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Analysis Health in South Asia

Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1420 (Published 11 April 2017) Cite this as: BMJ 2017;357:j1420
  1. Anoop Misra, professor1 2,
  2. Nikhil Tandon, professor3,
  3. Shah Ebrahim, honorary professor4,
  4. Naveed Sattar, professor5,
  5. Dewan Alam, visiting professor6,
  6. Usha Shrivastava, head of public health2,
  7. K M Venkat Narayan, professor7,
  8. Tazeen H Jafar, professor8 9 10
  1. 1Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
  2. 2National Diabetes, Obesity and Cholesterol Foundation, India, and Diabetes Foundation (India)
  3. 3Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
  4. 4Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  5. 5Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
  6. 6School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
  7. 7Rollins School of Public Health, Emory University, Atlanta, GA, USA
  8. 8Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
  9. 9Department of Medicine, Aga Khan University, Karachi, Pakistan
  10. 10Duke Global Health Institute, Durham, Duke University, NC, USA
  1. Correspondence to: T H Jafar tazeen.jafar{at}duke-nus.edu.sg

South Asians are more susceptible to diabetes and cardiovascular diseases and have worse outcomes than other ethnicities, say Anoop Misra, Tazeen Jafar, and colleagues. They call for urgent action to provide screening and treatment, complemented by population level lifestyle modifications.

All South Asian countries have adopted the World Health Organization’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases, which recommends a 25% relative reduction in the prevalence of raised blood pressure by 2025 and a halt to the rise in diabetes and obesity. Although considerable diversity exists between countries, all South Asians have markedly elevated risks of diabetes and variably elevated risks of cardiovascular disease compared with other ethnicities.12 In this paper, we review the burden of diabetes, cardiovascular disease, and chronic kidney disease in the region and policies to mitigate this burden. We identify key actions for health authorities and governments to attenuate the rise in non-communicable diseases and meaningfully improve outcomes for the millions of people with, or expected to develop, these diseases.

Methods

We gathered data on characteristics of populations and health systems from publicly available World Bank reports and WHO’s country profiles. Information on death and disability from cardiovascular disease, diabetes, and chronic kidney disease and their attributable risk factors came from Health Metrics and Evaluation’s data visualisation tool of the Global Burden of Disease Study 2015. We searched PubMed and Google scholar for relevant literature up to January 2017, using the terms “South Asians”, “diabetes”, “cardiovascular disease”, “myocardial infarction”, “stroke”, “renal”, and “kidney disease”. We formulated this paper by drawing from our collective experience in this field and the available literature.

Current epidemiology and trends

Cardiovascular disease, diabetes, and chronic kidney disease now account for 27%, 4.0%, and 3.0% of deaths, respectively, in South Asia (table 1⇓).3456 Notwithstanding …

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