Study on Cardiovascular Diseases and Cancer

Why in news?

A study by the Prospective Urban and Rural Epidemiologic (PURE) on cardiovascular diseases was recently published online in The Lancet journal.

What are the major findings?

• The study analysed the situation in 21 countries across 5 continents, categorised by income levels.
• CVD - Household air pollution has emerged as one of the key causes of cardiovascular diseases (CVDs).
• 12% of all CVDs in low-income countries are attributable to household air pollution.
• Hypertension is the largest risk factor for CVD in low-income countries including India.
• This is followed by high non-HDL cholesterol and household air pollution.
• Besides medical reasons, the single largest risk factor for cardiovascular diseases is low education level.

• Deaths - CVD remains the leading cause of mortality among middle-aged adults globally.
• However, this is no longer the case in high-income countries, where cancer is now responsible for twice as many deaths as CVD.
• In high-income countries, people have started living longer, so deaths due to CVD have reduced, and more are now dying due to cancers.

What does it mean for India?

• In low-income countries, including India, CVD is still the top killer.
• Deaths due to CVD here are three times more frequent than that due to cancer.
• Household air pollution is a greater risk factor for CVD in India than diabetes, tobacco use, low physical activity and poor diet.
• An earlier report from a PURE study showed that Indians had the lowest lung function among the 21 countries studied.
• At least 65% of homes in India use biomass fuel for cooking and heating.
• In urban areas, the use of mosquito coils, dhoop sticks and agarbattis contribute to high household air pollution.
• Household air pollution is becoming an important cause of overall and cardiovascular mortality in low-income countries.
• In other words, if the household air pollution is controlled, there will be a significant decrease in mortality including due to cardiovascular disease in India.

What does the report imply?

• The risk burden of CVD-linked mortality is inversely proportional - lower risk but higher mortality in low-income countries, and higher risk but lower mortality in high-income countries.
• PURE’s analysis concluded that the higher mortality in poorer countries was likely due to other factors.
• These primarily include ‘lower quality and less health care’.
• Access to affordable, quality health care is still not ensured in many regions in India.
• A great amount of out-of-pocket expenditure frustrates continuation of treatment, or adherence to drug routine.
• According to Health Ministry data for 2014-15, nearly 62.6% of India’s total health expenditure is out-of-pocket expenditure.

What is the way forward?

• Targeting risk factors is key to reducing deaths due to cardiovascular diseases.
• The major focus so far has been ambient air pollution i.e. pollution rising from motor vehicles and industries.
• It is now time to wake up and realise that the pollution generated in house is also responsible for significant adverse effects.
• Besides, the Centre’s Ayushman Bharat Yojana will have to take much of the burden of hospitalisation for complications of non-communicable diseases.
• National and State schemes running on mission mode will have to step up efforts to target people at risk with life-saving interventions.
• These include the National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke.
• Any plans targeting the risk factors of non-communicable diseases will have to be truly game-changing, and incorporate the environmental angle as well.

Source: Indian Express, The Hindu