Low and middle income countries now account for over 75% of global cardiovascular disease deaths. In India, cardiovascular diseases are a growing epidemic due to increasing risk factors like tobacco use, unhealthy diets, and physical inactivity accompanying urbanization. The National Programme for Prevention and Control of Cardiovascular Diseases aims to promote healthy lifestyles and provide screening, treatment and management of cardiovascular diseases nationwide. Globally, the WHO's action plan targets a 25% reduction in premature deaths from non-communicable diseases like cardiovascular disease by 2025 through cooperation between countries.

1. Changing Epidemiology of
Cardiovascular Diseases
Presenter: Dr. Goral Gondnale Vora
Department of Community Medicine
Jawaharlal Nehru Medical College, Sawangi(M)

2. Content
• Changing Epidemiology
• Problem Statement
• Global Burden
• Indian Scenario
• Changing Nature of Risk Factors
• NPCDCS
• Global Action Plan

3. Changing Epidemiology
• The epidemiologic transition is the shift in
mortality from childhood infectious diseases,
nutrient deficiencies, and epidemics at all ages
to degenerative and lifestyle-related diseases
at a later age.
• Many developing countries are undergoing
this transition.

4. • Improved public health measures and
medical care help people live longer, more
productive lives; concurrently, these countries'
populations often experience changes in diet
and reductions in physical activity that lead to
higher prevalence of cardiovascular disease
(CVD) and CVD risk factors.

5. Problem Statement
The mortality data from the Global Burden of
Diseases Studies has revealed that
Cardiovascular diseases such as coronary
heart disease are important causes of death in
low and middle income countries.

7. World Scenario
WHO. Preventing Chronic Diseases, 2005

8. WHO Key Facts of CVD, 2016
• CVDs are the number 1 cause of death globally: more
people die annually from CVDs than from any other
cause.
• An estimated 17.5 million people died from CVDs in
2012, representing 31% of all global deaths. Of these
deaths, an estimated 7.4 million were due to coronary
heart disease and 6.7 million were due to stroke .
• Over three quarters of CVD deaths take place in low- and
middle-income countries.
• Out of the 16 million deaths under the age of 70 due to
non-communicable diseases, 82% are in low and middle
income countries and 37% are caused by CVDs.

9. Cardiovascular diseases in India Challenges and way ahead

10. Increasing Burden of CVD in India
Ezzati M, et al. WHO 2004

11. Projections of CHD Cases in India
Gupta R, Gupta VP. Indian Heart J. 1996; 48:241-245.

12. CHD Prevalence in Urban Indian Population
Ghaffar et al. BMJ 2004; 328:807-10

13. CHD Prevalence in Rural
Population
Gupta R, Gupta VP. Indian Heart J. 1996; 48:241-245.

14. Cardiovascular diseases in India Challenges and way ahead

15. Heterogeneity of Coronary Heart
Disease Risk Factors
• There are differences in social and economic
circumstances, lifestyles, anthropometric
measures and diseases both between Indians,
Pakistanis, and Bangladeshis and between all
South Asians and Europeans.
Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and
European origin populations: cross sectional study – Raj Bhopal et al.

16. Changing Nature of Risk
Factors

17. CVD as an emerging epidemic
• The emergence of the CVD epidemic in the
developing countries during the past two to
three decades has attracted less comment and
little public health response, even within
these countries.
• It is not widely realized that at present, the
developing countries contribute a greater
share to the global burden of CVD than the
developed countries.

18. Early age of CVD Deaths in
Developing Countries
• In 1990, the proportion of CVD deaths
occurring below the age of 70 years was
26.5% in the developed countries compared
with 46.7% in the developing countries.
• The contrast between the truly developed
“established market economies” (22.8% of
CVD deaths at ,70 years) and a large
developing country like India (52.2%) was
even sharper.

19. Epidemiological Transition
• The life expectancy in India rose from 41.2 years
in 1951-1961 to 68.5 years in 2011-2015.
• This was principally due to a decline in deaths
occurring in infancy, childhood, and adolescence
and was related to more effective public health
responses to perinatal, infectious, and nutritional
deficiency disorders and to improved economic
indicators such as percapita income and social
indicators such as female literacy in some areas.

20. Lifestyle Changes
• There is an increase seen in CVD morbidity and
mortality as a consequence of adverse lifestyle
changes accompanying urbanization and
industrialization.
• An increase in body weight (adjusted for height),
blood pressure, and cholesterol levels in Chinese
population samples aged 35 to 64 years, between
the two phases of the Sino-MONICA study (1984 to
1986 and 1988 to 1989) and the substantially higher
levels of CVD risk factors in urban population groups
compared with rural population groups in India
provide evidence of such trends.

21. Nutrition Transition
• The global availability of cheap vegetable oils and
fats has resulted in greatly increased fat
consumption among low-income countries. The
transition now occurs at lower levels of the gross
national product than previously and is further
accelerated by rapid urbanization.
• The globalization of food production and
marketing is also contributing to the increasing
consumption of energy-dense foods poor in
dietary fiber and several micronutrients.

22. Tobacco Trends
• The rising tobacco consumption patterns in
most developing countries contrast sharply
with the overall decline in the industrial
nations.
• India, China, and countries in the Middle
Eastern Crescent will by then have tobacco
contributing to >12% of all deaths. In India
alone, the tobacco attributable toll will rise
from 1.4% in 1990 to 13.3% in 2020.

