According to the Global Burden of Disease Study, which of the following is the leading modifiable risk factor for cardiovascular disease mortality in India?

Explanation

## Leading Modifiable Risk Factor for CVD in India **Key Point:** High systolic blood pressure (hypertension) is consistently identified as the single leading modifiable risk factor for cardiovascular disease mortality in India across multiple Global Burden of Disease (GBD) iterations. ### Evidence Base The GBD Study 2019 and subsequent analyses show that hypertension accounts for the largest attributable burden of CVD deaths in the Indian population, surpassing tobacco use and dyslipidemia. ### Why Hypertension Dominates in India 1. **Prevalence**: Affects approximately 25–30% of urban and 15–20% of rural Indian adults 2. **Awareness gap**: Only ~30% of hypertensives are aware of their condition 3. **Control rates**: <10% achieve optimal blood pressure control 4. **Population attributable risk**: The combination of high prevalence and poor control makes it the largest preventable contributor ### Comparative Risk Factor Burden | Risk Factor | Attributable CVD Deaths (%) | Prevalence in India | | --- | --- | --- | | High SBP | ~35–40% | 25–30% (urban) | | High LDL | ~15–20% | 20–25% | | Tobacco use | ~20–25% | 10–15% | | Physical inactivity | ~10–15% | 40–50% | **High-Yield:** While tobacco use and dyslipidemia are important, hypertension's combination of high prevalence and poor control in India makes it the #1 modifiable risk factor by attributable burden. **Clinical Pearl:** This reflects the epidemiological transition in India — as infectious disease burden decreases, hypertension-driven CVD becomes increasingly dominant, especially in urban areas. [cite:Park 26e Ch 10]