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Hypertension:
Hypertension causes 5 million premature deaths a year worldwide. About 15-37% of global adult population has hypertension. 55. In Asia a steep increases in stroke mortality has accompanied a rapid rise in prevalence of hypertension. Projected figures suggest that in India hypertension will increase from 16.3% to 19.45% between 1995 and 2025.56. According to National Health Survey of Pakistan conducted during 1990-94 prevalence of hypertension in adults was estimated to be 23% and 18% in urban and rural areas respectively. 39. The unawareness rate in this survey has been reported at 70% which is amongst in the highest in the world. In Srilanka, reported rate of prevalence of hypertension is 17% in urban areas and 8 % in rural areas.57. while in Bangladesh Prevalence is 11.3%. 58. Factors such as delays in diagnosis, dietry habits and disparities in health system result in high prevalence of hypertension in south asians resulting in increase number of patients with target organ damage like heart failure, renal insufficiency and retinopathy.
Diabetes:
An estimated one million people have type 2 diabetes globally and this figure is expected to be double by 2025. 55. South Asia has a higher number of people with diabetes than any other region with the estimates ranging from 19.4 million in 1995 to 32.7 million in 2000. 59. The International Diabetes Federation gives an estimate of 12% PREVALENCE IN Pakistan WITH A TOTAL OF 8.8 MILLIONPEOPLE WITH DIABETES IN 2000. THIS IS EXPECTED TO INCREASE TO 14.5 MILLION BY YEAR 2025. 59. In India, number of people with diabetes is expected to rise by 19.5% during 1995-2025 to reach 57.2% in 2025.60. The prevalence of diabetes in urban areas of Bangladesh is double that of rural area, 8% verses 4% and continuously rising in both. 61. In Srilanka, the diabetes prevalence is recorded as 8% in rural areas as compared to 12.5% in urban areas. 62. while in Nepal reported rates are 3% and 15% respectively. 63. Overall diabetes is associated with two fold increase in the risk of death from cardiovascular disease. Taking in view above data as the number of people with diabetes increases so the prevalence of Cardiovascular disease increases accordingly.
Metabolic Syndrome:
Metabolic syndrome is constellation of multiple factors like insulin resistance, abdominal obesity, dyslipidemia, and high blood pressure. It is estimated that worldwide people with metabolic syndrome are at increased risk, twice as likely to die from and three times as likely to have a heart attack or stroke compared to people without metabolic syndrome. 64. Asian have a lower BMI and waist circumference but can still have high insulin resistance, so the WHO has recently modified the BMI cutoff for obesity in Asian to greater than 23kg/m2 with waist circumference > 90cm for male and > 80cm for female.65. Several studies done on Soth Asians immigrants prove that they have hyperinsulinemia, raised triglyceride, low HDL cholesterol levels and abdominal obesity with high waist to hip ratio indicating condition of insulin resistance and high incidence of cardiovascular disease. 66-67.Recent studies have shown that metabolic syndrome is more prevalent in urban population of India, 68. Which is also true for Pakistani counterparts? 69. More population surveys are needed to profile south Asian propensity for metabolic syndrome. Very high prevalence of waist hip ratio among men (0.95) and women (0.85) and truncal obesity in both urban (men 39.1% and women 70.9%) as well as rural subjects (men 32.4% and women 42.3%) was reported from Delhi, India 70. In Srilanka 18.2% of population was labeled as leading a sendatary life 47. A 10% prevalence rate of obesity amongst rural males and 20% amongst urban females has been reported from Pakistan 39.
Epidemiological data reveal that in south Asia the prevalence of metabolic syndrome and type 2 diabetes is increasing markedly at lower level of BMI tan in western population. Interestingly, a great proportion of South Asians have a low HDL cholesterol and a genetic predisposition to insulin resistance, contributing to significantly high rate of metabolic syndrome and type 2 diabetes in this part of the world.
Dyslipidemia:
In India the prevalence of dyslipidemia in the industrial urban and rural populations in Delhi was reported as 30.9%, 36.8% and 16.3% respectively in men and 21.7%, 39.7% and 16.3% in women. 71.
Cholesterol levels are reported between 5.2-6.5mmol/L in 2.7.9% of rural and 26.5% of the urban Srilankan population.72. In Pakistan 12.6% of the population over 15 years of age is reported to have serum cholesterol level over 200mg/dl. 39. Numerous observational studies suggest that there is strong, graded and independent association between the dyslipidemia and risk of coronary heart disease. Asian population has increase risk of cardiovascular disease at lower level of cholesterol as compared to their western counterparts due to high genetic predisposition and increased level of physical inactivity.
Tobacco Trends;
Recent projections from WHO suggest that by the year 2020, Tobacco will become the largest single cause of death, accounting for 12.3% of global deaths.73. Tobacco use is highly prevalent in South Asia. Tobacco is smoked in several forms as Hukka, beeri and cigarette in addition to the practice of chewing tobacco in form of pan, niswar and naas absorbed through oral and nasal mucous membrane. In India alone, the tobacco attributable death toll will rise from 1.4% in 1990 to 13.35 in 2020. 73. The prevalence of smokeless chewable tobacco is very high in south Asia with over 10% of the population in Pakistan, 22% of men in India and 16% men and 21% women in Bangladesh.74. Although tobacco consumption is decreasing n developed countries but in developing countries its use in every form is increasing day by day and will be the major cause of morbidity and mortality in coming era.
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