Kalra Ankur, Jose Arun Pulikkottil, Prabhakaran Poornima, Kumar Ashish, Agrawal Anurag, Roy Ambuj, Bhargava Balram, Tandon Nikhil, Prabhakaran Dorairaj
Cardiovascular Institute, Kalra Hospitals, New Delhi, India.
Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India.
Lancet Reg Health Southeast Asia. 2023 Feb 10;12:100156. doi: 10.1016/j.lansea.2023.100156. eCollection 2023 May.
Cardiovascular diseases (CVD) are the leading cause of death and disability in India. The CVD epidemic in Indians is characterized by a higher relative risk burden, an earlier age of onset, higher case fatality and higher premature deaths. For decades, researchers have been trying to understand the reason for this increased burden and propensity of CVD among Indians. It can partly be explained by population-level changes and the remaining by increased inherent biological risk. While increased biological risk can be attributed to phenotypic changes caused by early life influences, six major transitions can be considered largely responsible for the population-level changes in India-epidemiological, demographic, nutritional, environmental, social-cultural and economic. Although conventional risk factors explain substantial population attributable risk, the thresholds at which these risk factors operate are different among Indians compared with other populations. Therefore, alternate explanations for these ecological differences have been sought and multiple hypotheses have been proposed over the years. Prenatal factors that include maternal and paternal influences on the offspring, and postnatal factors, ranging from birth through childhood, adolescence and young adulthood, as well as inter-generational influences have been explored using the life course approach to chronic disease. In addition to this, recent research has illustrated the importance of the role of inherent biological differences in lipid metabolism, glucose metabolism, inflammatory states, genetic predispositions and epigenetic influences for the increased risk. A multifaceted and holistic approach to CVD prevention that takes into consideration population-level as well as biological risk factors would be needed to control the burgeoning CVD epidemic among Indians.
心血管疾病（CVD）是印度死亡和残疾的主要原因。印度人的心血管疾病流行具有相对风险负担更高、发病年龄更早、病死率更高和过早死亡更多的特点。几十年来，研究人员一直在试图弄清楚印度人心血管疾病负担增加和患病倾向上升的原因。部分原因可以用人口层面的变化来解释，其余原因则是内在生物风险增加。虽然生物风险增加可归因于早期生活影响引起的表型变化，但在印度，有六个主要转变在很大程度上导致了人口层面的变化，即流行病学、人口统计学、营养、环境、社会文化和经济方面的转变。尽管传统风险因素解释了相当大比例的人群归因风险，但与其他人群相比，这些风险因素在印度人身上发挥作用的阈值有所不同。因此，多年来人们一直在寻找对这些生态差异的其他解释，并提出了多种假设。利用慢性病的生命历程方法，人们探索了产前因素（包括母体和父体对后代的影响）以及从出生到童年、青少年和青年期的产后因素，还有代际影响。除此之外，最近的研究表明，脂质代谢、葡萄糖代谢、炎症状态、遗传易感性和表观遗传影响等内在生物差异在增加风险方面所起的作用至关重要。需要采取一种多方面、全面的方法来预防心血管疾病，该方法要同时考虑人口层面和生物风险因素，以控制印度人中迅速增长的心血管疾病流行。
