By 2010, India will carry 60 percent of the world’s heart disease burden, nearly four times more than its share of the global population, according to a recent study. Adding to the burden is a higher incidence of the types of heart disease resulting in serious illness and mortality, and the fact that these conditions strike at an earlier age, says the study. Death rates are especially high among the country’s poorest residents, unable to get to hospital quickly in an emergency, or to afford routine treatments and surgery. Ischaemic heart disease – mainly heart attacks and coronary artery disease – is the leading cause of mortality in the world, accounting for 7.1 million deaths in 2001. More than 80 percent of these were in developing countries. Researchers have long known that south Asia has the highest level of acute coronary syndromes in the world, but little statistical data was available about treatment and health outcomes. A team of researchers led by Denis Xavier of St. John’s National Academy of Health Sciences in Bangalore, India gathered data on nearly 21,000 coronary patients admitted to 89 hospitals across 50 cities across the country. They found that of 20,468 patients given a definite diagnosis, 60 percent showed evidence of a heart attack, compared with 40 percent in developing countries. With a average age of 60, these Indian patients were also younger by three to six years than their counterparts in richer nations. The risk factors — include tobacco use, high levels of lipids in the blood due to diets rich in saturated fat, and hypertension — are the same as elsewhere, but the gap between India and developed nations have more specific causes, the study found. One was simply the time needed for patients suffering an acute heart problem to get medical attention. On average, it took 300 minutes to reach a hospital in India, twice as long and in rich nations. “Few patients used an ambulance to reach the hospital. Most used private or public transport” due to financial constraints, the authors note. Poverty also prevented most patients in India — where 75 percent of health care expenses are paid out-of-pocket — from obtaining routine treatments in hospital, much less preventative surgery. Many of these findings were expected, but had never before been quantified. “This registry is a major milestone, since it provides the first comprehensive view of the epidemic of acute coronary syndrome in India and helps to identify opportunities for improvement in care,” notes cardiologist Kim Eagle in a commentary, also published in The Lancet. “As the Indian economy grows, there is a possibility to further increases in cardiovascular disease before we see a decline similar to that being witnessed in developed countries,” he warned. By 2020, ischaemic heart disease is expected to have increased over three decades by 137 percent for men and 120 percent for women in poorer nations, compared with 30 to 60 percent in rich economies, according to The Lancet.