… Comments on the Role of Preventive Cardiology
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With the increasing number of cases being reported for heart diseases in India, do you think preventive healthcare holds a significant impact on people?

Increase in the incidence of heart disease or the excess incidence of heart disease burden in South Asians is not a new finding. In the introduction to our book (Coronary Artery Disease in South Asians: Epidemiology, Risk Factors and Prevention) on Coronary Artery Disease (CAD), we wrote, “Studies done in Africa, New Zealand, Singapore, Malaysia, Fiji, United Kingdom and the USA have revealed a high incidence of CAD in men and women of South Asian origin compared to other ethnic groups”.

What is surprising is, in no country incidence or prevalence of CAD in South Asia has been reduced, reversed or prevented in the last two decades. This is although there is a significant reduction in CAD-related premature mortality in all the major industrial countries. Various metabolic risks such as oxidative stress, chronic inflammation, excess weight, obesity, endothelial dysfunction, subclinical atherosclerosis and type-2 diabetes contribute significantly to the morbidity and mortality associated with CAD. All of these metabolic risks are accelerated by an unhealthy lifestyle, sedentary habits and unhealthy diet.

Given this observation, creating awareness, developing preventive strategies to improve the lifestyle, physical activity, and diet will go a long way, in the reduction of healthcare burden in this population.

Preventive healthcare in itself is a subject to be understood for various classes of heart diseases. What could be the most important preventive measures one can take to keep in check the probability of a heart incidence?

Preventive healthcare is itself a subject that is poorly understood. In a country like India, where no one gets an annual medical checkup, how do you expect an early diagnosis of metabolic risks? By the time one recognizes common cardio-metabolic risks such as hypertension, excess weight, obesity and type-2 diabetes, the individual will have already developed early signs of vascular disease (like Atherosclerosis).

What is preventing early diagnosis?

Lack of education, awareness, trained human resources and the will of the stakeholders to address these public health issues. The Millennium Development Goals was signed by the UN Member Countries for Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCD) by 2013 – 2020. To strengthen the national efforts to address the burden of NCDs, the 66th World Health Assembly endorsed the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020 (resolution WHA66.10).

The Global Action Plan offers a paradigm shift by providing a road map and a menu of policy options for Member States, WHO, other UN organizations and intergovernmental organizations, NGOs and the private sector which, when implemented collectively between 2013 and 2020, will attain 9 voluntary global targets, including that of a 25% relative reduction in premature mortality from NCDs by 2025. Although India is a signatory to this resolution, I have not seen any concerted effort in developing preventive strategies to address the growing menace of cardiometabolic diseases.

These comments have been made and approved by Prof Gundu Rao, Emeritus Professor, University of Minnesota, for publication.

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