Coronary Artery Disease in Indians

Dr Santhosh Satheesh
Assistant Professor, Department of Cardiology,
Jawaharlal Institute of Post Graduate Medical Education and Research
(JIPMER), Pondicherry, India
Distribution Of Deaths By Leading Cause
Groups, World, 2002
INDIA – Alarming CAD Epidemic!
• India has the largest number of people dying due
to Coronary Artery Disease in the world
• World Health Organization (WHO) estimates that
60 percent of the world's cardiac patients will be
Indian by 2010.
• India has the highest number of patients with
Diabetes
• CAD responsible for 32% of all Deaths in India
 Trends in CAD in India
100%
90%
80%
70%
60%
Other Cardiac
50%
CAD deaths
40%
30%
20%
10%
0%
1960 1990 2000

Reddy KS: Cardiovascular diseases in India.  World Health Stat Q  1993; 46:101

 Predictions of the increase in the number of
productive years lost due to CAD
between 2000 and 2030

• South Africa - 28 percent

• China - 57 percent
• Brazil - 64 percent
• India - 95 percent

20% CAD deaths in the USA and Europe < 70yrs

50% of CAD Deaths in India in <70yrs

Leeder S, Raymond S, Greenberg H, et al: A Race Against Time: The Challenge of Cardiovascular Disease in
Developing Economies,  New York, Columbia University, 2004
Cardiovascular Disease in India

• Coronary Artery Disease the leading

cause of death
• Rheumatic Heart Disease still a problem in
areas with poor socio economic conditions
Coronary Artery Disease in Indians –
Different from the Rest of the World
• Initial indicators that Indians have a higher
predilection for CAD from studies on
Indians living abroad
• CAD rates among overseas Asian Indians
worldwide are 50% to 400% higher than
people of other ethnic origin irrespective of
gender, religion, diet or social class.
 Coronary Artery Disease in Indians
US, Canada, Singapore, UK, South Africa, Middle East, Trinidad, Mauritius, Fiji, Kenya
• Higher Rates
– 2-4 fold higher prevalence, incidence, hospitalization, mortality
• Greater Prematurity
– 10 yr earlier onset of first MI
– 10 fold higher rate of MI and death <40yrs
• Greater Severity
– 3vessel disease more common, even in premenopausal women
• Lower Prevalence of Conventional Risk Factors
– Smoking, Obesity, Hypertension
– Cholesterol levels lower than Americans but higher than other asians
• Higher Rates of CAD at any given level of Conventional Risk Factors
– 2 fold higher than in Americans,Europeans
– 4 fold higher than in Chinese
• Higher prevalance of Emerging Risk Factors
– Metabolic Syndrome
– Lower HDL
– High levels of Lipoprotein(a), Homocysteine, ApoB, Fibrinogen, Small Dense LDL
 Age-standardized death rates from heart disease
among Indian men per 100,000 per year compared
to other ethnic groups in
Canada, UK, Singapore and South Africa.

I= Indians, B=blacks, W=whites, C=Chinese, M= Malays

 Prevalence of heart disease among
non-Indian Americans compared to Indians in
the US in the CADI Study

Framingham Offspring Study (first column).

 Higher Risk-
Redefine the risk factors
Risk Factor AHA/ESC Indian

Age -Men >45 >25

-Women >55 >35

BP >140/90 >120/80

Obesity (BMI) >25 >23

Central Obesity Male >102 cm >90

Female >88 cm >80

Lipids LDL >130 >100

TG >150 >150
HDL( m/f) <40/ <50 <40/<50