Cardiovascular disease

Cardiovascular disease (CVD) is an umbrella term for conditions affecting the heart and blood vessels. It includes coronary artery disease (which causes heart attack), stroke, heart failure, hypertensive heart disease, rheumatic heart disease, and peripheral artery disease.

CVD is the leading cause of death in India, responsible for roughly 27% of all deaths. Indians also tend to develop CVD at younger ages and with lower BMI than Western populations — a pattern known as "South Asian paradox."

Main types of CVD

• Coronary artery disease (CAD) — narrowing of the arteries that supply the heart muscle, causing angina or heart attack
• Stroke — caused by a blocked (ischaemic) or bleeding (haemorrhagic) brain artery
• Heart failure — the heart can't pump blood effectively; often the end result of other CVD
• Hypertensive heart disease — effects of long-term high blood pressure
• Arrhythmias — abnormal heart rhythms (atrial fibrillation, ventricular arrhythmias)
• Rheumatic heart disease — valve damage from untreated streptococcal infection in childhood; still significant in India
• Peripheral artery disease — narrowed arteries in the limbs
• Congenital heart disease — structural problems present from birth

Risk factors

Many CVD risk factors are modifiable:

• High blood pressure
• High cholesterol — especially raised LDL
• Diabetes — very common in India and a major driver of CVD
• Smoking and tobacco (including smokeless)
• Obesity and abdominal (belly) obesity — particularly important in South Asians, who develop CVD at lower overall BMI
• Physical inactivity
• Unhealthy diet — high in salt, refined carbs, saturated/trans fats, and low in fruits, vegetables, whole grains
• Excessive alcohol
• Long-term stress and poor sleep
• Air pollution — increasingly recognised as a CVD risk factor, particularly relevant in Indian cities

Non-modifiable risk factors include age, male sex, family history, and genetic predisposition.

Warning signs of a heart attack or stroke

Heart attack — chest pain or pressure (often central, can spread to arm, jaw, back); shortness of breath; sweating; nausea; unusual fatigue. Women often have atypical symptoms (breathlessness, back or jaw pain, indigestion-like feeling).

Stroke — use FAST:

• Face drooping on one side
• Arm weakness on one side
• Speech slurred or difficulty speaking
• Time to call emergency — dial 112

Every minute matters. Don't drive yourself — call for an ambulance.

Prevention and treatment

• Stop smoking and tobacco use; avoid secondhand smoke
• Maintain a healthy weight; watch abdominal circumference (men <90cm, women <80cm as general South Asian targets)
• Regular physical activity — 150+ minutes a week of moderate activity
• A diet rich in vegetables, fruits, whole grains, pulses, nuts; limit salt, sugar, refined carbs, and saturated/trans fats
• Limit alcohol
• Control blood pressure, cholesterol, and blood glucose — with lifestyle changes and medicines as prescribed
• Manage stress, sleep well

Treatment of CVD depends on the specific condition — blood-pressure medicines, statins for cholesterol, antiplatelets, revascularisation (stenting, bypass surgery), valve surgery, pacemakers, and more. Cardiac rehabilitation after an event improves outcomes significantly.