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Cardiovascular
diseases are a type of non- communicable disease related to the blood vessels.
There are many types of CVDs but Ischemic Heart disease (coronary) has the
highest mortality of all, higher than stroke and rheumatic heart disease.
According to previous studies, approximately 90% of CVD is preventable as it is
caused by lack of healthy diet, exercise and bad social habits such as smoking
and drinking alcohol excessively.

 

CVD is the number one
cause of death in both developed and developing countries with approximately
17.7 million deaths (WHO, 2015). CVD can also lead to sever disability, which
can be measured using DALY (disability-adjusted life years). Generally the DALY
differs across economic regions where developing nations such as Asia and
Africa has DALY of more than 5000 per 100000 whereas developed regions such as
North America and UK has less than 3000 per 100000 (WHO, 2009).

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The figure below shoes the
number of DALYs lost per 100,000 to Ischemic heart disease.

Prevalence is an
estimate of how many people has a disease at a given point or period in time. The highest prevalence of a type of
CVD in developed countries was approximately 1184 per 100000 and 339 per 100000
in developing countries (AHA, 2013). By 2030, almost 23.6 million people will
die from CVDs, mainly from heart disease and stroke.

 

Cardiovascular diseases cause a
significant global burden due to the many costs for treatment.  For example, in 2016 cardiovascular diseases
cost America approximately $555 billion towards directs costs such as doctors,
hospitals, and prescription drugs as well as home health care and indirect
costs of losing productivity in the workplace as individuals are too sick to be
employed

CVDs are the number one cause of
mortality in India in all regions (cities, poorer and rural areas. The image to
the right shows in 2014,

26% of deaths were due to CVD.  The prevalence of this disease increases year
by year as premature mortality lost to CVD has increased by 53% in the past
decade, currently 272 per 100000, which is significantly higher than the global
average. 

The prevalence of CVD mortality in shows that in less developed
regions, such as the central and north-eastern states (that have a lower Human
development index),

There is decreased mortality as
compared to the better-developed states in the west and south.

 

 

Only a few studies have
investigated CVD mortality rates in as a general population in India. Most of
them are regional and not nationally representative as culture and
socioeconomic backgrounds varies from one region to another.

The PURE study reported
cardiovascular mortality rates in 155,000 adult men and women aged 35-70 years
old in 17 countries with different socioeconomic backgrounds. Low-income
countries such as India, Pakistan and Zimbabwe had higher CVD mortality rates
compared with high- and middle-income countries. Low-income countries (33,834)
were mainly represented by India (29,258).

 

The main factors causing the high
CVD mortality rates in India are the lack of primary interventions from the
government such policies to reduce CVD risk factors (tobacco, alcohol, physical
inactivity and poor diet) as well as the lack of tertiary intervention such as
lack of cardiovascular rehabilitation and long-term care for the CVD patients.

 

The epidemiology of Cardiovascular
diseases has show that CVDs are an epidemic in India and without more
preventative measures implemented by the government, the incidence rates of CVD
will keep rising in the next few decades. It would be cost effective for the
Indian Government to invest in interventions to promote a healthier lifestyle,
as it is a huge economic burden. Educating the population on the risk factors
of CVD can reduce the mortality, morbidity and DALYs.

Genetic factors have been
implicated in the development of premature atherosclerosis in Indians. In addition, the Asian Indian
Phenotype means that Indians have a predisposition to dyslipidaemia (high
triglyceride and low HDL levels) among hypertension and obesity, making the
Indian population more vulnerable to CVDs.

 

Poor behavioural habits such as use of
tobacco, drinking and unhealthy diet are all risk factors that contribute to the
development of CVD. Approximately 275 million people aged 15 and over consume
tobacco in India with tobacco usage prevalence higher in men than in women.

 

Despite having a huge population of
vegetarians in the country, Indians are not consuming enough fruits and
vegetables as shown by a large (156316 individuals) scale survey (NFHS-3)
conducted in which half the sample only had up to 1 fruit per week. This may be
due to the high cost of fruits and vegetables meaning people from a poorer
socioeconomic background are not able to have a healthy diet even if they
desired to.

In addition, India is
a rapidly developing country with a huge population, perfect for multinational
co-operate companies to irresponsibly target children and teen to increase the
consumption of junk food high in fat, salt and energy causing the incidence of
premature CVD mortality to increase.                          

The Indian Council of Medical Research
conducted a study with 14227 participants to assess physical activity found
that= every 1 in 2 individuals were considered physically inactive. This
further shows why 20 million Indians are
obese today, the lack of activity
and poor lifestyle choices that need to be modified in order to prevent the
development of CVD. Another recent study, using 6198
participants (3426 men and 2772 women) from eleven cities across India showed
that 39% of men and 46% of women were physically inactive with the incidence
rate increasing, year after year.

This graph shows a higher mortality
rate in men then women for cardiovascular disease. This may be due to the
prevalence of risk factors for CVD being lower in women than men in India
(consumes less tobacco m 25.1%vs.f 4% and less alcohol m 8% vs. f 0.5%).

Cardiovascular disease
(CVD), also known as heart disease is mainly due to a process called
atherosclerosis in which plaque builds up in the walls of arteries. This causes
the arteries to narrow and constrict the flow of blood as well as completely
stop blood flow, which can lead to a stroke or myocardial infraction. The
atherosclerosis is caused by problems such as unhealthy diet, lack of exercise,
being overweight and smoking, all of which are behavioural risk factors.  However,
there is some evidence that genetics may play a role in the likelihood of
developing CVD such as single nucleotide polymorphisms found in DNA but this
individually cannot influence the development of CVDs.

The diagnosis of CVD is usually done
through multiple tests such as blood tests, chest x-rays, ECGs and cardiac
catheterization. One of the most effective methods is an echocardiogram, a
non-invasive method of obtaining a detailed image of the heart using ultrasound
technology. The most common treatments are lifestyle changes; eating a low fat,
low-sodium diet as well as exercising regularly and medications; to aid the
lifestyle change such as tablets to control cholesterol levels and blood
pressure.  The last resort would is a
medical procedure such as inserting a stent due to extensive heart damage.

Primary preventions: the main strategy
used was population-based in which the risk factors to CVD was targets which
aimed to improved knowledge but this didn’t necessarily changes practices. For
example in Prabhkaran et al, a study was conducted to observe the benefits of
population based intervention and reported that after 3 years, the sample had
lower BMI, blood pressure and cholesterol. The image to the right shows primary
prevention adverts to promote the damage smoking causes, in an effort to reduce
the huge population of smokers in India.

Secondary prevention: These preventions
are generally quite poor in all regions of India, especially in women. The use
of CVD medications (ACE, beta-clockers, aspirin) is lower in women despite
women having a higher risk of CVD than men after they lose their hormonal
protection at menopause. The government is now implementing better practice
procedures for doctors to follow.

 

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