Advertisement

Burden of Cardiovascular Diseases in Women and Reduction Strategies in India

  • Meenakshi Sharma
  • N. K. Ganguly
Chapter

Abstract

Women in India bear an unequal burden of diseases. Coupled with high maternal deaths, and higher deaths than men due to HIV/AIDS and TB is the recent upsurge in female deaths due to non-communicable diseases (NCDs). In 2015, NCDs accounted for 2.7 million women’s deaths in India, of which 1.1 million were due to cardiovascular diseases (CVDs). Gender specific data for all cardiovascular conditions and their risk factors are not routinely collected. With only 38% of the share of medically certified deaths collected by the Office of Registrar General in India, the exact burden of disease in women remains far from clear. This review provides the unique aspects of cardiovascular health and disease in women. It presents gaps in the knowledge base regarding all aspects of CVDs in women and discusses issues surrounding women’s access to healthcare in India. A life course approach, originally advocated by Vedic culture, in shifting the trajectory from one of disease focus to healthy adults is advocated. We believe that targeting women’s cardiovascular health in India is essential to halt the CVD epidemic as it may not only improve their health but also of their families given their prime role in provision of nutrients to their family and inculcating other healthy lifetime habits.

Keywords

Cardiovascular diseases Rheumatic heart disease Premenopausal women STEMI MACE 

References

  1. 1.
    Office of the Registrar General &Census Commissioner, India. http://www.censusindia.gov.in/Vital_Statistics/SRS_Life_Table/Srs_life_Table_2011–15.html. Accessed 30 Aug 2017.
  2. 2.
    Health System in India: Bridging the Gap between Current Performance and Potential. NITI Aayog (National Institute for Transforming India) Health Division Working Paper Series 1 Paper No. 1/2015. https://www.mygov.in/sites/default/files/master_image/Health_System_in_India.pdf. Last accessed on 11th Jan 2018.
  3. 3.
    Alkema L, Chou D, Hogan D, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2015;S0140-6736(15):00838–7.Google Scholar
  4. 4.
    Cousins S. Assam: India’s state with the highest maternal mortality. BMJ. 2016;353:i1908.CrossRefPubMedGoogle Scholar
  5. 5.
    National Family Health Survey 4. 2015–16. India Fact Sheet. http://rchiips.org/NFHS/pdf/NFHS4/India.pdf. Accessed 29 Aug 2017.
  6. 6.
    Maternal and Child Mortality and Total Fertility Rates. Sample Registration System (SRS) July 2011. http://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_release_070711.pdf.
  7. 7.
    SRS bulletin. Sample registration system. Registrar General, India. 2016;50(2). ISSN 0971–3549. http://www.censusindia.gov.in/vital_statistics/SRS_Bulletin_2015.pdf.
  8. 8.
  9. 9.
    Institute of Health Metrics and Evaluation. GBD Compare 2015. http://vizhub.healthdata.org/gbd-compare/. Accessed 15 Aug 2017.
  10. 10.
    WHO. Burden of NCDs and their risk factors in India (Excerpted from Global Status Report on NCDs-2014). http://www.searo.who.int/india/topics/noncommunicable_diseases/ncd_situation_global_report_ncds_2014.pdf?ua=1. Accessed 13 Aug 2017.
  11. 11.
    Report on Medical certification of Death 2015. Office of Registrar General of India. http://www.censusindia.gov.in/2011-Documents/mccd_Report1/MCCD_Report-2015.pdf. Accessed 28 Aug 2017.
  12. 12.
  13. 13.
    Joshi R, Cardona M, Iyengar S, et al. Chronic diseases now a leading cause of death in rural India—mortality data from the Andhra Pradesh Rural Health Initiative. Int J Epidemiol. 2006;35:1522–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Soman KS, Kutty VR, Safraj S, et al. All-cause mortality and cardiovascular mortality in Kerala state of India: results from a 5-year follow-up of 161,942 rural community dwelling adults. Asia Pac J Public Health. 2011;23:896–903.CrossRefPubMedGoogle Scholar
  15. 15.
    Pednekar M, Gupta R, Gupta PC. Illiteracy, low educational status and cardiovascular mortality in India. BMC Public Health. 2011;11:e00568.CrossRefGoogle Scholar
  16. 16.
    Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high- income countries. N Engl J Med. 2014;371:818–27.CrossRefPubMedGoogle Scholar
  17. 17.
    Wig KL. Clinical evidence of rheumatic fever in the Punjab. Ind Med Gaz. 1935;70:260–3.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Oldgren J, Healey JS, Ezekowitz M, et al. RE-LY Atrial Fibrillation Registry Investigators. Variations in cause and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: the RE-LY Atrial Fibrillation Registry. Circulation. 2014;129:1568–76.Google Scholar
