 2 0 1 4 ) 1 4 8 e1 5 6 149
4. 150 a p o l l o me d i c i n e 1 1 ( 2 0 1 4 ) 1 4 8 e1 5 6
Though the high mortality rates due to CVDs in India may
have major economic repercussions, the analysis on eco-nomic
impact of CVDs remains incomplete, because of
inadequate coverage of these diseases in India's vital event
registration and absence of surveillance systems for disease
specific mortality data. It has been projected that GDP of
India will suffer a 1% loss during the next 10 years due to
heart diseases, stroke and diabetes.18 The financial implica-tions
of CAD on individuals as measured by ‘out of pocket
expenditure’ are substantial. Mahal et al. estimated that US$
15.52 billion (INR 846 billion) were spent by Indians as out of
pocket expenditure on health care in 2004, a 268% increase
from US$ 5.8 billion (INR 315 billion) spent in 1995e96.10 This
was 3.3% of country's GDP in that year with share of NCDs
increasing significantly from 31.6% in 1995e96 to 47.3% in
2004.10 However, such expenditures may also indicate
increased paying capacity of individuals due to growth of
Indian economy as well as increased awareness among in-dividuals
due to higher literacy rates and media coverage.10
But given the high rate of socio-economic inequalities in
India, such high out of pocket expenditures are undesirable.
Furthermore, the estimated annual income loss from NCDs
was US$ 18.34 billion (INR 1 trillion) in 2004.10 This figure may
be underestimation of actual losses as it has not taken into
account public subsidies on health expenditure (which lower
the net national savings/investments), impact of mortalities
and morbidities on household work allocation, schooling of
children and burden to caregivers and effect on labour
market.10
Given this high burden of CVDs and its economic impli-cations,
Government of India initiated National Program for
Prevention and Control of Cancer, Diabetes, CVDs and Stroke
in 2008. This program has recently been integrated with
another vertical program, National Rural Health Mission.
Though this is a welcome step, but for its effectiveness,
complete coverage of the country alone will not be enough. It
will also be important to have monitoring and quality control
measures in place from the beginning, so that best care
practices can be provided to the population.
4. Why Indians are at higher risk of CAD?
There are no large prospective studies on CHD risk factors in
Indians. The INTERHEART study and INTERSTROKE study
involving several countries established that conventional risk
factors for MI and stroke (both hemorrhagic and thrombotic),
such as smoking, abnormal lipids, hypertension, diabetes,
high waist-hip ratio, sedentary lifestyle, psychosocial stress,
and a lack of exercise and consumption of fruit and vegetables
explained more than 90% of acute CHD events and strokes in
South Asians in both sexes and at all ages.19,20 Hypertension
emerged out to be significant contributor to stroke occurrence,
whereas raised sugar levels and abnormal lipids were related
more with ACS and stroke.19,20
Government of India established Integrated Disease Sur-veillance
Project (IDSP), a vertical program, in the country with
assistance from World Bank in 2004 to carry out NCD risk
factor surveillance initially in 7 states.21 The program could
not be scaled up. One of the major drawbacks with IDSP is its
lack of integration with healthcare system. A well designed,
financially viable surveillance program for NCD risk factors
using low cost, indigenous electronic technologies through
primary health care workers will go a long way in capturing
data and making it available to policymakers through a na-tional
database repository. The data capturing system inte-grated
with a decision support system can decentralize the
health system by allowing grass root worker to guide the in-dividual
to a comprehensive health promotion, treatment and
intervention program.
We discuss below the CAD risk factors prevalent in Indian
population.
