Cardiovascular Diseases in India Compared With the United States

Abstract

This review describes trends in the burden of cardiovascular diseases (CVDs) and risk factors in India compared with the United States; provides potential explanations for these differences; and describes strategies to improve cardiovascular health behaviors, systems, and policies in India. The prevalence of CVD in India has risen over the past 2 decades due to population growth, aging, and a stable age-adjusted CVD mortality rate. Over the same time period, the United States has experienced an overall decline in age-adjusted CVD mortality, although the trend has begun to plateau. These improvements in CVD mortality in the United States are largely due to favorable population-level risk factor trends, specifically with regard to tobacco use, cholesterol, and blood pressure, although improvements in secondary prevention and acute care have also contributed. To realize similar gains in reducing premature death and disability from CVD, India needs to implement population-level policies while strengthening and integrating its local, regional, and national health systems. Achieving universal health coverage that includes financial risk protection should remain a goal to help all Indians realize their right to health.

Keywords: epidemiology; health policy; health systems; review.

FIGURE 1

State-Level Variation in Age-Adjusted IHD and Stroke Mortality Rate and DALYs per 100,000 People in India Between 1990 and 2016 State-level variation in age-adjusted ischemic heart disease (A) and stroke (B) mortality rate per 100,000 in India (2016) and state-level change in age-adjusted ischemic heart disease (C) and stroke (D) disability-adjusted life years per 100,000 in India between 1990 and 2016. India had substantial variation in the burden of ischemic heart disease mortality and stroke in 2016. All states experienced an increase in the age-adjusted burden of ischemic heart disease (IHD) measured by disability-adjusted life years (DALYs) per 100,000 persons between 1990 and 2016, whereas changes in the burden of stroke were variable.

FIGURE 2

CVD DALYs Attributable to Metabolic Risk Factors, Globally, in India, and in the United States From 1990 to 2016 The leading metabolic risk factors that contributed to the cardiovascular disease (CVD) disability-adjusted life years (DALYs) in 2016 were high blood pressure (BP) and high cholesterol levels, followed by high fasting blood glucose (FBG) levels and high body mass index (BMI). TC = total cholesterol.

CENTRAL ILLUSTRATION

Cardiovascular Disease Disability-Adjusted Life-Years Attributable to Behavioral Risk Factors (Dietary Risks, Tobacco Use, and Low Physical Activity), Globally, in India and the United States From 1990 to 2016 The leading behavioral risk factors that contributed to the cardiovascular disease (CVD) disability-adjusted life years (DALYs) in 2016 were dietary risks (low consumption of fruits, vegetables, grains, and nuts and high consumption of sodium, trans fat, and red meat), followed by tobacco use and low physical activity. BMI = body mass index; BP = blood pressure; FBG = fasting blood glucose; TC = total cholesterol.