Indians today are living longer but they do not seem to be living healthier. With increasing life
expectancy, we have seen a rise in the burden of age-related ailments such as hypertension, heart
disease, arthritis, and dementia. But, not the entire increased burden is attributable to longer
lives; a major source of this dubious rise has been fuelled by lifestyle factors.
In recent years, India has witnessed a major transition in its disease burden from communicable
to non-communicable diseases. In 1990, communicable diseases like tuberculosis, pneumonia,
malaria were the leading killers in India. However, they have now been replaced by
cardiovascular diseases. With improved medical services and advanced treatment options the
burden of communicable diseases such as cholera, diarrhea and tuberculosis has been on the
decline. However, a parallel rise in the burden of non-communicable diseases presents a major
health challenge.
The top ten causes of deaths in India in 2013 included Ischemic Heart Disease (IHD),
hypertensive heart and diabetes, stroke, chronic obstructive pulmonary disorder (COPD), among
others, according to data quoted to a study on 'Global Burden of Disease 2013' at the Institute for
Health Metrics and Evaluation (IHME), University of Washington. According to a study
supported by ASSOCHAM in 2010, India was projected to lose USD 236.6 billion because of
heart disease, stroke and diabetes, in the decade between 2005 and 2015. A study conducted by
Safola Life in 2013 found out that a whopping 70 per cent or more of the urban population in
India faces the risk of heart diseases.
Clearly, India is losing much health to the collective burden of cardiovascular diseases. And the
condition is not expected to reverse any time soon. As Indians adopt unhealthy western lifestyles,
with increasing intake of saturated fat, dependence on tobacco and alcohol, and absence of
physical activity, the number of cardiac patients is set to grow dramatically.
What are the factors fuelling the heart disease epidemic in India?
Diabetes and hypertension: These dual challenges are the biggest contributors to cardiovascular
diseases. As per International Diabetes Federation, the diabetic population in India is a massive
50.8 million. People suffering from diabetes have a higher risk of falling prey to heart diseases.
There has been an alarming rise in type 2 diabetes in India in recent years, including in people
who do not run a genetic risk to the pancreatic disorder. The prevalence of hypertension, on the
other hand, is 25 – 30 per cent in urban and nearly 10 – 15 per cent in rural people.
Urbanization and change in lifestyles: As more and more people move to urban centres, they
experience a radical change in their lifestyles including increased dependence on fast food that is
rich in salt and empty carbs; increased stress that disturbs diet and sleeping patterns; complete
dependence on technology; and addiction to smart devices that reduce lives to the click of a
mouse. Another factor that comes into play is reduced public spaces in cities, lack of clean and
hygienic areas to walk or exercise.
Physical inactivity: Habits such as walking down to the neighborhood store; cycling to schools,
colleges and work; climbing stairs; that were a normal part of lifestyles earlier are receding fast.
Conveniences such as home deliveries, ubiquitous elevators and a general disinclination to
physically exert have drastically reduced our levels of physical activity. Sedentary jobs coupled

with addiction to smart devices imply that we do not even walk a minimum 30 minutes every
day. Inactivity is a direct contributor to increased risk of cardiovascular diseases, mainly
coronary heart disease involving deposition of fats on artery walls. Hypertension, type 2
diabetes, obesity – all are contributing factors to heart diseases – and major risks for cardiac
diseases.
Dual role stress in women: One of the most notable features of the heart disease epidemiology
in recent years has been the rising incidence in women. This development matches the
phenomenon of increased presence of women in leading professional roles and highly
demanding corporate work environments. Yet, an absence of role-sharing at home by spouses
has seen professional women in urban centres dealing with high levels of stress and lack of time
to take care of their own health.
Demographic challenge
India takes pride in being a country with the largest population of productive youth. However,
the demographics will not remain the same forever. As more people age, we will see a further
rise in the burden of age-related diseases. A failure to induce today’s youth towards healthy
living and conscious lifestyle management may result in a major health crisis for India 50 years
from now. It is imperative, therefore, to advocate the need of weight control; effective control of
diabetes, hypertension and LDL; getting rid of smoking indulgence, and increase the habit of
exercising daily.

(The article has been written by Dr T S Kler, Executive Director (Cardiac Sciences), HOD
Cardiology, Director Electrophysiology at Fortis Escorts Heart Institute & Research Centre, New
Delhi.)

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