Fighting heart disease - A community approach to better health
This article is authored by Dr Niranjan Hiremath, senior consultant, Cardiovascular and Aortic Surgery, Apollo Indraprastha, New Delhi.
Heart disease has emerged as one of the most significant public health crises in India, claiming millions of lives annually and leaving a devastating social and economic impact. Cardiovascular diseases (CVDs) now account for more than 25% of all deaths in the country. What is even more alarming is the shifting demographic of those affected; once primarily seen in older adults, heart disease is now increasingly prevalent among younger populations, including individuals in their 30s and 40s. This trend underscores the urgent need for a community-driven approach to tackle this issue, emphasising prevention, early detection, treatment, and sustainable lifestyle changes.
Cardiovascular diseases are a group of disorders affecting the heart and blood vessels, including coronary artery disease, arrhythmias, heart failure, and congenital heart defects. Among these, coronary artery disease, characterised by the narrowing or blockage of arteries supplying the heart, is the most common and deadly. This condition is primarily caused by atherosclerosis, the buildup of fatty deposits within arterial walls, which restricts blood flow and can lead to heart attacks.
The prevalence of heart disease in India has been fuelled by a combination of genetic predisposition and lifestyle factors. The Indian population, due to certain genetic traits, is at a higher risk of developing insulin resistance, diabetes, and dyslipidemia (abnormal cholesterol levels). When coupled with environmental and lifestyle changes—such as unhealthy diets, physical inactivity, tobacco use, and rising stress levels—the risk factors for heart disease become even more pronounced.
Hypertension, or high blood pressure, stands as one of the leading causes of heart disease and stroke in India. Often called the "silent killer," hypertension frequently goes unnoticed until it leads to severe complications. In India, about one in five adults suffers from hypertension, with many remaining undiagnosed or inadequately managed. Elevated blood pressure exerts additional strain on the heart and arteries, leading to structural and functional changes that increase the likelihood of heart failure, stroke, or kidney disease.
Diabetes is another significant contributor to the growing burden of cardiovascular disease. With India being home to the second-largest population of diabetics globally, the interplay between diabetes and heart disease has become a pressing concern. High blood sugar levels damage blood vessels and nerves, impairing the cardiovascular system. Diabetic individuals are two to four times more likely to develop heart disease than those without diabetes.
Lifestyle changes in recent decades have also played a pivotal role in the surge of heart disease cases. Rapid urbanisation has led to dietary shifts toward high-calorie, low-nutrient foods, including processed and fast foods, which are rich in saturated fats, sugar, and salt. This "nutrition transition" has contributed to rising obesity rates and metabolic syndrome, both precursors to heart disease. Simultaneously, sedentary behaviour has become the norm, with fewer people engaging in regular physical activity due to desk jobs, urban commuting patterns, and an increasing reliance on technology.
Tobacco use, encompassing smoking and smokeless forms, remains a significant modifiable risk factor for heart disease. Smoking damages the lining of blood vessels, promotes plaque formation, and increases the likelihood of blood clots. Despite public health campaigns, tobacco consumption continues to thrive in India, with approximately 29% of the adult population using some form of tobacco. The situation is exacerbated by cultural acceptance of smokeless tobacco products in certain regions, which are equally detrimental to cardiovascular health.
Stress is another often-overlooked contributor to heart disease. Chronic stress triggers the release of stress hormones like cortisol, which can elevate blood pressure and cholesterol levels, disrupt glucose metabolism, and increase the risk of heart attacks. In India, societal pressures, financial insecurities, and long working hours contribute to high stress levels, further amplifying cardiovascular risk.
Given the complexity and scale of the problem, a community-based approach offers the most promising path forward. Unlike individual interventions, which often fail due to lack of support and sustainability, community-driven efforts can create an ecosystem of health promotion and disease prevention that benefits everyone. By focusing on education, prevention, early detection, and access to care, communities can play a transformative role in reducing the burden of heart disease.
