Coronary artery disease epidemic in Indians: a cause for alarm and call for action

Coronary artery disease (CAD) rates in urban areas in India are now 4-fold higher than in the United States (US) although the rates were similar in 1968. Both overseas and resident Indians have the highest rates of CAD, although almost half of them are life-long vegetarians. When compared to Whites, Blacks, Hispanics and other Asians, CAD rates among Indians worldwide are two to four times higher at all ages and five to ten times higher in those < 40 years of age. Although CAD is a fatal disease with no known cure, it is also highly predictable, preventable, and treatable. During the past 30 years, CAD rates halved in the US, Australia, Canada, France, Japan, and Finland. These vast reductions in CAD mortality are attributed to nationwide changes in specific risk factors that were identified through epidemiological research and addressed through population-based interventions, rather than extensive use of expensive technology. Reduction in risk factors explains most of the decline with modest contributions from advances in treatment. Ironically, the CAD rates doubled in India during the same period, primarily due to dietary changes associated with epidemiological transition from a rural sustenance economy to an urban market oriented economy. The impact of such changes appears to be greater in Indians than in other populations due to a genetic predisposition. Significant decline of CAD is readily achievable in India, by adopting a combined population-wide and high-risk primary prevention strategy. This requires concerted action by the medical profession, govemment, media, and the public.