24. Socio-economic Status
• There is a significant positive correlation of
cardiovascular mortality with obesity, visible
fat intake, and sugar/jaggery intake and
negative correlation with fruit and vegetable
consumption. On the other hand no
correlation of various indices of poverty such
as illiteracy, infant mortality rate and fertility
rates with cardiovascular mortality is
observed.

25. Hypertension
• Hypertension is the most important risk factor
for cardiovascular and cerebrovascular
diseases. The prevalence of hypertension has
been exponentially increasing in India and
many developing countries whereas the rates
of awareness, treatment and control remain
dismally low.

26. The prevalence of hypertension
ranges from 20-40% in urban adults
and 12-17% among rural adults. The
number of people with hypertension
is projected to increase from 118
million in 2000 to 214 million in
2025, with nearly equal numbers of
men and women.

27. NPCDCS
• The Focus of NPCDCS:
Promotion of Healthy Lifestyle
Early Diagnosis and Management of
Diabetes, Hypertension, Cardiovascular
Diseases & Common Cancers

28. Tiers under NPCDCS
CHC
• ‘NCD’ Clinic
• Screening, Diagnosis and Management undertaken
DH
• CCU, NCD Clinic
• Preventive, Supportive and Curative Services
TCC
• Focussing especially on Cancer Treatment

29. Strategies
• Health promotion, awareness generation and
promotion of healthy lifestyle
• Screening and early detection
• Timely, affordable and accurate diagnosis
• Access to affordable treatment
• Rehabilitation
Programme Data of NPCDCS as on 31st March 2015

30. Action on the Global Level
Under the leadership of the WHO, all Member
States ( 194 countries) agreed in 2013 on
global mechanisms to reduce the avoidable
NCD burden including a "Global action plan
for the prevention and control of NCDs 2013-
2020". This plan aims to reduce the number of
premature deaths from NCDs by 25% by 2025
through nine voluntary global targets.

31. Voluntary Global Targets
• A 25% relative reduction in risk of premature
mortality from cardiovascular diseases, cancer,
diabetes, or chronic respiratory diseases.
• At least 10% relative reduction in the harmful
use of alcohol, as appropriate, within the
national context.
• A 10% relative reduction in prevalence of
insufficient physical activity

32. • A 30% relative reduction in mean population
intake of salt/sodium.
• A 30% relative reduction in prevalence of
current tobacco use in persons aged 15+
years.
• A 25% relative reduction in the prevalence of
raised blood pressure or contain the
prevalence of raised blood pressure, according
to national circumstances.

33. • Halt the rise in diabetes and obesity.
• At least 50% of eligible people receive drug
therapy and counselling (including glycaemic
control) to prevent heart attacks and strokes.
• An 80% availability of the affordable basic
technologies and essential medicines,
including generics, required to treat major
noncommunicable diseases in both public and
private facilities.

34. Taking Action
• In line with WHO’s Global action plan for the
prevention and control of NCDs 2013- 2020, in
2015 India became the first country to
develop specific national targets and
indicators aimed at reducing the number of
global premature deaths from NCDs by 25%
by 2025

35. • India’s National Monitoring Framework for
Prevention and Control of NCDs calls for a 50%
relative reduction in household use of solid
fuel and a 30% relative reduction in
prevalence of current tobacco use by 2025

36. • India has implemented WHO’s Framework
Convention on Tobacco Control aimed at
reducing the demand for tobacco products.
The country has prohibited sales of tobacco
products around educational institutions,
restricted tobacco imagery in films and TV
programmes, banned some smokeless
tobacco products and developed tobacco-free
guidelines for educational institutions.

37. 22 September, 2016: “Global Hearts”, a new
initiative from the World Health Organization
(WHO) and partners launched on the margins
of the UN General Assembly, aims to beat
back the global threat of cardiovascular
disease, including heart attacks and strokes -
the world’s leading cause of death.

38. To Summarize...
Low- and moderate-income nations account for
approximately 78% of the world’s deaths from
non-communicable disease and 85% of non-
communicable disease prevalence. Non-
communicable disease occurs disproportionately
among people in their most productive years of
youth and middle age. A dramatic shift is
expected to occur by 2025 when non-
communicable diseases will account for an
increasing proportion of disease burden in low-
income nations.

39. • Trends in Changing Risk Factors and
epidemiological transition are asking for the
actions to be taken.
• In India, NPCDCS and Global Action Plan are
working towards the control or halt in this
evolution.

41. References
• Coronary Heart Disease in Low Socioeconomic Status S
ubjects in India: “An Evolving Epidemic” -
Rajeev Gupta,KD Gupta
• WHO Factsheet- Cardiovascular Diseases
• Global Action Plan For The Prevention And Control Of
Noncommunicable Diseases 2013-2020
• Emerging Epidemic of Cardiovascular Disease in
Developing Countries- K. Srinath Reddy
• National Programme For Prevention and Control of
Cancer, Diabetes, Cardiovascular Disease and
Stroke(NPCDCS)

42. • Burden of Cardiovascular Diseases in India Rajeev Gupta,
MD PhD
• http://www.world-heart-
federation.org/fileadmin/user_upload/documents/Fact_sh
eets/2016/Cardiovascular_diseases_in_India.pdf
• Heterogeneity of coronary heart disease risk factors in
Indian, Pakistani, Bangladeshi, and European origin
populations: cross sectional study – Raj Bhopal et al.
• An Epidemiologic Transition of Cardiovascular Disease Risk
in Carriacou and Petite Martinique, Grenada: the Grenada
Heart Project, 2005-2007- Robert C. Block MD
• Cardiovascular diseases in India Challenges and way ahead