Prevention of coronary heart disease among Indians: focus on primary prevention.

Epidemiological transition with increasing life expectancy and demographic shifts in population age-profile combined with lifestyle related increases in the levels of cardiovascular risk factors is accelerating coronary heart disease (CHD) epidemic in India. As prospective cohort studies for evaluation of coronary risk factors do not exist, urban-rural differences in prevalence of coronary risk factors and case-control studies provide important information regarding coronary risk factors that need prevention to control the CHD epidemic. The risk factors more in urban Indians or associated with increased risk in case-control studies are: Sedentary lifestyle, smoking, truncal obesity, hypertension, hypercholesterolaemia, impaired glucose tolerance, insulin resistance and diabetes. Primordial prevention ie, prevention of risk factors can be achieved by encouragement of positive health behaviour and promotion of the concept of health as a social value. Special target groups are children, adolescents, family unit, under-privileged and high-risk groups. Behavioural and environmental changes relevant to primordial prevention are changes in eating patterns, drinking, smoking, physical activity and stress management. Primary prevention focuses on population and on high-risk groups. Specific high-risk subjects are those with family history of CHD, hypertension or diabetes or those having sedentary lifestyle, obesity, truncal obesity and biochemical coronary risk factors. The interventions are smoking cessation, increased physical activity, weight regulation, blood pressure control, lipid regulation and diabetes management.