Reflections From India on Scaling Up Risk Factor Control for Cardiovascular Diseases to Reach 1 Billion Adults


The cardiovascular disease (CVD) burden in India is increasing at an unprecedented rate. In 2016, CVDs were responsible for about 28% of all deaths in India. The poor access to world-class cardiac care among most Indians and the low number of cardiologists per capita (just 1 per 100,000 population) are further exacerbating the CVD burden in India.

The following factors are playing a role in India’s challenges related to cardiovascular medicine:

  • A very large population with heterogeneous socioeconomic backgrounds, dietary practices, disease patterns, and healthcare distributions. Information asymmetry between patients and physicians is also prevalent.
  • Concurrent burden of infectious diseases, maternal and neonatal diseases, nutritional deficiencies, and noncommunicable diseases — all of which are competing for the country’s limited healthcare resources.
  •  Lack of skilled healthcare workers, standard management protocols and health information and surveillance systems are impeding India’s pursuit of universal healthcare and financial protection.

India has taken steps to improve CVD risk factor control. Some of these include the establishment of the ‘National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke’, tobacco control policies like warning labels in packages, and international partnerships to advance research in cardiovascular medicine. However, the following points need to be further considered for effective population-wide CVD management:

  • Larger national-level financial commitments are necessary to sustain chronic disease-related programs that have been rolled out.
  • Primary care provision needs to be strengthened to identify and treat high-risk patients like those with hypertension and diabetes. The interventions could be related to technology-enabled task shifting/sharing, decision support systems, and combination therapies.
  • CVD care to low-income and rural patients needs to be drastically improved. Innovative and sustainable interventions like mobile health applications that provide patient profiles and clinical decision support can potentially enhance cardiac care in these subpopulations.

Hence, continued government support, increased financing, and successful multi-sectoral programmes and policies are required to tackle India’s CVD epidemic.