  19. 19.
    Shrivastava S. Rheumatic heart disease: is it declining in India? Indian Heart J. 2007;59:9–10.PubMedGoogle Scholar
  20. 20.
    Kutumbiah P. Rheumatic fever and rheumatic heart disease in India; review of 25 years of study and progress. Indian J Pediatr. 1958;25:240–5.PubMedGoogle Scholar
  21. 21.
    Berry JN. Prevalence survey for chronic rheumatic heart disease and rheumatic fever in northern India. Br Heart J. 1972;34:143–39.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Shah B, Sharma M, Kumar R, et al. Rheumatic heart disease: progress and challenges in India. Indian J Pediatr. 2013;80:S77–86.CrossRefPubMedGoogle Scholar
  23. 23.
    Kumar R, Sharma YP, Thakur JS, et al. Streptococcal pharyngitis, rheumatic fever and rheumatic heart disease: eight-year prospective surveillance in Rupnagar district of Punjab. Natl Med J India. 2014;27(2):70–5.PubMedGoogle Scholar
  24. 24.
    Bhardwaj R, Kandoria A, Marwah R, et al. Prevalence of rheumatic fever and rheumatic heart disease in rural population of Himachal—a population based study. J Assoc Physicians India. 2012;60:13–4.PubMedGoogle Scholar
  25. 25.
    Jai Vigyan Mission Mode Project. Community Control of Rheumatic Fever/Rheumatic Heart Disease in India. Comprehensive Project report 2000–2010. http://www.icmr.nic.in/final/Jai%20Vigyan%20Mission%20Mode%20Project%20on%20Rheumatic%20Fever%20and%20Rheumatic%20Heart%20Disease%20(1).pdf. Accessed 23 Aug 2017.
  26. 26.
    Gewitz MH, Baltimore RS, Tani LY. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015;131:1806–18.CrossRefPubMedGoogle Scholar
  27. 27.
    Kumar RK, Tandon R. Rheumatic fever & rheumatic heart disease: the last 50 years. Indian J Med Res. 2013;137:643–58.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Vora A, Kapoor A, Nair M, et al. Clinical presentation, management, and outcomes in the Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF) registry. Indian Heart J. 2017;69:43–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Harikrishnan S, Leeder S, Huffman M, et al. A race against time: the challenge of cardiovascular disease in developing economies. 2nd ed. New Delhi Centre for Chronic Disease Control: New Delhi; 2014.Google Scholar
  30. 30.
    Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions. Circulation. 2016;133:1605–20.CrossRefPubMedGoogle Scholar
  31. 31.
    Oommen AM, Abraham VJ, George K, Jose VJ. Prevalence of coronary heart disease in rural and urban Vellore: a repeat cross-sectional survey. Indian Heart J. 2016;68:473–9.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Banerjee TK, Das SK. Fifty years of stroke research in India. Ann Indian Acad Neurol. 2016;19:1–8.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke. 2013;15:128–34.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Pandian JD, Singh G, Kaur P, et al. Incidence, short-term outcome, and spatial distribution of stroke patients in Ludhiana, India. Neurology. 2016;86:425–33.CrossRefPubMedGoogle Scholar
  35. 35.
    Kalkonde YV, Deshmukh MD, Sahane V, et al. Stroke is the leading cause of death in rural Gadchiroli, India: a prospective community-based study. Stroke. 2015;46:1764–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Report of the National Commission on Macroeconomics and Health. New Delhi, India: Ministry of Health and Family Welfare, Government of India; 2005.Google Scholar
  37. 37.
    Harikrishnan S, Sanjay G, Anees T, et al. Clinical presentation, management, in-hospital and 90-day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry. Eur J Heart Fail. 2015;17:794–800.CrossRefPubMedGoogle Scholar
  38. 38.
    SARRC Development Goals-India Country Report-2013. New Delhi, India:Central Statistics Office, Ministry of Statistics and Programme Implementation, Government of India. http://mospi.nic.in/mospi_new/upload/SAARC_Development_Goals_%20India_Country_Report_29aug13.pdf. Accessed 24 May 2017.
  39. 39.
    Global Adult Tobacco Survey. India 2009–2010. http://mohfw.nic.in/WriteReadData/l892s/1455618937GATS%20India.pdf. Accessed 24 May 2017.
  40. 40.
    Giovino GA, Mirza SA, Samet JM, et al. Tobacco use in 3 billion individuls from 16 countries: an analysis of nationally representative cross sectional household surveys. Lancet. 2012;380:668–79.CrossRefPubMedGoogle Scholar
  41. 41.