4.1. Socio-demographic factors
As compared to USA, western European countries and Japan,
there is far more rapid pace of nutritional epidemiological
shift marked by shift in occupation structures, urbanization,
introduction of processed food, increased prevalence of
obesity, mass media and environmental toxins in India.22
Duality of food insecurity in the form of undernutrion and
obesity are visible and indicate failure of food systems to
provide optimal diets to the population.23 It has been
contemplated that through a rapid entry into the markets of
developing countries accompanied by mass marketing cam-paigns,
global multinational and beverage companies are
bringing about a very rapid nutritional transition from a
traditionally simple diet to a highly processed diet rich in
refined flour, salt, sugar and fat.22e24 Increase in diabetes,
childhood obesity and cardiovascular diseases has also been
linked to increased consumption of these highly processed
fast foods.25e30 However, in India the issue is more complex
due to presence of unregulated food vendors at nooks and
corners of almost every street in the country. The increased
consumption of energy dense foods and decrease in physical
activity along with the genetic makeup of the population and
other biological factors may have caused a surge in CVDs in
the country.
Though rural urban migration is an important factor in
increasing CAD prevalence in India, no nationally represen-tative
study on rural urban migration is available. A large
proportion of rural migrants shifted from agricultural sector to
less labor intensive industrial and service sectors and
contribute to urban slum population (52.4 million as per 2001
Census and 96.9 million in 2013).31,32 Though Government has
launched various schemes for the benefit of urban slum
population, these are seldom known to get trickled down to
end users because of problems with implementation. Evi-dences
exist for increased tobacco smoking and physical
inactivity among slum dwellers and lower socioeconomic
status.11 Studies have reported physical inactivity of the level
of 14.7% and 12.2% in urban and rural population.11 In an
ICMR's multi-centric study on NCD risk factors undertaken at
6 centres in Haryana, Tamil Nadu, Assam, Delhi, Maharashtra
and Kerala among men and women aged 15e64 years, tobacco
smoking and alcohol consumption were found to be highest in
periurban areas, whereas fruit and vegetable consumption
was low in rural and periurban population.33 Rural population
was however more active than their urban and periurban
counterparts and had lower BMI.33
5. 4.2. Behavioral risk factors
a pol l o m e d i c i n e 1 1 ( 2 0 1 4 ) 1 4 8 e1 5 6 151
Ebrahim et al. (2010) observed comparable prevalence of
obesity (37.8% versus 19.0%) and diabetes (13.5% vs. 6.2%) in
industrial migrants and urban men as compared to rural sib-lings
of industrial migrants.34 This is explained by increase in
median energy intake, dietary intake of meat, dairy product
and sugar in migrant population.35 The food balance sheets of
Food and Agriculture Organization (FAOSTAT) of the United
Nations also estimate an increase in available energy, protein
and fat with largest increase in fat consumption in Indians.36
The diet derived energy (kcal) from fat increased from 13.5% in
1971 to 19.4% in 2009.36 The 2004e05 National Sample Survey
Organization (NSSO) also observed a higher fat intake in urban
areas (48 g) as compared to rural areas (36 g) but similar energy
intake in both areas (2047 kcal in rural and 2020 kcal in urban
areas).37 Significantly, the number of meals taken at home has
decreased by 1.66% in the urban area and 0.57% in rural areas
from 1993 to 94 to 2004e05.37 The survey does not provide data
on types of meals taken away from home. Acquiring exact
estimates of number and quality of meals taken outside is
important as frequent consumption of fast food is known to
increase prevalence of obesity.38 In India, estimated smoking
associated deaths have increased within a short period - from
930,000 in 2008 to 1million in 2010.39 Tobacco consumption in
India is largely through bidis (sun dried tobacco rolled in leaf)
with 8e10 bidis being smoked for every cigarette.39 About 100
million premature deaths in men aged 35 years occurring
between 1910 and 2010 in India have been ascribed to tobacco
consumption, of which 77 million deaths were due to bidi
consumption.39 The Global Adult Tobacco Survey (GATS)
estimated that one out of every three Indian adults (around
275 million) use tobacco in one form or the other; 164 million
use smokeless tobacco, 69 million only smoke and 43 million
smoke as well as use smokeless tobacco.40 Overall prevalence
of tobacco use among males is 48% and 20% in females.
