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Heart disease and its treatment a serious concern for
India: Study
HAMILTON, ON – There are major gaps in the treatment of heart disease in the
one country that has the most serious concern, India.
A new study published in the medical journal The Lancet today says India’s
residents have a higher rate of serious heart disease at a younger age but they
are less likely to receive quick care than in other developed countries.
The CREATE study, a prospective registry study of almost 21,000 patients
across India, was directed by Dr. Salim Yusuf, director of the Population Health
Research Institute at McMaster University and Hamilton Health Sciences. Dr.
Yusuf is a professor of medicine of the Michael G. DeGroote School of Medicine
and vice-president, research at Hamilton Health Sciences in Hamilton, Ontario,
Canada. Another McMaster author on paper was P.J. Devereaux, assistant
professor of medicine.
Heart disease is the leading cause of death globally. In 2001, the disease
accounted for 7.1 million deaths worldwide, 80% of which were in low-income
countries. Between 1990 and 2020, these diseases are expected to increase by
137% for men and 120% for women in developing countries, compared with 30%
to 60% in developed countries. Previous studies have said that by 2010, 60% of
the world’s heart disease burden is expected to occur in India.
Dr. Yusuf’s team found that of the 20,468 patients given a definite diagnosis of a
heart condition, 60% had the most serious types of heart disease – which
compares with less than 40% in developed countries. The Indian patients were
also younger than those in developed countries.
Three quarters of patients in CREATE were from lower middle class and poor
backgrounds and were less likely to be able to afford routine treatments in
hospitals and for secondary prevention. Time taken to reach hospital was much
longer in India (5 hours) than in developed countries (2 hours and 20 minutes to
2 hours and 50 minutes). Reason for delays included using public or private
transport instead of ambulance, traffic delays, long delays and lack of awareness
of symptoms.
The authors also found major differences between treatment patterns in India
and developed countries. Rates of coronary interventions such as balloon
angioplasty (reopening blocked arteries by inserting and then inflating a small
balloon) were lower, and treatments such as streptokinase (a drug that dissolves
blood clots) were higher than in developed countries.
“This is probably because about three quarters of patients in India pay directly
for their own treatments and angioplasty is considerably more expensive than
medication,” said Dr. Yusuf.
However, use of key medical treatments such as antiplatelet drugs, beta
blockers, ACE inhibitors and lipid-lowering drugs were similar to that in
developed countries, showing awareness of evidence-based treatments by
Indian physicians, and also the relatively low cost of generic drugs in India. But
use of all treatments except antiplatelet drugs differed across socioeconomic
groups, with fewer poor patients received treatments proven to save lives.
Mortality rates among Indian heart patients were also higher than in developed
countries, and highest among poor patients.
“Patients with acute coronary syndromes in India tend to be young and from low
socioeconomic groups, and to have a higher rate of serious heart disease than
do patients in developed countries,” said Dr. Yusuf. “Strategies to reduce delays
in access to hospital, and improve the affordability of urgent care could reduce
morbidity and mortality from acute coronary syndromes in India.”
-30A copy of the published research study is available upon request
For more information contact:
Dr. Salim Yusuf
Population Health Research Institute
McMaster University
Hamilton General Hospital
Hamilton, Ontario
905-527-7327
[email protected]
Veronica McGuire
Media Relations
Faculty of Health Sciences
McMaster University
905-525-9140, ext. 22169
[email protected]
Heather Pullen
Public Relations
Hamilton Health Sciences
905-521-2100, ext. 75939
Paging: 905-521-5030
[email protected]