    Goel S, Tripathy JP, et al. Smoking trends among women in India: analysis of nationally representative surveys (1993–2009). South Asian J Cancer. 2014;3:200–2.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Ray CS, Pednekar MS, Gupta PC, et al. Social impacts on adult use of tobacco; findings from the international tobacco control project India, wave 1 survey. WHO South East Asia J Public Health. 2016;5:123–32.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Samet JM, Bahrami H, Berhane K. Indoor air pollution and cardiovascular diseases:new evidence from Iran. Circulation. 2016;133:2342–4.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    TERI. Air pollution and health. New Delhi: Discussion Paper by The Energy and Resources Institute; 2015.Google Scholar
  45. 45.
    Anjana RM, Pradeepa R, Deepa M, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011;54:3022–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Anjana RM, Pradeepa R, Das AK, et al. ICMR–INDIAB Collaborative Study Group. Physical activity and inactivity patterns in India—results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5]. Int J Behav Nutr Phys Act. 2014;11:26.Google Scholar
  47. 47.
    Mithal A, Bansal B, Kalra S. Gestational diabetes in India: science and society. Indian J Endocrinol Metab. 2015;19:701–4.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Norboo T, Stobdan T, Tsering N, et al. Prevalence of hypertension at high altitude: cross sectional survey in Ladakh, Northern India 2007–2011. BMJ Open. 2015;5:e007026.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Roy A, Praveen PA, Amarchand R, et al. Changes in hypertension prevalence, awareness, treatment and control rates over 20 years in National Capital Region of India: results from a repeat cross sectional survey. BMJ Open. 2017;7:e015639.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Coffey D. Prepregnancy body mass and weight gain during pregnancy in India and sub-Saharan Africa. Proc Natl Acad Sci U S A. 2015;112:3302–7.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Katre P, Yajnik CS. Pune experience. Influence of early life environment on risk of non-nommunicable diseases (NCDs) in Indians. Sight and Life. 2015;29(1).Google Scholar
  52. 52.
    India’s Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Strategy A Case of Extraordinary Government Leadership. July 2014. http://www.mchip.net/sites/default/files/RMNCH+A%20in%20India.pdf. Accessed 2 Aug 2017.
  53. 53.
  54. 54.
    Xavier D, Pais P, Devereaux PJ, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371:1435–42.CrossRefPubMedGoogle Scholar
  55. 55.
    Chow CK, Teo KK, Rangarajan S, Fanghong L, et al. PURE (Prospective Urban Rural Epidemiology) Study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310:959–68.CrossRefPubMedGoogle Scholar
  56. 56.
    Mohanan PP, Mathew R, Harikrishnan S, et al. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J. 2013;34:121–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Graham G. Acute coronary syndrome in women: recent treatment trends and outcomes. Clin Med Insights Cardiol. 2016;10:1–10.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Alexander T, Mullasari AS, Joseph G, et al. A system of care for patients with ST-segment elevation myocardial infarction in India: the Tamil Nadu-ST-segment elevation myocardial infarction program. JAMA Cardiol. 2017;2:498–505.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Killugudi J. Novel Indian clotbuster. Nat Biotechnol. 2012;30:903.Google Scholar
  60. 60.
    Singh MG, Chandran N, Thomas Z, et al. Economic impact of technology interventions—streptokinase delivering affordable healthcare with clot-buster drugs. EPW. 2016;51(38):55–4. http://www.epw.in/system/files/pdf/2016_51/38/Economic_Impact_of_Technology_Interventions--Streptokinase_0.pdf Google Scholar
  61. 61.
    National Pharmaceutical Pricing Authority. http://www.nppaindia.nic.in/ceiling/press13Feb2017/so412e-13-02-17.pdf . Accessed 11 Aug 2017.
  62. 62.
    Society for Biomedical technology. http://www.sbmtindia.org/activities/kalam_raju_coronary_stent/. Accessed 24 May 2017.
  63. 63.
    Tewari R. Industry Academia R&D Ecosystem in India. An evidence based study. 2017. ISBN 81-85322-61-9. http://cpr.puchd.ac.in/wp-content/uploads/2017/05/Industry-Academia-RD-Ecosystem-in-India.pdf.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of NCDIndian Council of Medical ResearchNew DelhiIndia
  2. 2.Policy Center for Biomedical ResearchFaridabadIndia

Personalised recommendations