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HEALTH IMPACT FRAMEWORK RESEARCH PAPER

Health Impact Framework Research Paper

Cardiovascular Disease in India

Grisnel Rosario-Hernandez

Nursing Department, Delaware Technical Community College

NUR 310 Global Health

Prof. Tammy Brown RN MSN NEA-BC OCN

December 2, 2023
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According to the World Health Organization, Cardiovascular disease is a compilation of

illnesses related to the heart and the blood vessels. In this group the following are included:

coronary artery disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart

disease, congenital heart disease, and deep vein thrombosis. Included in these diseases are heart

attack and stroke, which are the consequence of the blockage of circulation to the vessels that

supply the heart and the brain (WHO, 2021). Cardiovascular disease has modifiable risk factors

that include diet, exercise, smoking, and alcohol use. “Cardiovascular diseases remain the

leading cause of disease burden in the world. CVD burden continues its decades-long rise for

almost all countries outside high-income countries, and alarmingly, the age-standardized rate of

CVD has begun to rise in some locations where it was previously declining in high-income

countries” (Roth, et.al., 2020, p. 2983).

Cardiovascular diseases are considered non-communicable diseases. “CVDs such as

ischemic heart disease and cerebrovascular such as stroke account for 17.7 million deaths and are

the leading cause.1 In accordance with the World Health Organization, India accounts for one-

fifth of these deaths worldwide especially in younger population” (Sreeniwas & Sinha, 2020,

p.1). Current statistics for cardiovascular disease in India might not be accurate due to the

amount of deaths happening outside of hospital facilities that are not attributed to any of the

diseases on the list. According to the data provided by the World Health Organization, ischemic

heart disease is the main cause of death in females (90.1 of 100,000) and males (130 out of

1000,000), followed by stroke with females dying at a rate of 50 out of 100,000 and males 52 out

of 100,000. “Heart diseases are rising in Asian Indians 5–10 years earlier than in other

populations around the world. The mean age for first presentation of acute myocardial infarction

in Indians is 53 years” (Sharma & Ganguly, 2005, p.217).

leading to decrease and prevention of disease in world populations. “In this pyramid, efforts to

address socioeconomic determinants are at the base, followed by public health interventions that

change the context for health (e.g., clean water, safe roads), protective interventions with long-

term benefits (e.g., immunizations), direct clinical care, and, at the top, counseling and

education. In general, public action and interventions represented by the base of the pyramid

require less individual effort and have the greatest population impact” (Frieden, 2010, p.5).

Cardiovascular disease is prevalent around the world as a direct consequence of health

behaviors that can put individuals at risk of developing the illness or due to non-modifiable risk

factors. “Notably, India, the world’s largest and fastest-growing country, witnessed nearly 6

million NCD-related deaths in 2016 alone, constituting 63% of total deaths in the same year.

Despite the escalating burden, health care services for NCDs in India remain inadequately

established because of limited resources and competing priorities from other health challenges”

(Ko, et. al., 2023, p. 2). Studies on socioeconomic factors in India yield inaccurate results due to

the under reporting of deaths and its causes, however the risk remains high in disadvantaged

populations and the poor.

A study published by the Lancet, “found that people with lower SES measured by

education or wealth and those living in rural areas experienced stronger adverse trends in

unhealthy weight, hypertension, and diabetes between 2015–16 and 2019–21. While these risk

factors were initially higher among higher SES and urban populations, these trends over time

resulted in a substantial flatting or even reversal of SES gradients to the disadvantage of

relatively poor and less educated subpopulations” (Wetzel, et. al., 2023, p. 9). In the beginning,

wealthy classes would observe more prevalence of disease, but now the curve moves to affect
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the poor, possibly related to changes in diet and other nutritional deficiencies. “The changing

socioeconomic and geographic gradients we observe are consistent with the ‘reversal hypothesis’

that as countries develop, CVD risk goes from being disproportionate among the rich to

disproportionate among the poor” (Wetzel, et. al., 2023, p.10).

While Indian diet is plant based, this population is still very susceptible to develop

cardiovascular disease earlier than other world populations. “Global health statistics report

acculturative dietary and lifestyle changes (e.g., a reduced consumption of traditional foods; a

greater reliance on processed and convenience foods high in fat, sugar, and salt; reduced

physical activity) as primary determinants for the high rates of chronic degenerative diseases and

associated complications in various ethnic populations, including urban and migrant AIs

regardless of geographic location. Rapid socioeconomic developments, a changing food system,

and migration-related transitions in nutrition, dietary practices, and lifestyles are cited as

determinants for these changes” (Misra, et. al., 2018, p. 2). This can also point to think that the

higher incidence of illness goes beyond cultural practices and more into their own genetic

predisposition for developing the disease.

According to the Indian Heart Association (2023) , “demographic data indicate that the

heart disease rate among Indians is double that of national averages of the western world. This

may be attributed to an underlying genetic predisposition to metabolic deregulation and

cardiomyopathy, as well as a recent shift of modifiable risk factors towards increasing

consumption of red meats, saturated fats and trans fats, junk foods and higher stress in sedentary

call-center workers in India” (Indian Heart Association, 2023, para 5).

