According to the Global Burden of Disease Study, which of the following is the leading cause of cardiovascular mortality in India?

Explanation

## Cardiovascular Mortality Burden in India **Key Point:** Ischemic heart disease (IHD) is the leading cause of cardiovascular mortality in India, accounting for approximately 40–45% of all cardiovascular deaths, followed by stroke (both ischemic and hemorrhagic). ### Epidemiological Context The Global Burden of Disease (GBD) Study and Indian Council of Medical Research (ICMR) data consistently show: | Cause | % of CVD Deaths | Rank | |-------|-----------------|------| | Ischemic heart disease | 40–45% | 1st | | Stroke (all types) | 30–35% | 2nd | | Rheumatic heart disease | 5–8% | 3rd | | Hypertensive heart disease | 3–5% | 4th | | Peripheral arterial disease | <2% | Lower | **High-Yield:** India has a paradoxically high burden of IHD relative to developed nations at similar GDP levels — attributed to rapid urbanization, lifestyle changes, metabolic syndrome, and high prevalence of diabetes and hypertension. **Clinical Pearl:** Although rheumatic heart disease was historically the leading cause of CVD in India, it has been surpassed by IHD due to demographic and epidemiological transition, though RHD remains more common in India than in developed countries. ### Why IHD Dominates 1. Rising prevalence of risk factors (smoking, diabetes, hypertension, dyslipidemia, obesity) 2. Rapid urbanization and lifestyle changes 3. High prevalence of metabolic syndrome 4. Younger age at first MI compared to Western populations