Coronary heart disease in low socioeconomic status subjects in India: "an evolving epidemic"

In developing countries such as India, the focus for long has been on the control of acute and chronic infections and communicable diseases. Mortality data from Global Burden of Diseases Studies has revealed that cardiovascular diseases, especially coronary heart disease are important causes of death. Worldwide, of the 17.5 million deaths from cardiovascular diseases, 20% deaths ocurred in high income countries, 8% in upper-middle income countries, 37% in lower-middle income countries and 35% in low income countries including India. There is epidemiological evidence that health transition is occurring rapidly in low and middle income countries. In many regions of these countries cardiovascular diseases, especially coronary heart disease, are more prevalent among the illiterate and low socioeconomic subjects. Recent case-control studies in India have reported that being illiterate or poor is an independent risk factor for acute myocardial infarction. Many of the standard coronary risk factors such as smoking and tobacco use, low physical activity, high dietary fat intake, uncontrolled hypertension, uncontrolled hypercholesterolemia and diabetes are also more common among the low socioeconomic individuals. Data shows that access and affordability for acute care managements and long term secondary prevention practices and compliance are lacking in these subjects. These attributes forecast a grim scenario for the evolving epidemic of coronary heart disease in India.