Recent developments in cardiovascular diseases control and prevention in India

Abstract

Sir, Chronic non-communicable diseases are assuming increasing importance among the adult population in both developed and developing countries. The prevalence of non-communicable diseases is showing an upward trend in most countries and India is not an exception. For one reason, life expectancy is increasing in India and greater number of people is living to older ages and at greater risk to chronic diseases like. For another reason, the life-styles and behavioral patterns of people are changing rapidly, these being favorable to onset of non-communicable diseases. In India in the past five decades, rates of coronary disease among urban populations have risen from 4% to 11%. The World Health Organization (WHO) estimates that 60% of the world's cardiac patients will be Indian by 2010. Nearly 50% of cardiovascular-related deaths in India occur in patients below the age of 70, compared with just 22% in the West.[1] In India, cardiovascular diseases are ranked third in overall the burden of disease, the other two being infectious and parasitic diseases and unintentional injuries. In India, deaths from coronary heart disease rose from 1.17 million in 1990 to 1.59 million in 2000 and are expected to rise to 2.03 million in 2010.[2] In response to ever-rising burden of cardiovascular diseases in India, at national level Government of India has undertook some actions in various National health programmes and projects. As a part of the Eleventh (XI) five year plan (2007-2012), a new program “National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS)” has been launched. The NPDCS will be implemented in a phased manner with a pilot being done in the Preparatory Phase 2006-07. Subsequently, the program would be implemented across the country through select institutions. The aim of the program is prevention and control of common non-communicable disease (NCDs) risk factors through an integrated approach and reduction of premature morbidity and mortality from diabetes mellitus, cardiovascular diseases and stroke. In the long term, the program envisages, reduction in prevalence of risk factors of common NCDs, reduction in morbidity and mortality due to diabetes, Cardiovascular diseases and Stroke and building capacity of health systems to tackle NCDs and improvement of quality of care.[3] National Rural Health Mission (NRHM) which is an ambitious program of Government of India which is launched in April 2005 for seven years span from 2005 to 2012. Prevention and control of communicable and non-communicable diseases is one of the goals of NRHM. Core strategy for prevention of non-communicable diseases is “developing capacities for preventive health care at all levels for promoting healthy lifestyles, reduction in consumption of tobacco and alcohol.”[4] “Integrated Disease Surveillance Project (IDSP)” was launched in November 2004. In IDSP, the emphasis is given on surveillance of communicable as well as non-communicable diseases. The regular periodic survey of non-communicable disease risk factors such as anthropometry, physical activity, blood pressure, tobacco, and nutrition is done, but this program limits itself to surveillance only no emphasis is given on the intervention aspects.[5] Recently Public Health Foundation of India in collaboration with the Ministry of Health and Family Welfare, Government of India launched a website http://healthy-india/org. Healthy India endeavors to advance consciousness of disease prevention opportunities, encourage earlier detection and treatment of chronic diseases, and foster healthy living through information and resources on healthy lifestyle, namely healthy diet; physical activity; tobacco and alcohol-related health problems; environment; yoga; stress management; high blood pressure; diabetes; cancers; heart attacks and strokes.[6] The Indian Parliament has passed the Cigarettes and other Tobacco Products Bill 2003 in April 2003 and it became an Act on 18th may 2003. Rules were formulated in 1st May 2004 and are being vigorously implemented throughout India. It is hoped that tobacco use would reduce after its implementation. This would be an effective step in the direction of prevention of major NCDs specially CVD and stroke.[7] To conclude with, considering the ever increasing burden of cardiovascular diseases in India the Government of India has taken certain initiatives at national that is really commendable. Now it is also important to implement these initiatives effectively and sustaining these efforts in future.