Skip to main content
Erschienen in: Current Cardiology Reports 12/2021

01.12.2021 | Public Health Policy (SS Virani and D Mahtta, Section Editors)

Can Sound Public Health Policies Stem the Tide of Burgeoning Epidemic of Cardiovascular Disease in South Asians?

verfasst von: Pirbhat Shams, Mohsina Hussain, Salima Karani, Sana Mahmood, Alina Hasan, Sameen Siddiqi, Salim S. Virani, Zainab Samad

Erschienen in: Current Cardiology Reports | Ausgabe 12/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

To revisit the importance of prevention strategies and policies in reducing the burden of ischemic heart disease in South Asian countries.

Recent Findings

South Asia has seen rapid growth in its population with variable improvement in health indicators such as life expectancy at birth over the last three decades. Parallel to these improvements, there has been a stark rise in noncommunicable diseases (NCDs) but without a commensurate improvement in infrastructure/policies and health system interventions to address NCDs. South Asia is the epicenter of the cardiovascular disease (CVD) epidemic in Asia. It has a population that manifests accelerated atherosclerosis at a younger age. Poverty, lower health literacy, lack of health-promoting behaviors, poor urban design, rising air pollution, weak health systems, and lack and poor implementation of existing policies contribute to the continued rise in the incidence of CVD and the associated case fatality rates.

