Cardiovascular Disease Prevention

Intro & Scope - CVD Crisis India

• India faces a CVD epidemic; a leading public health challenge.
• Responsible for ~27% of total deaths, over 3 million annually.
• Rapidly ↑ prevalence across urban and rural settings; urban areas more affected.
• Substantial economic drain: premature mortality in working-age adults, high out-of-pocket expenditure.
• Worrying trend: younger age of onset in Indians vs. Western counterparts.

⭐ CVDs have emerged as the number one killer in India, surpassing all other causes.

Risk Factors - Dodging Danger

Key CVD risk factors:

Indian Context: Key for India: ↑Central obesity, dyslipidemia (↑TG, ↓HDL), T2DM risk.

📌 MetS (IDF, S. Asians): Central Obesity (WC M≥90cm, F≥80cm) + ≥2 of:

• ↑TG (≥150 mg/dL)
• ↓HDL (<40M, <50F mg/dL)
• ↑BP (≥130/85 mmHg or Rx)
• ↑Fasting Glucose (≥100 mg/dL or T2DM)

Prevention Levels - Shield Up Stages

• Primordial: Prevent risk factor development. Target: Whole population, esp. children. Interventions: Health education, promoting healthy lifestyles.

  ⭐ Primordial prevention focuses on maintaining healthy lifestyles from childhood.

• Primary: Prevent disease in at-risk individuals.
  • Strategies: Population (e.g., community salt ↓ to <5g/day) & High-risk (e.g., statins for dyslipidemia).
  • Interventions: Diet (DASH), exercise (150 min/wk moderate or 75 min/wk vigorous), tobacco cessation.
• Secondary: Halt/slow disease progression in diagnosed patients. Interventions: Aspirin, β-blockers post-MI, risk factor control.
• Tertiary: Limit disability, improve quality of life. Interventions: Cardiac rehabilitation, managing complications.

Screening & Action - Early Bird Wins

• Hypertension: Screen ≥18 yrs. Annually if BP 120-139/80-89 mmHg; else 3-5 yrs. Diagnose ≥140/90 mmHg.
• Diabetes: Screen ≥30 yrs (earlier if high-risk e.g., BMI >23 kg/m² + risk factors). HbA1c ≥6.5%, FPG ≥126 mg/dL. Use Indian Diabetes Risk Score (IDRS).
• Dyslipidemia: Screen ≥20 yrs. Lipid profile (TC, LDL-C, HDL-C, TG). Target LDL <100 mg/dL (varies with risk).
• Opportunistic screening in all healthcare settings is key.
• Assess overall risk: WHO CVD Risk Charts (SEAR D).

⭐ First BP screening is recommended from age 18 years.

National Efforts - India Fights CVD

• NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke): Aims to prevent & control major NCDs.
  • Key Components: Health promotion, early diagnosis, screening, timely referral, management at different healthcare levels.
  • Services: Opportunistic screening, diagnosis, treatment, and follow-up.
• Other Initiatives:
  • National Tobacco Control Programme (NTCP): Reduces tobacco consumption.
  • FSSAI regulations: e.g., limiting trans-fats (target <2% by 2022), promoting ↓salt intake.
  • Ayushman Bharat (HWCs): Strengthens NCD screening & management at primary level.

⭐ NPCDCS targets a 25% relative reduction in premature mortality (30-70 years) from NCDs by 2025.

High‑Yield Points - ⚡ Biggest Takeaways

• Primordial prevention targets preventing the development of risk factors like obesity.
• Primary prevention focuses on controlling established risk factors (e.g., hypertension, smoking).
• Population strategy aims to shift the average risk level in the entire community.
• High-risk strategy identifies and manages individuals with multiple risk factors.
• Tobacco cessation offers the most significant and cost-effective impact on CVD reduction.
• Key WHO "Best Buys" include tobacco control, reduced salt intake, and managing hypertension.
• India's NPCDCS program is crucial for CVD prevention and control efforts nationwide.