Sunil Wani on India’s Cardiovascular Crisis and Preventive Strategies
By Arunima Rajan
In an interview with Arunima Rajan, Sunil Wani, cardiologist at Kokilaben Dhirubhai Ambani Hospital, discusses why cardiovascular disease is a serious concern in India, factors contributing to CVD, its economic impact and preventive strategies.
Why is the CVD epidemic in India a matter of concern?
Cardiovascular disease (CVD) in India is a serious and growing concern. India already bears the highest burden of CVD in the world. According to the World Health Organization, nearly 60% of the global heart disease burden is borne by Indians, which highlights the urgency of the issue.
A report last year in the Lancet estimated that CVD accounted for almost 27% of total deaths in India in 2017, a significant increase from 15% in 1990. The number of people affected by CVDs has more than doubled, rising from 25.7 million in 1990 to 54.5 million in 2016. There has been a 2.3-fold increase in both ischemic heart disease (IHD) and stroke.
The prevalence of CVD in India has risen over the past two decades due to lifestyle factors, population growth, aging, and a stable age-adjusted CVD mortality rate. Further contributing to the increasing CVD burden is diabetes and hypertension, both widespread and increasing the risk of CVD in individuals significantly. The Interheart Study across 52 countries confirmed that Indians have a higher risk of CVD, with factors like genetics, psychosocial stress, and dietary habits playing a significant role.
Unlike Western countries, Indians tend to develop heart disease at a younger age and with greater severity. This leads to the economic impact of CVD due to the loss of productive working age individuals to heart disease.
If we don’t act now to address these risks, India is headed for a long-term CVD epidemic that will strain our healthcare system. Immediate steps to educate the population and implement preventive healthcare are essential.
What are the peculiarities and differences from the rest of the world when it comes to CVD in Indians?
CVD in India differs from the rest of the world in several ways. Indians are more likely to develop CVD at a younger age, with nearly two-thirds of cardiovascular deaths being classified as premature. The Interheart Study revealed that South Asians, including Indians, experience their first heart attack about five years earlier than people of European descent, with the average age of first myocardial infarction being 53 years for South Asians, compared to 58.8 years in other populations.
The burden of CVD in India is also much higher than the global average. For instance, India’s age-standardized death rate for CVD is 282 per 100,000 people, compared to the global rate of 233 per 100,000. The rates of ischemic heart disease (IHD) and stroke in India are also 1.6 to 2.4 times higher than the global average, respectively.
Several factors contribute to this higher risk in Indians, including a genetic predisposition, and lifestyle-related risk factors like poor diet, lack of physical activity and an increase in stress from high-pressure careers and fast-moving lifestyles.
The growing shift towards processed, high-calorie foods and reduced physical activity, driven by urbanization and economic growth, has further exacerbated the problem. There has been a rise in other non-communicable diseases such as hypertension and diabetes, which are poorly controlled and contribute to the increased risk of developing heart disease.
What strategies can India adopt to combat this epidemic?
If we focus on prevention and early detection, we can substantially reduce the long-term burden of heart disease in India. Education is the key to this. Educating the public about the dangers of high blood pressure, diabetes, and high cholesterol is essential. The government and private sector must work together to run awareness campaigns and offer regular health check-ups in both urban and rural areas.
Regular check-ups for people with high blood pressure, diabetes, or family histories of heart disease, and lifestyle changes help to prevent and catch any problem at an early stage. Simple actions like regular exercise, a balanced diet, and stress management help.
Lifestyle modification is another key strategy. Promoting regular exercise and a healthy diet rich in fruits and vegetables can drastically reduce heart disease. For individuals with family histories of CVD, early intervention is critical—medical advice should be sought at the first signs of chest pain, breathlessness, or other symptoms.
How to improve access to care for CVD?
To improve access to care for CVD, we must address both conventional and emerging risk factors. Conventional risks like diabetes, hypertension, and high cholesterol are well-known, but the Interheart Study highlighted other important factors such as psychosocial stress and low fruit and vegetable intake. Recognizing these expanded risk factors can help improve access to care by raising awareness about the need for preventive measures and regular check-ups. Telemedicine and expanding access to diagnostic services can also play a role in improving access, especially in underserved regions.
What sort of diagnostic tests are available today? What are the benefits of each test?
Several diagnostic tests are available for CVD, each serving a unique purpose. These include:
Blood Tests: These help identify high cholesterol and diabetes—both major contributors to heart disease.
Electrocardiogram (ECG): An ECG records the heart’s electrical activity and helps detect irregular heartbeats or blocked arteries.
Echocardiogram: This test uses ultrasound to get a clear picture of the heart and its functioning, helping detect structural abnormalities.
Treadmill Stress Test: This test evaluates how well the heart functions during physical activity and is useful in identifying early signs of heart disease.
These tests, when combined with a thorough clinical evaluation, can provide a comprehensive view of an individual’s cardiovascular health. Early diagnosis enables timely treatment, which is crucial in preventing major heart events.
With India’s genetic predisposition to CVD, how can healthcare providers integrate genetic counselling or testing into preventive care programs to mitigate long-term risks?
India’s genetic predisposition to CVD is well-documented, with a study identifying 109 genetic loci
as associated with CAD. But it has been difficult to pin point one genetic loci as responsible for CVD and it is believed the multiple genes regulate CVD. Experts also believe that it is the interaction of these genes with environmental factors such as smoking and air pollution that increases the risk.
However, integrating genetic counselling into preventive care on a large scale is a challenge given the costs and lack of easily available infrastructure. Genetic testing may identify individuals at high risk, but it is the lifestyle factors—like smoking, stress, and pollution—that will activate these genetic markers. We need a tailored approach where genetic testing is used in conjunction with counselling on lifestyle changes and environmental factors to mitigate these risks. While clinical implementation is still evolving, early adoption of genetic testing in high-risk populations could help prevent the onset of severe disease.
What role do you see technology—such as wearables and AI-based health apps—playing in enhancing early detection and prevention efforts in India?
Technology, especially AI and wearables can be a game-changer for early detection and prevention. Wearables that monitor heart rate and physical activity levels can help in encouraging people to maintain a healthy lifestyle by giving them a goal to be achieved in tracking calories burned and activity levels.