Gupta Rajeev
Department of Medicine, Monilek Hospital and Research Centre, Jawahar Nagar, Jaipur 302004, India.
Indian Heart J. 2008 Mar-Apr;60(2 Suppl B):B4-18.
Coronary heart disease (CHD) is epidemic in India and one of the major causes of disease-burden and deaths. Mortality data from the Registrar General of India shows that cardiovascular diseases are a major cause of death in India now. Studies to determine the precise causes of death in urban Chennai and rural areas of Andhra Pradesh have revealed that cardiovascular diseases cause about 40% of the deaths in urban areas and 30% in rural areas. Analysis of cross-sectional CHD epidemiological studies performed over the past 50 years reveals that this condition is increasing in both urban and rural areas. The adult prevalence has increased in urban areas from about 2% in 1960 to 6.5% in 1970, 7.0% in 1980, 9.7% in 1990 and 10.5% in 2000; while in rural areas, it increased from 2% in 1970, to 2.5% in 1980, 4% in 1990, and 4.5% in 2000. In terms of absolute numbers this translates into 30 million CHD patients in the country. The disease occurs at a much younger age in Indians as compared to those in North America and Western Europe. Rural-urban differences reveal that risk factors like obesity, truncal obesity, hypertension, high cholesterol, low HDL cholesterol and diabetes are more in urban areas. Case-control studies also confirm the importance of these risk factors. The INTERHEART-South Asia study identified that eight established coronary risk factors--abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, low fruit and vegetable consumption, and lack of physical activity--accounted for 89% of the cases of acute myocardial infarction in Indians. There is epidemiological evidence that all these risk factors are increasing. Over the past fifty years prevalence of obesity, hypertension, hypercholesterolemia, and diabetes have increased significantly in urban (R2 0.45-0.74) and slowly in rural areas (R2 0.19-0.29). There is an urgent need for development and implementation of suitable primordial, primary, and secondary prevention approaches for control of this epidemic. An urgent and sincere bureaucratic, political, and social will to initiate steps in this direction is required.
冠心病（CHD）在印度呈流行态势，是疾病负担和死亡的主要原因之一。印度注册总署的死亡率数据显示，心血管疾病目前是印度死亡的主要原因。对金奈市区和安得拉邦农村地区的死亡确切原因进行的研究表明，心血管疾病导致市区约40%的死亡，农村地区为30%。对过去50年进行的冠心病横断面流行病学研究分析表明，这种疾病在城市和农村地区都在增加。城市地区成年人患病率从1960年的约2%增至1970年的6.5%、1980年的7.0%、1990年的9.7%以及2000年的10.5%；而农村地区则从1970年的2%增至1980年的2.5%、1990年的4%以及2000年的4.5%。就绝对数字而言，这意味着该国共有3000万冠心病患者。与北美和西欧的人群相比，印度人患这种疾病的年龄要小得多。城乡差异表明，肥胖、腹型肥胖、高血压、高胆固醇、低高密度脂蛋白胆固醇和糖尿病等危险因素在城市地区更为常见。病例对照研究也证实了这些危险因素的重要性。南亚心脏研究（INTERHEART-South Asia）确定，八种既定的冠心病危险因素——血脂异常、吸烟、高血压、糖尿病、腹型肥胖、心理社会因素、水果和蔬菜摄入量低以及缺乏体育锻炼——占印度人急性心肌梗死病例的89%。有流行病学证据表明，所有这些危险因素都在增加。在过去五十年中，肥胖、高血压、高胆固醇血症和糖尿病的患病率在城市地区显著上升（R² 0.45 - 0.74），在农村地区则缓慢上升（R² 0.19 - 0.29）。迫切需要制定和实施适当的一级、二级和三级预防措施来控制这种流行病。需要有紧急且真诚的官僚、政治和社会意愿来朝着这个方向采取行动。
