Is India really going to be the capital of cardiovascular disease (CVD)? The answer should probably be “Yes”. There are plenty of risk factors and more control measures are needed to make a significant impact. Let’s take a look.

The aging population in India is something that can’t be ignored. An ever-increasing percentage of Indians are crossing the age-65 line, which is a big risk factor for CVD. Older individuals are more likely to get the disease, typically because of less physical activity and weaker heart muscles. This scenario is understandable and indeed similar to many other countries. However, what’s worrying is the country’s younger population—they are also falling prey to CVD in alarming numbers.

Why is this happening? The first factor to discuss here is lifestyle, which has undergone a substantial transition in recent years. High fat diets, lower vegetable/fruit intake and an increase prevalence of smoking have doubled the risk of cardiovascular disease in India. Additionally, a steady increase in hypertension levels due to sleep deprivation and less physical activity—in turn due to an increase in white collar office jobs in India—in the younger population is making things worse by increasing the diabetic population base. In fact, India has one of the largest populations of diabetes patients in the world, with more than 65 million patients suffering from the disease.

Awareness is another factor that impacts the overall cardiovascular population profoundly but mostly goes unnoticed. Huge sections of the rural population in India are completely unaware of their heart conditions and blood pressure levels, making a control process even tougher to implement. Moreover, the limited access to health care facilities in rural areas just adds to the worry—close to 60% of the population in India has limited access to these facilities. However, there are many cardiovascular disease awareness programs that are run throughout the country in urban and rural areas, by the hospitals, the manufacturers of the devices and drugs, or even by the private insurance companies, helping to steadily increase awareness.

That’s all well and good, but it always comes down to the money—and that’s what I think is the biggest factor of all, especially because of the country’s cost-sensitive market. Most of the CVD diagnostic procedures, drugs, and treatment procedures are expensive. Device treatments are expensive primarily due to premium-priced cardiac devices and the need for highly skilled physicians (which I will discuss further in an upcoming blogpost). For example, a regular single-chamber pacemaker costs around 60 thousand INR while a branded heart valve ranges from 45 to 90 thousand INR. And considering only a very small proportion of people have medical insurance, the cost of the devices becomes even more significant. As a result, many people avoid or delay a diagnosis and treatment because they would need to pay out-of-pocket.

However, the government has taken on initiatives like improving the reimbursement structure. For example, in government hospitals, patients can receive single-chamber pacemakers for only approximately 34 thousand INR.  The government has also started promoting locally manufactured medical devices, which are much more affordable than devices from foreign brands. For example, a heart valve manufactured by a local company can cost around 22 thousand INR.  Efforts are also being made to strengthen health insurance and health care infrastructure. Control over lifestyle factors like ‘no smoking’ campaigns or high taxes on the cigarettes may also come in handy to tackle the CVD rate.

So, yes—the government efforts are showing some results, but these will still only have a minor effect against the factors influencing the occurrence of CVD mentioned earlier. Overall, the prevalence of CVD in India looks set to grow strongly unless the control measures are significantly ramped up.

 

Follow Swarnadip on twitter @Swarnadip_DRG

 

 

 

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