Abstract
SummaryBackgroundThe burden of cardiovascular diseases is increasing in India, but a systematic understanding of its distribution and time trends across all the states is not readily available. In this report, we present a detailed analysis of how the patterns of cardiovascular diseases and major risk factors have changed across the states of India between 1990 and 2016.MethodsWe analysed the prevalence and disability-adjusted life-years (DALYs) due to cardiovascular diseases and the major component causes in the states of India from 1990 to 2016, using all accessible data sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. We placed states into four groups based on epidemiological transition level (ETL), defined using the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed heterogeneity in the burden of major cardiovascular diseases across the states of India, and the contribution of risk factors to cardiovascular diseases. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsOverall, cardiovascular diseases contributed 28·1% (95% UI 26·5–29·1) of the total deaths and 14·1% (12·9–15·3) of the total DALYs in India in 2016, compared with 15·2% (13·7–16·2) and 6·9% (6·3–7·4), respectively, in 1990. In 2016, there was a nine times difference between states in the DALY rate for ischaemic heart disease, a six times difference for stroke, and a four times difference for rheumatic heart disease. 23·8 million (95% UI 22·6–25·0) prevalent cases of ischaemic heart disease were estimated in India in 2016, and 6·5 million (6·3–6·8) prevalent cases of stroke, a 2·3 times increase in both disorders from 1990. The age-standardised prevalence of both ischaemic heart disease and stroke increased in all ETL state groups between 1990 and 2016, whereas that of rheumatic heart disease decreased; the increase for ischaemic heart disease was highest in the low ETL state group. 53·4% (95% UI 52·6–54·6) of crude deaths due to cardiovascular diseases in India in 2016 were among people younger than 70 years, with a higher proportion in the low ETL state group. The leading overlapping risk factors for cardiovascular diseases in 2016 included dietary risks (56·4% [95% CI 48·5–63·9] of cardiovascular disease DALYs), high systolic blood pressure (54·6% [49·0–59·8]), air pollution (31·1% [29·0–33·4]), high total cholesterol (29·4% [24·3–34·8]), tobacco use (18·9% [16·6–21·3]), high fasting plasma glucose (16·7% [11·4–23·5]), and high body-mass index (14·7% [8·3–22·0]). The prevalence of high systolic blood pressure, high total cholesterol, and high fasting plasma glucose increased generally across all ETL state groups from 1990 to 2016, but this increase was variable across the states; the prevalence of smoking decreased during this period in all ETL state groups.InterpretationThe burden from the leading cardiovascular diseases in India—ischaemic heart disease and stroke—varies widely between the states. Their increasing prevalence and that of several major risk factors in every part of India, especially the highest increase in the prevalence of ischaemic heart disease in the less developed low ETL states, indicates the need for urgent policy and health system response appropriate for the situation in each state.FundingBill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Highlights
The disability-adjusted life-years (DALYs) rate due to ischaemic heart disease is currently higher in the more developed states of India, this study shows that the increase in age-standardised DALY rates from 1990 was higher in less developed states
Cardiovascular diseases contributed to 28·1% (95% uncertainty intervals (UIs) 26·5–29·1) of total deaths and 14·1% (12·9–15·3) of total DALYs in India in 2016—compared with 15·2% (13·7–16·2) and 6·9% (6·3–7·4), respectively, in 1990.31 Ischaemic heart disease and stroke were the predom inant cardiovascular diseases, contributing to 61·4% and 24·9% of total DALYs from cardiovascular diseases, respectively, in 2016
The proportion of deaths and DALYs from ischaemic heart disease was significantly higher in men than in women, but were similar in the two sexes for stroke
Summary
Cardiovascular diseases are the leading cause of disease burden and deaths globally.[1,2,3] The UN, alarmed by the increasing burden of non-communicable diseases (NCDs) and high disease severity and case-fatality in low-income and middle-income countries compared with high-income countries, acknowledged in 2012 that the rising burden of NCDs was one of the major threats to sustainable development in the 21st century.[4,5,6,7,8,9] WHO subsequently developed targets for prevention and control of NCDs in 2013, which included 25% relative reduction in overall mortality from cardiovascular diseases, 25% relative reduction in prevalence of high blood pressure, halting the rise in www.thelancet.com/lancetgh Vol 6 December 2018 e1339 e1340Research in contextEvidence before this study We searched PubMed and publicly available reports on March 29, 2018, without language or publication date restrictions, for estimates of the burden of cardiovascular diseases across the states of India, using the terms “burden”, “cardiovascular diseases”, “cause of death”, “cerebrovascular disorders”, “coronary heart disease”, “CVD”, “DALY”, “death”, “epidemiology”, “India”, “ischaemic heart disease’’, “morbidity”, “mortality”, “prevalence”, “rheumatic heart disease”, “stroke”, and “trends”. Added value of this study This study provides comprehensive estimates of the burden due to cardiovascular diseases in every state of India from 1990 to 2016, based on all accessible data and using the standardised Global Burden of Diseases, Injuries, and Risk Factors Study methodology. These findings highlight that the prevalent cases of ischaemic heart disease and stroke have more than doubled in India from 1990 to 2016, with an increase in prevalence in every state of the country. The findings emphasise that, the prevalence of cardiovascular disease risk factors varied considerably across the states of India, the prevalence of high systolic blood pressure, high total cholesterol, and high fasting plasma glucose increased across all state groups since 1990
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