Education and awareness campaigns form the bedrock of any community health initiative. Public health messaging must go beyond mere information dissemination and engage communities in meaningful ways. For example, interactive workshops, health fairs, and village meetings can foster a deeper understanding of risk factors such as smoking, poor diet, and physical inactivity. Schools and workplaces can also serve as platforms for health education, targeting young people and working adults who may otherwise lack access to such information.
Community health workers (CHWs) are instrumental in bridging the gap between healthcare systems and local populations. These workers, often members of the communities they serve, can deliver culturally sensitive health education, provide basic medical care, and encourage behaviour change. Programmes like the Comprehensive Rural Health Project (CRHP) in Jamkhed, Maharashtra, have demonstrated the effectiveness of empowering CHWs to address heart disease through education, lifestyle interventions, and support for chronic disease management.
Screening and early detection are critical components of a community-based approach. Regular monitoring of blood pressure, blood sugar, and cholesterol levels can identify individuals at risk before complications arise. Mobile health units and health camps can play a vital role in reaching underserved populations, particularly in rural areas where access to healthcare facilities is limited. Such initiatives not only facilitate early diagnosis but also build a culture of proactive health management.
Accessible and affordable healthcare services must complement these preventive measures. Strengthening primary healthcare infrastructure is essential to ensure that communities have access to timely and appropriate care. Primary health centres should be equipped to manage common cardiovascular conditions, such as hypertension and diabetes, while also providing referrals to specialised facilities for more complex cases. Training CHWs and primary care providers to deliver basic cardiovascular care can significantly alleviate the burden on tertiary hospitals.
Policy support is crucial in sustaining community-driven initiatives. Governments must prioritise cardiovascular health in their public health agendas, allocating resources for preventive measures and treatment programmes. Policies that promote heart-healthy environments—such as taxing sugary drinks and junk food, mandating clear food labelling, and restricting tobacco advertising—can create systemic changes that benefit entire populations. Encouraging active transportation through pedestrian-friendly infrastructure & public parks can also support healthier lifestyles.
Technology offers immense potential to enhance community-based cardiovascular care. Telemedicine platforms can connect remote communities with specialists, providing timely consultations and follow-ups. Mobile health applications can help individuals track their risk factors, such as blood pressure and physical activity, while wearable devices can monitor heart rate and detect irregularities. These tools not only empower individuals to take charge of their health but also provide valuable data for community health programmes.
Despite these promising strategies, challenges remain. Resource constraints, including insufficient funding and a shortage of trained healthcare professionals, often limit the reach and effectiveness of community health initiatives. Cultural resistance to lifestyle changes can also hinder progress, particularly in regions where traditional diets and behaviours are deeply ingrained. Ensuring the sustainability of programmes requires ongoing community engagement, consistent funding, and robust monitoring systems to evaluate their impact.
India can draw inspiration from successful community health models. The Comprehensive Rural Health Project in Jamkhed, Maharashtra, for instance, has achieved remarkable results by empowering local women as health workers and fostering community ownership of health initiatives. Similarly, task-shifting programmes, where non-specialist health workers are trained to manage cardiovascular risk factors, have demonstrated significant improvements in blood pressure control and health behaviours.
The fight against heart disease is not just a medical challenge—it is a societal imperative. Cardiovascular diseases impose enormous economic burdens on families and the healthcare system, with ripple effects that undermine national development. By embracing a community-based approach, India can not only reduce the prevalence of heart disease but also ensure healthier, more productive lives for its citizens.
Heart disease is a formidable foe, but it is not invincible. Through collective action, informed decision-making, and sustained investment in community health, India can pave the way for a future where cardiovascular diseases are no longer the leading cause of death but a challenge that communities have learned to overcome together. The heart of the nation depends on it.
This article is authored by Dr Niranjan Hiremath, senior consultant, Cardiovascular and Aortic Surgery, Apollo Indraprastha, New Delhi.
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