## Epidemiology of CVD Risk Factors in India **Key Point:** Hypertension is the single most common modifiable risk factor for CVD mortality in Indian adults, responsible for approximately 25–30% of CVD deaths in the 40–69 age group. ### Population Attributable Risk (PAR) in India The INTERHEART study and subsequent Indian CVD epidemiological surveys (including the PURE-India cohort) have consistently demonstrated that hypertension carries the highest PAR for premature MI and stroke in the Indian population. | Risk Factor | PAR (%) | Prevalence in India | | --- | --- | --- | | Hypertension | 25–30 | 25–35% in urban, 10–15% in rural | | Tobacco use | 20–25 | 30–40% in males | | Diabetes mellitus | 15–20 | 8–10% overall | | Physical inactivity | 10–15 | 40–50% in urban areas | | Dyslipidemia | 10–12 | 30–40% | **High-Yield:** While tobacco use has a high prevalence (especially in males), hypertension affects a broader demographic (both sexes, all socioeconomic strata) and has a higher absolute population attributable risk for CVD mortality. ### Why Hypertension Ranks First 1. **Ubiquity:** Present in ~25–35% of urban Indian adults; rising with age. 2. **Severity:** Uncontrolled BP is a direct driver of LVH, AF, MI, and stroke. 3. **Underdiagnosis:** Many Indians remain unaware of their hypertension status, delaying intervention. 4. **Synergy:** Hypertension amplifies the effect of other risk factors (diabetes, dyslipidemia, tobacco). **Clinical Pearl:** In India, only ~30% of hypertensive patients are aware of their diagnosis, and <10% achieve adequate BP control — a major contributor to the high CVD burden. **Mnemonic — CHAMP (Common modifiable risk factors in India, ranked by PAR):** - **C**ardiovascular: Hypertension (highest PAR) - **H**abits: Tobacco use (high prevalence, especially males) - **A**lternative lipids: Dyslipidemia - **M**etabolic: Diabetes mellitus - **P**hysical: Inactivity [cite:Park 26e Ch 10]
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