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"Let food be thy medicine and medicine be thy food." Hippocrates
We read with interest the study by T.Sekhri,R.S.Kanwar et al(1).The
authors needs to be congratulated for such a meticulous and unique study
involving subjects from all over India.The study is first of its kind in
India and an eye-opener. However,the following issues we shall like to
1.As it was a non-interventional and free-of-cos...
1.As it was a non-interventional and free-of-cost to the
participating subjects study.Why only 14,500 subjects( 55%) gave the
informed consent out of approximately 26,000.It may be worth mentioning
some important reasons of this rather less acceptance for the study.This
low level of participation compromises the external validity of the study.
2.The subjects with known coronary artery disease (CAD) were
excluded.It would have been interesting to know how many subjects with
newly discovered CAD were detected,including silent old MI pattern in ECG.
3.As mentioned in the introduction of the study(1),over 60% of CAD in
native Indians remain unexplained by conventional risk factors,why only
conventional risk factors were considered in the study.
4.Gainfully,in the protocol,disease history is included,it would have
been relevant to know about the other diseases and if any correlation with
the risk factors could have been made. Like patients with
depression/psychiatric morbidity (common diseases these-days)and
obstructive sleep apnea have much worse risk factor profile and are
increasing recognized as novel risk factors per se. Interestingly in
women( obstetric history was ascertained),any correlation with adverse
obstetric history and risk factor profile was observed?.The data is
rapidly accumulating between adverse obstetric history and development of
cardiovascular disease in future(2).
5.In the present study interestingly only 27% of hypertensives were
aware about their condition ( 73% were newly discovered).A rather lower
percentage particularly for civilian government employee,having free
access to the medical services.
6.78.6% of the subjects had two or more risk factors is a disturbing
fact.In Prabhakaran's study(3) in 2005 amongst industrial workers of north
India 47% subjects had atleast two risk factors.Is it a temporal trend or
the difference is due to the location of the subjects in the study,needs
to be explained.
The study emphasized the disturbing trend in the health status in
India and serious thoughts and actions are needed to contain this unabated
epidemic.What will be the peak of the epidemic is anybody's guess.
However, we have the following suggestions to offer:
1.When the epidemic reaches this gigantic proportion,secondary and
tertiary prevention have very limited impact at a community level.
2.The primordial and primary prevention assume huge importance. As
they are much more cost-effective and result yielding.
3.For Primordial prevention and primary prevention ,in a nutshell the
message is : to eat and try to assume the level of physical activity and
lifestyle ( may not be possible for everyone) similar to what our
grandparents used to have.
4.To counteract the adverse health consequences of modern life .We
advocate three levels of prevention: health education, health education
and health education of the entire world ( in particular developing
world), with emphasis upon educating health policy - makers.
1.T Sekhri, R S Kanwar, R Wilfred, P Chugh, M Chhillar, R Aggarwal, Y
K Sharma, J Sethi, J Sundriyal, K Bhadra, S Singh, N Rautela, Tek Chand, M
Singh, and S K Singh.Prevalence of risk factors for coronary artery
disease in an urban Indian population. BMJ Open 2014 4:e005346;
2.Bellamy L,Casas JP,Hingorani AD,Williams DJ.Pre-eclampsia and risk
of cardiovascular disease and cancer in later life:Systematic review and
3.Prabhakaran D, Shah P, Chaturvedi V, et al. Cardiovascular risk
factor prevalence among men in a large industry of northern India. Natl
Med J India 2005;18:59-65.