مقاله انگلیسی رایگان در مورد مهمترین عامل خطرساز در بیماری های غیر واگیر – الزویر 2018

Non-communicable diseases are important causes of mortality and morbidity in India. Data from the Registrar General of India, World Health Organization and Global Burden of Disease (GBD) Study have reported that cardiovascular diseases (CVD) are the most important causes of death and disability. Ageadjusted mortality from these conditions has increased by 31% in last 25 years. Case-control studies have reported that hypertension is most important risk factor for CVD in India. GBD Study has estimated that hypertension led to 1.6 million deaths and 33.9 million disability-adjusted life years in 2015 and is most important cause of disease burden in India. Intensive public health effort is required to increase its awareness, treatment and control. UN Sustainable Development Goals highlight the importance of high rates of hypertension control for achieving target of 1/3 reduction in non-communicable disease mortality by 2030. It is estimated that better hypertension control can prevent 400–500,000 premature deaths in India.

Introduction

Morbidity and mortality data in India have always highlighted primacy of communicable diseases and maternal and childhood conditions as leading causes.1,2 Indeed, up to end of the last century acute and chronic infections, e.g., neonatal and childhood gastrointestinal infections, viral and bacterial lower respiratory infections, poliomyelitis, malaria and tuberculosis along with neonatal sepsis, childhood malnutrition and maternal mortality were important causes.1 Public health measures focused on these conditions, along with overall socioeconomic change have led to a remarkable decline in death rates from these conditions.3 This has been due to focus on preventive measures directed towards these conditions- better hygiene, immunization, improved maternal and childhood nutrition and health systems focused on health during pregnancy and management of acute and chronic infections.3 Chronic non-communicable diseases have emerged as leading causes of mortality and morbidity only at the turn of the present century in India.4 Registrar General of India first reported this transition while enumerating causes of deaths in the country for years 2001–2003.5 Non-communicable diseases (NCD’s), also known as chronic diseases and better as socially transmitted diseases, caused more than 50% of deaths in these years and cardiovascular diseases (CVDs) emerged as the most important cause. Increasing proportion of NCD’s as cause of deaths has been reported in the latest Registrar General of India report also.6 Serial data from the Census of India have also reported increasing proportionate mortality from CVD in India.7 The present article summarizes trends in major CVD’s (ischemic heart disease-IHD and stroke) in terms of absolute numbers and age-adjusted rates in India using the World Health Organization (WHO) and Global Burden of Diseases (GBD) Study data. We used previous studies to identify CVD risk factors of importance in Indians.8,9 We then summarized the trends in CVD risk factors in India using previous reviews.7,10–15 Using GBD study data along with risk factor prevalence trends have highlighted the observation that hypertension is the most important risk factor for CVD, non-communicable diseases as well as overall diseases in India. Public health, health systems based as well as clinic-based interventions are needed to increase awareness, treatment and control of hypertension.16 It is well known that up to a third of cardiovascular deaths can be avoided by proper treatment and control of hypertension17 and by addressing this risk factor we can significantly prevent premature CVD mortality in India.