This Article Full Text Full Text (PDF) All Versions of this Article: 119/14/1950    most recent CIRCULATIONAHA.108.819201v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Joshi, R. Articles by Neal, B. Search for Related Content PubMed PubMed Citation Articles by Joshi, R. Articles by Neal, B. Related Collections Secondary prevention Cerebrovascular disease/stroke Chronic ischemic heart disease Epidemiology Related Article

(Circulation. 2009;119:1950-1955.)
© 2009 American Heart Association, Inc.

Preventive Cardiology

Fatal and Nonfatal Cardiovascular Disease and the Use of Therapies for Secondary Prevention in a Rural Region of India

Rohina Joshi, MBBS, MPH, PhD; Clara K. Chow, MBBS, FRACP, PhD; P. Krishnam Raju, MBBS, MD, DM; Rama Raju, MBBS, MS, MCh; K. Srinath Reddy, MBBS, MD, DM; Stephen MacMahon, DSc, PhD, FCSANZ; Alan D. Lopez, BSc, PhD, MS; Bruce Neal, MBChB, PhD, FRCP

From The George Institute for International Health (R.J., C.K.C., S.M., B.N.), University of Sydney, Sydney, Australia; Department of Cardiology, CARE Hospital, Hyderabad, India (P.K.R.); Department of Urology, CARE Hospital, and Byrraju Foundation, Hyderabad, India (R.R.); Public Health Foundation of India, New Delhi, India (K.S.R.); School of Population Health, University of Queensland, Brisbane, Australia (A.D.L.); and Australian Division of World Action on Salt and Health (B.N.).

Correspondence to Rohina Joshi, Senior Research Fellow, The George Institute for International Health, Lecturer, Faculty of Medicine, University of Sydney, PO Box M201, Missenden Rd, Sydney, NSW 2050, Australia. E-mail rjoshi{at}thegeorgeinstitute.org

Received September 2, 2008; accepted January 23, 2009.

Background— The rate of cardiovascular disease is widely considered to be increasing throughout India. Precise and reliable data on fatal and nonfatal cardiovascular disease, however, are few, and little is known about the use of preventive therapies. This is particularly true for rural regions.

Methods and Results— Data were collected from 53 villages in the Godavari region of Andhra Pradesh. Mortality data were obtained from a verbal autopsy-based mortality surveillance system during a 12-month period in 2003 to 2004. The prevalence of nonfatal cardiovascular disease and the use of preventive therapies were estimated from a stratified random sample of 4535 adults (30 years of age) in 2005. Cardiovascular disease was the leading cause of mortality, accounting for at least 32% of all deaths. The average age at cardiovascular death was 65 years, and 51% of all cardiovascular deaths occurred in patients <70 years of age. Among adults, the prevalence of coronary heart disease was estimated to be 4.8% (95% CI, 4.1 to 5.5), and the prevalence of cerebrovascular disease was estimated at 2.0% (95% CI, 1.5 to 2.4). Among individuals with either diagnosis, 14% (95% CI, 10 to 18) reported taking aspirin, 41% (95% CI, 36 to 47) took a blood pressure-lowering medication, and 5% (95% CI, 3 to 7) reported using a cholesterol-lowering medication.

Conclusion— This region has a large disease burden attributable to cardiovascular disease with significant underuse of proven, low-cost preventive medications.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2009 119: 1843-1845. [Extract] [Full Text]

This article has been cited by other articles:

				T. A. Gaziano Is the Horse Already Out of the Barn in Rural India? Circulation, April 14, 2009; 119(14): 1850 - 1852. [Full Text] [PDF]