Regional variations in prevalence of current smoking range
from 10% in Maharashtra to 40% in Mizoram and that of
smokeless tobacco varied from 5% in Kerala to 50% in Miz-oram.
21 Initiation of smoking occurred at a younger age in
Indians. Mean age of initiation of smoking varied from 17 to 20
years with lowest among females in Andhra Pradesh (14
years).21 Lower levels of education and income are considered
to be associated with higher consumption of tobacco.41 Thus
interventions need to target reduction of tobacco consump-tion
in younger age groups.
4.2.1. Physiological risk factors
Major physiological risk factors for CAD appear to be
increasing in Indians. Systolic and diastolic BP have been
shown to be strong, independent continuous variables
significantly associated with cardiovascular mortality and all-cause
mortality.42 As many as 54% of deaths due to stroke and
24% of deaths due to CAD are due to hypertension in India.43 It
has been estimated that reduction of blood pressure by
2 mm Hg can prevent 151,000 stroke and 153,000 CAD deaths
in India.43 Review of studies conducted between 1994 and 2013
indicates that the prevalence of hypertension is around
20e48% in urban and 7e36% in rural population.12,44e52 Gupta
et al. (2013) reported an age-adjusted prevalence of pre
hypertension in men and women as 40.2% and 30.1% respec-tively
and of hypertension as 32.5% and 30.4%.48 Prevalence of
pre hypertension in the IDSP study was higher and ranged
from 46% to 62% in urban areas and 41%e54% in rural areas,
with an overall prevalence rate of 43%e58%.21 Pre hyperten-sive
individuals are known to have at least one more CVD risk
factor, suclinical atherosclerosis and significantly higher CVD
events as compared to normotensives.53e57 Lifestyle modifi-cations
including diet rich in potassium (fruits and vegeta-bles),
decrease in sodium intake (2400 mg/day), moderation
in alcohol intake and physical activity (30 min/day) can
reduce systolic blood pressure and incidence of hyperten-sion.
58 Screening of population for pre hypertensive stage is
vital for undertaking population level prevention measures.
The proportion of fat in Indians is high and centrally
(abdominal obesity) distributed for any given weight.59 This
pattern of central obesity is known to be associated with
diabetes, hypertension and insulin resistance.
Prevalence of diabetes has increased from 1e3% to
10e15% in urban areas in last 20 years and was 3e5% in rural
areas.60 The ICMR multicentric study using WHO steps for
surveillance observed that proportion of men and women
with glucose levels 126 mg/dl was 11.4% and 10.3% respec-tively
among urban, 6.2% and 5.7% among rural and 8.5% and
9.6% among periurban population.33 Hypercholesterolemia
(cholesterol 200 mg/dl) was present in one third of urban
men and women and one quarter of rural and periurban
population.33
4.2.2. Challenges to foetal programming e a risk for CAD
The risk of CAD is also known to increase if intrauterine life/
early childhood is challenged by nutritional and environ-mental
toxin insults or metabolic diseases like diabetes in the
mother.61,62 Epigenetic modifications including changes in
DNA methylation, histone modifications and non-coding RNA
expressions, caused by nutritional imbalance and exposure to
environmental toxins during development, may be respon-sible
for the early development of CAD and its risk factors
such as blood pressure, factor VIII concentration, fibrinogen
concentration and glucose intolerance.63e67 The New Delhi
Birth Cohort of persons born between 1969 and 1973 observed
a correlation between adult metabolic syndrome and
impaired glucose tolerance with BMI gain in infancy.68
4.2.3. Emerging risk factors
The care model for CAD patients targets conventional risk