The most common risk factors associated with cardiovascular disease in Indians are

smoking, alcohol, smokeless tobacco, health food habits, obesity and hypertension. Shaikh &
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Khan completed a study to see if clustering of risk factors had any influence on Indian

cardiovascular risk. “This study shows that clustering of multiple lifestyle risk factors of non-

communicable diseases is higher amongst individuals of age 30–49 years, population having no

education, among the separated and divorced and among the poor. The pattern of clustering of

increasing number of non-communicable disease risk factors across gender is observed for the

entire country with highest prevalence in the North-Eastern region. The NFHS, 2015–16 data

reveals that, hypertension is another risk factor showing higher likelihood of co-occurrence with

other risk factors of NCDs among both men and women” (Shaikh & Khan, 2020, p. 9) .

Based on the results of several studies, Indian healthcare and government agencies should

put in place a plan to focus on some preventative interventions to help reduce the burden of

disease but short term and long term. “The sustained decline since 2009 might indicate the

potential effectiveness of strong preventive efforts and serve as a promising example for other

CVD risk factors: over the last decades, India introduced several laws and prevention programs

to curb the disease burden caused by tobacco consumption (e.g., Cigarettes and Other Tobacco

Products Act from 2003 and the National Tobacco Control Programme)” (Wetzel, et. al., 2023,

p.10). However, smoking is not the only risk factor. It is important that these preventative

measures are cost-effective, and that are realistic and applicable in any setting implemented and

more importantly that these measures can be sustained indefinitely. Some of the secondary

prevention measures that could be implemented include improving the price and access of health,

diabetes education, and encouraging blood pressure screenings for early detection of disease.

Cardiovascular disease is affecting Indians at a younger age. This means that people in

their late 30’s and early 40’s are receiving care at hospitals due to disease, heart attacks and

strokes related to this non-communicable disease. “Many low-risk individuals currently receive
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BP lowering therapy, while treatment gaps among intermediate- and high-risk populations

remain” (Praveen, et.al., 2018, p. 7). Clinical interventions should address treatment of disease,

follow up, proper patient education on risk factors and lifestyle changes. Making sure that

adequate transitions in care happen is also crucial for patients to continue managing their

condition and improve their outcomes.

The main role for the nurse in the process of care is education. “The European Guidelines

(2016) on cardiovascular disease prevention in clinical practice suggest that the education stage,

which is indispensable in nursing professional care, needs to be developed in a targeted manner.

According to a recent study, the nurses’ knowledge of educational methods in cardiovascular

disease management should be implemented through an ad hoc training, to improve the

knowledge of care and the principles that support the role of the patient in carrying out its own

self-care. All this requires deep knowledge not only of the bio clinical dimension (e.g. vital

parameters check, anthropometrics indexes) but also of the patient’s psycho-socio-relational

dimension (e.g. evaluation of the patient’s mood alterations, its self-efficacy) with the purpose of

educating them in early recognition of the signs and symptoms of the disease, and to self-manage

the disease also psychologically” (La Sala, et. al., 2017, p.23)

Cardiac nursing plays a very influential role in the treatment of patients with

cardiovascular diseases, both in-patient and outpatient. According to Ruan et. al. (2023), nurses

can direct focused interventions to assist patients with cardiovascular disease. They can work as

coordination to manage the patient condition and enhance the effectiveness of the interventions.

“Community nurses or cardiovascular specialist nurses can independently accomplish the

comprehensive assessment of patients prior to Home-based Cardiac Rehabilitation (HBCR),

including assessment of physical condition and understanding the disease risk factors,
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psychological status, eating habits, and medication adherence of patients” (p. 437) . For the

current status of disease prevalence in India, the field would greatly benefit from nursing

research, cardiovascular nursing, and community nursing to follow the patients through the

whole process of diagnosis, treatment, and prevention of progress of the disease.

Some innovative interventions that can further reduce cardiovascular risk in Indian

population may be the use of technology to remotely follow up and monitor patients with

cardiovascular disease. “Nurses may adopt telenursing strategies to overcome the physical

problems that typically impeded post-discharge access to patients with HF” (Arjunan & Trichur,

2020, p.8).

Cardiovascular diseases have become a major epidemic worldwide, but especially for

India in which is considered the main cause of mortality among the population. Changes in

lifestyle of Indians, increased consumption of red meat, more sedentary lifestyles due to work,

and increase in stress are affecting the early onset of cardiovascular disease. There is also an

apparent biological disposition for developing cardiovascular disease. Smoking, alcohol, eating

habits, obesity, diabetes, and high blood pressure are the most common risk factors among

Indians. The government and healthcare organizations need to implement a more aggressive

preventative plan for early screening, detection, and treatment of cardiovascular diseases as well

as improved education to the population regarding the risks and implications of cardiovascular

disease. As nurses is our responsibility to educate patients and advocate through research and

support to improve outcomes for this patient population.

References
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