Summary

A relatively young population presents an opportunity for implementation of prevention measures now which if not adequately utilized will result in an exponential rise in the CVD burden. There is a large gap between policymaking and implementation in this part of the world. Economic realities further constrain coverage of prevention policies; and therefore, stronger collaboration between governments, stakeholders, civil society, and regional and international funding agencies is needed to universally implement prevention strategies in South Asia.
Literatur
1.
Zurück zum Zitat Organization WH. Non-communicable diseases and mental health in South Asia region. 2021. Organization WH. Non-communicable diseases and mental health in South Asia region. 2021.
2.
Zurück zum Zitat Ohira T, Iso H. Cardiovascular disease epidemiology in Asia: an overview. Circ J. 2013;77(7):1646–52.CrossRef Ohira T, Iso H. Cardiovascular disease epidemiology in Asia: an overview. Circ J. 2013;77(7):1646–52.CrossRef
3.
Zurück zum Zitat Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286–94.CrossRef Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286–94.CrossRef
4.
Zurück zum Zitat Bank TW. United Nations Population Division. World urbanization prospects: 2018. Bank TW. United Nations Population Division. World urbanization prospects: 2018.
5.
Zurück zum Zitat Wang H, Abbas KM, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, et al. Global age-sex-specific fertility mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet (London, England). 2020;396(10258):1160–203. CrossRef Wang H, Abbas KM, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, et al. Global age-sex-specific fertility mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet (London, England). 2020;396(10258):1160–203. CrossRef
6.
Zurück zum Zitat Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2018;392(10159):1859–922.CrossRef Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2018;392(10159):1859–922.CrossRef
7.
Zurück zum Zitat Organization WH. Global Health Observatory data repository. 2021. Organization WH. Global Health Observatory data repository. 2021.
8.
Zurück zum Zitat Worldometer. World population by region. 2021. Worldometer. World population by region. 2021.
9.
Zurück zum Zitat Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1–25.CrossRef Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1–25.CrossRef
10.
Zurück zum Zitat (IHME) TIfHMaE. Global burden of diseases. 2019. (IHME) TIfHMaE. Global burden of diseases. 2019.
11.
Zurück zum Zitat IHME. GBD 2019 Cause and risk summaries. 2019. IHME. GBD 2019 Cause and risk summaries. 2019.
12.
13.
Zurück zum Zitat Volgman AS, Palaniappan LS, Aggarwal NT, Gupta M, Khandelwal A, Krishnan AV, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018;138(1):e1–34. CrossRef Volgman AS, Palaniappan LS, Aggarwal NT, Gupta M, Khandelwal A, Krishnan AV, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018;138(1):e1–34. CrossRef
14.
Zurück zum Zitat Kanaya AM, Kandula N, Herrington D, Budoff MJ, Hulley S, Vittinghoff E, et al. Mediators of Atherosclerosis in South Asians Living in America (MASALA) study: objectives, methods, and cohort description. Clin Cardiol. 2013;36(12):713–20.CrossRef Kanaya AM, Kandula N, Herrington D, Budoff MJ, Hulley S, Vittinghoff E, et al. Mediators of Atherosclerosis in South Asians Living in America (MASALA) study: objectives, methods, and cohort description. Clin Cardiol. 2013;36(12):713–20.CrossRef
15.
Zurück zum Zitat Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet (London, England). 2004;364(9438):937–52.CrossRef Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet (London, England). 2004;364(9438):937–52.CrossRef
16.
Zurück zum Zitat Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet (London, England). 2017;390(10107):2050–62.CrossRef Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet (London, England). 2017;390(10107):2050–62.CrossRef
17.
Zurück zum Zitat • Swaminathan S, Dehghan M, Raj JM, Thomas T, Rangarajan S, Jenkins D, et al. Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study. BMJ. 2021;372:m4948. This analysis based on a large number of subjects showed that higher intake of refined grains was associated with higher mortality and cardiovascular events, globally. • Swaminathan S, Dehghan M, Raj JM, Thomas T, Rangarajan S, Jenkins D, et al. Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study. BMJ. 2021;372:m4948. This analysis based on a large number of subjects showed that higher intake of refined grains was associated with higher mortality and cardiovascular events, globally.
18.
Zurück zum Zitat • Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223–49. Hypertension followed by smoking was the leading level 2 risk factor globally for attributable deaths. The paper highlights the importance of smoking related regulation and policymaking in reducing the high attributable death burden. • Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223–49. Hypertension followed by smoking was the leading level 2 risk factor globally for attributable deaths. The paper highlights the importance of smoking related regulation and policymaking in reducing the high attributable death burden.
19.
