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Developing cardiovascular disease risk programs in India

Cardiovascular diseases, like heart attacks and strokes, are rapidly rising in India, and experts opine that lifestyle choices could be the culprit. A recent study, that collected data from households between 2012-2014 on the prevalence of cardiovascular diseases across the country had pointed out that they were more prevalent in urban, wealthy homes than their poor, rural counterparts. The research identified regional ‘hotspots’ that were at a higher risk of such diseases in North India, North East India and South India.

Considering that almost 90% of all  CVDs are preventable if the risk is addressed early on, what intervention strategies can the country take? A recent article, published in the journal PLOS Medicine, by researchers from The George Institute for Global Health, Australia and the Centre for Chronic Disease Control, India, has considered the findings from the above survey to propose better programs in areas that are identified to be at a higher risk.

The researchers believe that the freely-available data from the survey can drive government policy and health service planning by subsidising treatments and identifying areas that need intensive care for treating cardiovascular diseases (CVD). “While epidemiologists, who study the distribution of diseases, might be unimpressed by the variations in the CVD risk profiles, this study is a goldmine for policymakers”, they remark. 

The article points out some low-hanging solutions that can address the growing epidemic of cardiovascular diseases in India. One of them is the need to solve the problem of a large section of the society that is unable to access immediate care. Besides, it urges an assessment of these health technologies by India’s new Medical Technology Assessment Board. These assessments could help to make informed decisions on the use of money on preventive programs and to design better methods of implementation that cater to the population instead of trying to meet service demands.

The researchers also propose two different approaches that policymakers can take to lower the risk of CVDs. The first is a ‘population level’ approach, which attempts to shift the risk distribution of the whole community with the help of policies, laws and regulations. Improving food supply, making environments healthier and controlling tobacco sales could help in this regard. This approach is more feasible and could lower the risk of CVDs of a large population at one go. The second approach caters to the individual level by setting up programs at health care facilities to assess CVD risk of individuals and put preventative measures against the disease in place.

However, there is some scepticism on the reliability of the survey data, as risk factors and incidences of CVD are rapidly changing due to demographic and socioeconomic changes in the community. Since the survey data is now over five years old, it may not represent the current scenario. Also, the data used in studies on the effectiveness of CVD intervention based on the risk factors is usually simulated, and not on trial data. Hence, the validity of the mathematical equations used to predict the disease risk are often questioned. Besides, there has been a wide variation in the risk estimates between the study and the World Health Organization’s (WHO) risk charts and Globorisk scores, and there is no way of knowing which is accurate.

Although better data for risk profiles is critical to design and fund evidence-based programs, it is equally essential to overcome the implementation barriers of such programs. With the Ayushman Bharat National Health Protection Scheme launched to provide health coverage to over ten crore poor and vulnerable families, data from such studies that include a large population could help drive policies and help in the implementation of these schemes.