factors including lowering of cholesterol, management of
hypertension and diabetes. Despite the advances in CAD risk
factor management, half of the MI and stroke are estimated to
be occurring in patients well below the recommended goals.69
Concentration of CRP, an inflammatory marker, has been
shown to be associated with a wide variety of disorders
including risk of CAD, ischaemic stroke, vascular mortality,
cancer, etc.70 Recently, addition of CRP and fibrinogen to risk
prediction models using conventional risk factors like age,
sex, smoking status, blood pressure, history of diabetes, total
cholesterol and HDL cholesterol levels to categorize in-dividuals
into predicted 10-year CVD risk factor categories
[“low”(10%), “intermediate” (10% to 20%) and “high” (20%)]
was shown to result in prevention of two additional CAD or
6. 152 a p o l l o me d i c i n e 1 1 ( 2 0 1 4 ) 1 4 8 e1 5 6
stroke event over a period of 10 year per 800 to 1000 in-dividuals
in intermediate risk category (Emerging Risk Factor
Collaboration study).71 Unlike CRP and fibrinogen, Lip-oprotein(
a) (Lp[a]) and lipoprotein associated phospholipase
A2 (Lp-PLA2) are continuous and independent markers for
CAD.72,73 However, Lp(a) is specific marker for vascular out-comes
in contrast to Lp-PLA2 which is not exclusive to these
events.72,73 Genetic studies indicate a causal relationship of
Lp(a) with CAD risk. Higher benefits of cholesterol lowering
are suggested in individuals with high levels of Lp(a).72 Addi-tion
of values of apolipoprotein B and apolipoprotein A-I, lip-oprotein(
a), or lipoprotein-associated phospholipase A2 to
total cholesterol and HDL cholesterol slightly improved CVD
prediction in individuals without baseline CVD with a median
follow up for 10.4 years.74
The 1131T C (rs662799) promoter polymorphism of the
apolipoprotein A5 (APOA5) gene is strongly related to triglyc-eride
concentrations and modestly associated with low HDL
cholesterol and apolipoprotein AI concentration and high
apolipoprotein B levels.75 A 32.6% or 9.2 mg/dl increase in TG
levels in individuals homozygous for C alleles as compared to
non-carriers was observed in Emerging Risk Factor Collabo-ration
study of cohorts of western population. Studies in In-dian
population have shown a higher triglyceride levels in
individuals with 1131 C risk allele of APOA5 gene.76e78 Be-sides
these biological risk factors, addition of measures of
adiposity (Body Mass Index (BMI), waist circumference, waist-to-
hip ratio) to the risk prediction models has recently been
shown not to improve risk prediction in populations of
developed countries.79 However, as most of these studies have
analyzed results from studies in European population, there-fore
more studies in population of developing countries like
India are required.
5. Addressing prevention of heart diseases
The three pillars of prevention include health promotion
activities, early detection and management of existing dis-ease.
An effective CVD prevention program will need to be
multidisciplinary, multi professional and multi stakeholder
so as to focus on social, environmental and policy de-terminants,
thereby supporting people to make healthy
choices. The three pillars of prevention of CVDs/NCDs can be
addressed through surveillance, development of knowledge
(what works in a given community) and its dissemination,
involving communities, creating health promoting environ-ments,
building capacity at different levels of the health
system and policy level changes. The surveillance at regular
intervals is important for understanding and evaluating the
preventive activities. Due to deep embedment of risk factors
into the cultures of societies, promotion activities need to
focus families and communities.