Zurück zum Zitat Huaman MA, Henson D, Ticona E, Sterling TR, Garvy BA. Tuberculosis and cardiovascular disease: linking the epidemics. Trop Dis Travel Med Vaccines. 2015;1. Huaman MA, Henson D, Ticona E, Sterling TR, Garvy BA. Tuberculosis and cardiovascular disease: linking the epidemics. Trop Dis Travel Med Vaccines. 2015;1.
20.
Zurück zum Zitat Wong BW, Meredith A, Lin D, McManus BM. The biological role of inflammation in atherosclerosis. Can J Cardiol. 2012;28(6):631–41.CrossRef Wong BW, Meredith A, Lin D, McManus BM. The biological role of inflammation in atherosclerosis. Can J Cardiol. 2012;28(6):631–41.CrossRef
21.
Zurück zum Zitat Wongtrakul W, Charoenngam N, Ungprasert P. Tuberculosis and risk of coronary heart disease: a systematic review and meta-analysis. Indian J Tuberc. 2020;67(2):182–8.CrossRef Wongtrakul W, Charoenngam N, Ungprasert P. Tuberculosis and risk of coronary heart disease: a systematic review and meta-analysis. Indian J Tuberc. 2020;67(2):182–8.CrossRef
22.
Zurück zum Zitat Ramegowda S, Ramachandra NB. Parental consanguinity increases congenital heart diseases in South India. Ann Hum Biol. 2006;33(5–6):519–28.CrossRef Ramegowda S, Ramachandra NB. Parental consanguinity increases congenital heart diseases in South India. Ann Hum Biol. 2006;33(5–6):519–28.CrossRef
23.
Zurück zum Zitat Studies. NIoP. Demographic and health survey. 2017–18. Studies. NIoP. Demographic and health survey. 2017–18.
24.
Zurück zum Zitat Saleheen D, Zaidi M, Rasheed A, Ahmad U, Hakeem A, Murtaza M, et al. The Pakistan Risk of Myocardial Infarction Study: a resource for the study of genetic, lifestyle and other determinants of myocardial infarction in South Asia. Eur J Epidemiol. 2009;24(6):329–38.CrossRef Saleheen D, Zaidi M, Rasheed A, Ahmad U, Hakeem A, Murtaza M, et al. The Pakistan Risk of Myocardial Infarction Study: a resource for the study of genetic, lifestyle and other determinants of myocardial infarction in South Asia. Eur J Epidemiol. 2009;24(6):329–38.CrossRef
25.
Zurück zum Zitat Saleheen D, Natarajan P, Armean IM, Zhao W, Rasheed A, Khetarpal SA, et al. Human knockouts and phenotypic analysis in a cohort with a high rate of consanguinity. Nature. 2017;544(7649):235–9.CrossRef Saleheen D, Natarajan P, Armean IM, Zhao W, Rasheed A, Khetarpal SA, et al. Human knockouts and phenotypic analysis in a cohort with a high rate of consanguinity. Nature. 2017;544(7649):235–9.CrossRef
26.
Zurück zum Zitat Fischer L, Galler J. Early childhood malnutrition increases metabolic syndrome in adulthood. FASEB J. 2015;29(S1):258–62. Fischer L, Galler J. Early childhood malnutrition increases metabolic syndrome in adulthood. FASEB J. 2015;29(S1):258–62.
27.
Zurück zum Zitat Organziation WH. National Nutrition Survey Pakistan 2018. 2018. Organziation WH. National Nutrition Survey Pakistan 2018. 2018.
28.
Zurück zum Zitat Murarkar S, Gothankar J, Doke P, Pore P, Lalwani S, Dhumale G, et al. Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health. 2020;20(1):1559.CrossRef Murarkar S, Gothankar J, Doke P, Pore P, Lalwani S, Dhumale G, et al. Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health. 2020;20(1):1559.CrossRef
29.
Zurück zum Zitat Roth Gregory A, Mensah George A, Johnson Catherine O, Addolorato G, Ammirati E, Baddour Larry M, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. J Am Coll Cardiol. 2020;76(25):2982–3021.CrossRef Roth Gregory A, Mensah George A, Johnson Catherine O, Addolorato G, Ammirati E, Baddour Larry M, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. J Am Coll Cardiol. 2020;76(25):2982–3021.CrossRef
30.
Zurück zum Zitat Rizvi SF, Khan MA, Kundi A, Marsh DR, Samad A, Pasha O. Status of rheumatic heart disease in rural Pakistan. Heart. 2004;90(4):394–9.CrossRef Rizvi SF, Khan MA, Kundi A, Marsh DR, Samad A, Pasha O. Status of rheumatic heart disease in rural Pakistan. Heart. 2004;90(4):394–9.CrossRef
31.
Zurück zum Zitat Sriharibabu M, Himabindu Y, Kabir Z. Rheumatic heart disease in rural South India: a clinico-observational study. J Cardiovasc Dis Res. 2013;4(1):25–9.CrossRef Sriharibabu M, Himabindu Y, Kabir Z. Rheumatic heart disease in rural South India: a clinico-observational study. J Cardiovasc Dis Res. 2013;4(1):25–9.CrossRef
32.
Zurück zum Zitat Vartiainen E. The North Karelia project: cardiovascular disease prevention in Finland. Glob Cardiol Sci Practice. 2018;2018(2):13. Vartiainen E. The North Karelia project: cardiovascular disease prevention in Finland. Glob Cardiol Sci Practice. 2018;2018(2):13.
33.
Zurück zum Zitat IHME GBoD. High burden, low budget: non-communicable diseases in low- and middle-income countries. 2018. IHME GBoD. High burden, low budget: non-communicable diseases in low- and middle-income countries. 2018.
34.
Zurück zum Zitat Organization WH. WHO tools to prevent and control noncommunicable diseases. 2021. Organization WH. WHO tools to prevent and control noncommunicable diseases. 2021.
35.
Zurück zum Zitat Organization WH. World statistics. 2019. Organization WH. World statistics. 2019.
36.
Zurück zum Zitat FCTC abtCotPttW. WHO Framework Convention on Tobacco Control. 2003. FCTC abtCotPttW. WHO Framework Convention on Tobacco Control. 2003.
37.
Zurück zum Zitat Ministry of Planning Development and Reform. Pakistan Dietary Guidelines for Better Nutrition. 2018. Ministry of Planning Development and Reform. Pakistan Dietary Guidelines for Better Nutrition. 2018.
38.
Zurück zum Zitat Bank TW. External health expenditure per capita, PPP (current international $). 2011. Bank TW. External health expenditure per capita, PPP (current international $). 2011.
