Cardiovascular disease (CVD) continues to be the leading cause of death across the world, but there are significant variations between rich and poor nations. While in high income countries, death from cancer is twice that of CVD, in low income countries, including India, death from cardiac disease was three times that of cancer. Additionally, indoor or household air pollution has been identified as a key cause of CVD, research papers published in the Lancet , on Tuesday, have shown.

The PURE study, which was also presented at the European Society of Cardiology Congress, tracked over 1,62,000 individuals, aged 35-70 years, living in 21 countries across five continents, over about 9.5 years. The mortality was highest in the Low Income Countries (LIC) despite lower risk factors, and lowest in the High Income Countries (HIC).

“The high mortality in poorer countries is not due to a higher burden of risk factors, but likely other factors including lower quality and less health care,” said Salim Yusuf, principal investigator of the study and executive director of Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences, Canada.

“The fact that cancer deaths are now twice as frequent as CVD deaths in HIC indicates a transition in the predominant causes of death in middle age,” he said.

“The study establishes that though risk factors are lower in low income countries, factors such as access to quality health care and lack of insurance have a play, leading to the mortality,” explained V. Mohan, one of the co-authors of the study, and president, Madras Diabetes Research Foundation, Chennai. With better insurance and improving hospital standards, it is possible for LIC to head towards similar outcomes, he said.

The HIC in the study were Canada, Saudi Arabia, Sweden and United Arab Emirates. The middle-income countries (MIC) were Argentina, Brazil, Chile, China, Columbia, Iran, Malaysia, Palestine, Philippines, Poland, Turkey and South Africa. The LIC were Bangladesh, India, Pakistan, Tanzania and Zimbabwe. Five Indian research institutes also participated in the study.

In another paper, also published in the Lancet on Tuesday, on ‘Modifiable risk factors, cardiovascular disease, and mortality’, researchers established indoor air pollution as an emerging source of risk for cardiovascular disease in LIC and MIC.

“This is a worrisome fact — the identification of indoor air pollution or household pollution as a risk factor for CVD. So far we have looked at upper respiratory diseases as a consequence, but this does not sound good, and we must take measures to modify this particular risk factor,” Dr. Mohan added.

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