Both population based measures to reduce the risks
of developing CVDs/NCDs and targeted interventions in those
at highest risk will be required to halt and reverse the
CVD epidemic. There are enough evidences of the impact
of prevention of CVD risk factors. A reduction of heart
attack risk by 50% is observed following one year of quitting
smoking.80 Similarly a decrease in risk by 25%e30% on
10e12% reduction in systolic blood pressure and total
cholesterol has been documented.80 Given these strong evi-dences,
Global Cardiovascular Disease Task Force supports
four exposure targets to reduce premature mortality due to
CVDs (Box 1).81
Box 1
Exposure targets to prevent CVDs supported by Global
Cardiovascular Disease Task Force.84
1. Physical activity: 10% relative reduction in prevalence
of insufficient physical activity
2. Raised blood pressure: 25% relative reduction in
prevalence of raised blood pressure
3. Salt/sodium intake: 30% relative reduction in mean
population intake of salt, with an aim of achieving
recommended level of 5 g/d (2000 mg of sodium)
4. Tobacco: 30% relative reduction in prevalence of cur-rent
tobacco smoking
Treatment of individuals through a combination pharma-cotherapy
approach (fixed dose of aspirin, a statin and one or
two blood pressure reducing drugs) has been viewed as a harm
reduction strategy similar to nicotine replacement therapy in
tobacco smokers with a potential of increasing compliance
and to reach the populations of developing countries .82,83 The
safety and efficacy of such a combination pharmacotherapy is
a subject of research globally.84 UMPIRE study in participants
with established CVD from India and Europe observed that
polypill can increase adherence to therapy and reduce systolic
blood pressure and LDL cholesterol.85 However exercise, a
cheap strategy with low adverse effects, is thought to have
more benefits than pharmacotherapy.86 In a diabetes pre-vention
program study, overweight participants assigned to
30 min walking per day, 5 days a week and decreasing their
caloric intake through reduction in fat consumption with a
target of reduction of 5e7% in weight, had a higher (58%)
reduction/delay in onset of diabetes as compared to controls.
The moderate activity group performed better than the
one on metformin.87 We argue for stronger advocacy of cheap
prevention strategies like regular exercise with dietary
modifications for reducing the CVD risk as this is likely to
produce overall health benefits to individuals as well as
population.
Early detection of CVD will be required for prevention of
development of disease or slowing down its progress. This
needs development and validation of simple cost effective
tools. Gaziano et al. compared laboratory based method using
age, systolic blood pressure, smoking status, total cholesterol,
reported diabetes status, and current treatment for hyper-tension
for assessment of CVD risk with non-laboratory-based
model, substituting body-mass index for cholesterol and
observed that both models were able to predict fatal events
with a comparable c statistics.88 The limitation of this study is
that this risk score has been tested in US population and will
require validation in India. In India, two simple Risk Scores
7. a pol l o m e d i c i n e 1 1 ( 2 0 1 4 ) 1 4 8 e1 5 6 153
have been devised by Mohan et al.89 and Ramachandran et al90
The Indian Diabetes Risk Score (IDSR) developed by Mohan
et al. using two non-modifiable risk factors (age and family
history) and two modifiable risk factors (physical activity and
waist circumference) was useful as screening tool for finding
the prevalence of diabetes and pre-diabetes.89,91,92 A similar
Box 2
Shifting towards global health partnerships (GHP)
simple tool will need to be developed for heart attack and
validated in a community setting for its sensitivity and spec-ificity
as well as its use by a community worker. This is chal-lenging
given the need to correlate with actual outcomes of
interest (MI) in a prospective cohort setting.
5.1. Need for global health partnerships
Though India shares a large proportion of the CVD burden, the
research capacity and financial investments are often inade-quate.
These lead to deficiencies in its policies, advocacy,
planning strategies and legislations. On the other hand,
developed countries further increase their scientific produc-tivity
by attracting scientific immigration by providing
better opportunities to persons with high standards from
developing countries. India needs to create lucrative research
opportunities for its brightest, database for technical and
operational factors for making prevention and control of CVDs
feasible using national and international multidisciplinary
collaborations. Box 2 shows the impact of global health part-nerships
in combating a disease of public health importance
in various parts of the world.
6. Conclusion
Though there are evidences of higher burden of CAD in India,
disease surveillance nationally representative data for mor-talities
and risk factors, generated through both public and
private healthcare setups, is essential for careful strategic
policy level as well as individual level interventions for pre-vention
and control of CAD. India will also require to create
database for technical and operational factors for making
prevention and control of CVDs feasible using national and
international multidisciplinary collaborations to halt the
onslaught of these diseases.
Conflicts of interest
All authors have none to declare.
8. 154 a p o l l o me d i c i n e 1 1 ( 2 0 1 4 ) 1 4 8 e1 5 6
r e f e r e n c e s
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