39.
Zurück zum Zitat OECD.stat. Health expenditure and funding. 2021. OECD.stat. Health expenditure and funding. 2021.
40.
Zurück zum Zitat Organization WH. Scaling up action against NCDs: how much will it cost. 2011. Organization WH. Scaling up action against NCDs: how much will it cost. 2011.
41.
Zurück zum Zitat •• Jafar TH, Gandhi M, de Silva HA, Jehan I, Naheed A, Finkelstein EA, et al. A community-based intervention for managing hypertension in Rural South Asia. N Engl J Med. 2020;382(8):717–26. This study is an excellent example of how a community-based and cost-effective intervention of home visits can help achieve significant blood pressure control in South Asian countries. •• Jafar TH, Gandhi M, de Silva HA, Jehan I, Naheed A, Finkelstein EA, et al. A community-based intervention for managing hypertension in Rural South Asia. N Engl J Med. 2020;382(8):717–26. This study is an excellent example of how a community-based and cost-effective intervention of home visits can help achieve significant blood pressure control in South Asian countries.
42.
Zurück zum Zitat Organization WH. The labour market for human resources for health in lowand middle-income countries. 2012. Organization WH. The labour market for human resources for health in lowand middle-income countries. 2012.
43.
Zurück zum Zitat Koniak-Griffin D, Brecht ML. Awareness of cardiovascular disease and preventive behaviors among overweight immigrant Latinas. J Cardiovasc Nurs. 2015;30(5):447–55.CrossRef Koniak-Griffin D, Brecht ML. Awareness of cardiovascular disease and preventive behaviors among overweight immigrant Latinas. J Cardiovasc Nurs. 2015;30(5):447–55.CrossRef
44.
Zurück zum Zitat Ha DA, Chisholm D. Cost-effectiveness analysis of interventions to prevent cardiovascular disease in Vietnam. Health Policy Plan. 2011;26(3):210–22.CrossRef Ha DA, Chisholm D. Cost-effectiveness analysis of interventions to prevent cardiovascular disease in Vietnam. Health Policy Plan. 2011;26(3):210–22.CrossRef
45.
Zurück zum Zitat Singh K, Chandrasekaran AM, Bhaumik S, Chattopadhyay K, Gamage AU, Silva PD, et al. Cost-effectiveness of interventions to control cardiovascular diseases and diabetes mellitus in South Asia: a systematic review. BMJ Open. 2018;8(4):e017809.CrossRef Singh K, Chandrasekaran AM, Bhaumik S, Chattopadhyay K, Gamage AU, Silva PD, et al. Cost-effectiveness of interventions to control cardiovascular diseases and diabetes mellitus in South Asia: a systematic review. BMJ Open. 2018;8(4):e017809.CrossRef
46.
Zurück zum Zitat Organization WH. Rapid assessment of servcie delivery of non-communicable diseases during the COVID-19 pandemic. 2020. Organization WH. Rapid assessment of servcie delivery of non-communicable diseases during the COVID-19 pandemic. 2020.
47.
Zurück zum Zitat IHME. Health data term definitions. 2021. IHME. Health data term definitions. 2021.
48.
Zurück zum Zitat Nishtar S, Faruqui AM, Mattu MA, Mohamud KB, Ahmed A. The national action plan for the prevention and control of non-communicable diseases and health promotion in Pakistan—cardiovascular diseases. J Pak Med Assoc. 2004;54(12 Suppl 3):S14-25.PubMed Nishtar S, Faruqui AM, Mattu MA, Mohamud KB, Ahmed A. The national action plan for the prevention and control of non-communicable diseases and health promotion in Pakistan—cardiovascular diseases. J Pak Med Assoc. 2004;54(12 Suppl 3):S14-25.PubMed
49.
Zurück zum Zitat UNION T. Tobacco control in Pakistan. Published on 12 August 2020 updated: 2 October 2020. Authored by Anonymous. THE TOBACCO EPIDEMIC. UNION T. Tobacco control in Pakistan. Published on 12 August 2020 updated: 2 October 2020. Authored by Anonymous. THE TOBACCO EPIDEMIC.
50.
Zurück zum Zitat Ministry of Health and Family Welfare GoI. Prevention and control of common non-communicable disease. 2017. Ministry of Health and Family Welfare GoI. Prevention and control of common non-communicable disease. 2017.
51.
Zurück zum Zitat Misra A, Tandon N, Ebrahim S, Sattar N, Alam D, Shrivastava U, et al. Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions. BMJ (Clinical research ed). 2017;357:j1420.CrossRef Misra A, Tandon N, Ebrahim S, Sattar N, Alam D, Shrivastava U, et al. Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions. BMJ (Clinical research ed). 2017;357:j1420.CrossRef
Metadaten
Titel
Can Sound Public Health Policies Stem the Tide of Burgeoning Epidemic of Cardiovascular Disease in South Asians?
verfasst von
Pirbhat Shams
Mohsina Hussain
Salima Karani
Sana Mahmood
Alina Hasan
Sameen Siddiqi
Salim S. Virani
Zainab Samad
Publikationsdatum
01.12.2021
Verlag
Springer US
Erschienen in
Current Cardiology Reports / Ausgabe 12/2021
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-021-01612-1

Weitere Artikel der Ausgabe 12/2021

Current Cardiology Reports 12/2021 Zur Ausgabe

Hypertension (DS Geller and DL Cohen, Section Editors)

Athletes and Hypertension

Stroke (DL Tirschwell, Section Editor)

Stroke Prevention in Cervical Artery Dissection

Invasive Electrophysiology and Pacing (E. Kevin Heist, Section Editor)

Management of Atrial Fibrillation in the Emergency Department

Cardiac PET, CT, and MRI (P Cremer, Section Editor)

Imaging Coronary Allograft Vasculopathy with Cardiac PET and Cardiac MRI

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.