Guarding the Heart

Guarding the Heart

A new study establishes that tobacco-control laws and steep taxes could prevent deaths due to heart diseases and strokes in India

If the writing on the wall was not bold enough yet,a new study has established that implementing smoke-free laws and increased tobacco taxes in India would yield substantial and rapid health benefits by averting future cardiovascular disease (CVD) deaths. The results of this study,conducted by Sanjay Basu of Stanford University,the US,along with his colleagues,suggest that specific tobacco control strategies would be more effective than others for the reduction of CVD deaths over the next decade in India and possibly in other low and middle-income countries. The study was recently published in PLOS Medicine.

Cardiovascular diseases are conditions that affect the heart and/or the blood vessels. With medicos across the globe observing September 29 as World Heart Day,alarm bells have started ringing about the burden of CVD that is rapidly rising in lower and middle-income countries as well.

The researchers investigated which tobacco control measures could best reduce the burden of CVD effectively in such countries by using a mathematical model. Their micro-simulation model estimated the effects of various tobacco-control measures and pharmacological therapies on deaths from heart attack and stroke in India between 2013 and 2022.

Five different tobacco-control measures were compared in the model — smoke-free legislation,tobacco taxation,provision of brief cessation advice by healthcare providers,mass media campaigns,and advertising bans. In addition,other factors such as increased access to aspirin,anti-hypertensive drugs,and statins were simulated for their effect on deaths from heart attack and stroke.


The authors concluded that based on their model,smoke-free legislation and tobacco taxation are expected to be the most effective strategies for reducing heart attack and stroke deaths over the next decade. These two measures alone could prevent about nine million deaths from heart attack and stroke in India by 2022,and a combination of tobacco-control policies and pharmacological interventions could help even more deaths.

“One of the advantages of using large-scale surveys to inform these models,” said Basu,“is that we can account for unique populations who have different risk factors from the US and the UK. For example,many Indians smoke informal cigarettes or bidis,which are highly risky to health but are often missed by standard models focusing only on manufactured cigarettes.”

Christopher Millett from Imperial College London and the Public Health Foundation of India,said,“These findings highlight the importance of accelerating implementation of WHO recommended policies in India,especially increasing tax on tobacco products and having smoke-free public places.”

Young at Risk

To commemorate World Heart Day,cardiologists from across India participated in Ranbaxy Renaissance Walk in Mumbai to reiterate the need for physical activity or walking as the first step towards a healthy heart. The growing prevalence of coronary heart disease at a relatively younger age is making women in Pune more vulnerable to heart attack,cardiologists in the city said. “Coronary artery disease leading to heart attack is occurring in younger men and women. A decade ago,men were susceptible to heart attack at around 35 years of age. Now,even 25-year-olds are suffering such attacks. Similarly,in women,cases of coronary heart disease were a rarity before menopause,that is around age of 50. But now it is being observed in the 35-40 age group,” said Dr Kedar Kulkarni,visiting cardiologist at Sahayadri and KEM Hospital. According to Dr Satej Jonarkar,cardiologist at Deenanath Mangeshkar Hospital,a growing number of women are falling prey to heart attack. “Earlier the prevalence of heart attacks among working women was 2.5 per cent and 1 per cent among housewives. This has grown to 6.4 per cent and 5.1 per cent among working women and housewives respectively,” he said. City-based senior cardiologist Dr Shireesh Sathe said the symptoms of coronary heart disease among women were very different from men. Due to this,it is more likely that prevalence of heart disease in women could get missed.

Anuradha Mascarenhas