Burden of Disease: CVD and Stroke

Cardiovascular Diseases

Cardiovascular disease (CVD) ranks as the world’s top cause of death. An estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to coronary heart disease and 6.7 million were due to stroke.¹

At least three quarters of the world's deaths from CVDs occur in low- and middle-income countries.¹ People in low- and middle-income countries often do not have the benefit of integrated primary health care programs for early detection and treatment of people with risk factors compared to people in high-income countries.

People in low- and middle-income countries suffering from CVDs and other non-communicable diseases have less access to effective and equitable health care services which respond to their needs. As a result, many people are detected late in the course of the disease and die younger from CVDs and other non-communicable diseases, often in their most productive years.¹

Cardiovascular diseases (CVDs) have now become the leading cause of mortality in India. A quarter of all mortality is attributable to CVD. Ischemic heart disease and stroke are the predominant causes and are responsible for >80% of CVD deaths.² According to the Global Burden of Disease study age-standardized estimates (2016), nearly a quarter (28.1%) of all deaths in India are attributable to CVD.³ The age standardized CVD death rate of 272 per 100 000 population in India is higher than the global average of 235 per 100 000 population.²

Cerebrovascular Accidents (Stroke)

Worldwide, stroke are the second leading cause of death and the third leading cause of disability⁴. Annually, 15 million people worldwide suffer from stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on family and the community.⁵ Over the last four decades, the stroke incidence in low- and middle-income countries has more than doubled. The risk factors for stroke are similar to those for coronary heart disease and other vascular diseases. Combinations of prevention strategies have proved effective in reducing stroke mortality even in some low-income settings.^{6, 7}

Furthermore, as most guidelines are based on high-income country data, uncertainty remains regarding best management of stroke of unknown type in low- and middle-income countries. The patient management challenges, combined with inadequate rehabilitation services, lack of preventive measures, as well as poor understanding of the possible unique risk factors associated with stroke in low- and middle-income countries, may account for the disproportionately large stroke burden borne by these countries. Managing acute stroke in low-resource settings requires a novel approach to increase awareness of stroke, generate better surveillance data and guide better prevention and management.

The contribution of most of the major non-communicable disease groups to the total disease burden has increased all over India since 1990, including cardiovascular diseases. Among the leading non-communicable diseases, the disease burden or DALY rate due to ischemic heart disease increased from 1990 to 2016 by 34%. In 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischemic heart disease as the top cause and stroke as the fifth leading cause. The range of disease burden or DALY rate among the states in 2016 was 9 fold for ischemic heart disease, and 6 fold for stroke across India.⁸

References

1. Cardiovascular Diseases Factsheet, May 2017. World Health Organization.

2. Prabhakaran Dorairaj, Panniyammakal Jeemon and Roy Ambuj. Cardiovascular Diseases in India. Circulation. 2016;133:1605-1620

3. Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. GBD India Compare Data Visualization. New Delhi: ICMR, PHFI, and IHME; 2017.

4. Global Health Estimates. Geneva: World Health Organization; 2012

5. Global Burden of Stroke. The Atlas of Heart Disease and Stroke. World Health Organization.

6. O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al.; INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010 Jul 10;376(9735):112–23.

7. Mayosi BM, Lawn JE, van Niekerk A, Bradshaw D, Abdool Karim SS, Coovadia HM; Lancet South Africa team. Health in South Africa: changes and challenges since 2009. Lancet. 2012 Dec 8;380(9858):2029–43

8. India: Health of the Nation’s States. The India State-Level Disease Burden Initiative. ICMR, PHFI, and IHME; 2017