60% of deaths from heart disease could be in India by 2010

Compared with patients in developed countries, those with heart disease in the developing world are likely to be younger and to first present with more severe disease, according to this new study from India.

The study, published in The Lancet comes from Denis Xavier and colleagues, who looked at data from more than 20 000 patients with acute coronary syndrome admitted to 89 hospitals across 50 cities in India. Morbidity and mortality was high, ascribed to low use of lipid-lowering treatments, beta-blockers and ACE inhibitors. There was also a very low incidence of invasive coronary revascularisation techniques. In short, there was 'substantial underutilisation' of evidence-based treatment among poor people, leading to worse outcomes.

The authors point out that as the Indian economy grows there is the potential for further increases in the incidence of cardiovascular disease before any decline - such as is seen in developed countries - is likely.

Tobacco use is expected to be the cause of 10% of deaths worldwide by 2015 and this is one of the main reasons for coronary heart disease in India - and in many other developing countries. Reductions in smoking lead to definite decreases in the incidence of heart disease in countries where punitive taxation has lowered smoking rates. Diet also plays a part - even a modest decrease in the use of saturated fats, changing to polyunsaturated fats, can lead to a measureable decrease in heart disease. Improved treatment of hypertension and hyperlipidaemia is required, as is optimal treatment of those who present with actute coronary syndrome.

Let's do Biz