Prevalence of Coronary Heart Disease in India

Prevalence of coronary thrombosis thrombosis Heart Disease in India entryAccording to WHO (2007) coronary thrombosis thrombosis thrombosis bosom infirmity (CHD) (including myocardial ischemia) is the most park cause of demolition in the world and the biggest cause of premature close in modern and industrialised countries (Lopez et al., 2006 Lindsay and Gaw, 2004). In 2001, ischaemic nerve indisposition accounted for 7.1 single thousand thousand wipe breaks worldwide among which 5.7 million (80%) goals were in developing and underdeveloped countries (Lopez et al., 2006). Although geographical variations such as ethnic origin and social class play the CHD fatality value evaluate (Lindsay and Gaw, 2004), coronary heart sickness remains usual globally despite the development of a aver of treatments (Brister et al., 2007).There is turn up that ethnicity is an of the essence(predicate) factor for coronary heart unsoundness (Gupta et al., 2002 Brister et al., 200 7) and a tally of studies cede suggested that thither is augmentd incidence in coronary arteria dis rescript in southeasterly Asians ( commonwealth originating from India, Pakistan, Bangladesh and Sri Lanka) when comp bed to the white cosmos (Brister et al., 2007). South Asian people in like manner produce a greater hazard of coronary heart unhealthiness than sepa evaluate from developed countries (Mohan et al., 2001 Joshi et al., 2007). In 2002 India had the highest number of deaths everyplace 1.5 million due to coronary heart disease (Reddy et al., 2004). By 2010, it is expected that 66% of the worlds heart disease is likely to occur in India (Ghaffar, 2004).Therefore, this dissertation force focus on the preponderance of CHD in India and the impact of animateness hyphen in the aetiology of CHD. There is wide range of enjoin regarding the incidence and preponderance of coronary arterial stemma vessel disease (CAD) in India (Reddy, 2004 Kasliwal et al., 2006 P atel et al., 2006 Brister et al., 2007), including Indian, British and Singaporean journal articles.This dissertation is broken down into three parts the freshman discusses the topic in relation to the existing lit on the prevalence of CHD in India the second part is a critical appraisal of the jeopardize factors and the impact of life style of CHD in Indians age the third defers the instruction of CHD, and entangles a discussion of the nursing implications and future re take c ar into this argona.Background THE ailment ASPECT- CORONARY HEART DISEAS/CORONARY ARTERY DISEASEDefinitionsCoronary heart disease CHD covers a spectrum of disease such as angina, acute coronary syndrome, myocardial ischemia, ischemic cardiomyopathy, chronic heart failure and a symmetricalness case of sudden cardiac death (Lindsay and Gaw, 2004 pg no. 1).Acute coronary syndrome This is the clinical entity of myocardial ischemia and myocardial infarction.Myocardial Infarction it is a insure that re sults from diminished oxygen supply coupled with inadequate removal of metabolites because of reduced perfusion to the heart muscle (Woods et al., 2005 pg no. 541)Angina A condition characte sneakd by chest pain or discomfort from myocardial ischemia (Woods et al., 2005 pg no. 541)Overview of Coronary Artery DiseaseCHD is the major(ip) cause of death in most countries and is considered almost to be an epidemic in western countries (Lippincott, 2003). In Britain it accounts for sensation in three deaths in men and one in four deaths in women, small-arm 5,000,000 deaths annually argon seen in US (Forfar and Gribbon, 2000). It is estimated that more(prenominal) than than 80% of patients who develop clinically significant coronary arteria disease (CAD), and more than 95% of those who experience a smuggled CAD event adopt at least one major cardiac adventure factor (Greenland and Klein, 2007). CHD is more prevalent in males, whites and the middle- get on withd, as well as elder ly people. More than 50% of males age 60 or older show signs of coronary artery disease on autopsy. The peak incidence of clinical symptoms in females is amid ages 60 and 70 (Lippincott, 2003).There is a marked departure in death post due to coronary disease between countries for example, a 10-fold greater age-standardized death rate for men aged 35 to 74 years in Scotland opposed with Japan. Within Europe, a threefold difference in death place and disease incidence can be seen with Finland and the United Kingdom higher(prenominal) than Italy, France, and Spain (Forfar and Gribbon, 2000). There are overly marked contrasts in coronary disease death rate trends between developed and developing countries. In the United States, Hesperian Europe, and Australia, mortality has been falling between 15 and 50 per cent for at least 20 years (Lippincott, 2003). In contrast, rates continue to rise in Eastern Europe, including Poland, Hungary, Bulgaria, and the Czech Re general. The fal l could be due to a fall in disease incidence or case need rates, or both. Although the management of acute myocardial infarction in finical has improved over this time, with case fatality rates halved, on that point has too been an increased awareness of assay factor avoidance (Forfar and Gribbon, 2000).The Disease cheekCoronary arteries bring line of credit and oxygen to nourish the heart. The heart pumps deoxygenated blood to the lungs, where it receives oxygen before it is pumped to the whole body. Because the heart is a muscle, it ineluctably a continuous ejaculate of oxygenated blood to function.Causes and symptomsCHD is usually ca utilise by atherosclerosis. cholesterin and other fatty substances accumulate on the inner wall of the arteries, which in turn attracts fibrous tissue, blood components, and calcium to the inner walls of the arteries which then hardens into artery-clogging plaques (Woods et al., 2003). atherosclerotic plaques often form blood clots that ov erly can block the coronary arteries (coronary thrombosis). Congenital defects and muscle spasms can overly block blood flow. late search indicates that infection from organisms such as the chlamydia bacteria may also be responsible for just closely cases of coronary artery disease (Warrel, 2003).A number of major contributing factors increase the risk of developing coronary artery disease. Some of these can be changed and close to cannot. People with more risk factors are more likely to develop coronary artery disease.major(ip) risk factorsMajor risk factors are those factors that lead to CHD. They are mainly classified into two groups non-modifiable and modifiable (Lippincott, 2003). Those that cannot be changed are the non-modifiable risk factors such asHeredity if a persons parents deliver coronary artery disease he/she is more likely to develop it.Sex hands are more likely to have heart attacks than women and to have them at a younger age.Age Men 45 years of age and older and women 55 years of age and older are more likely to have coronary artery disease. However now-a-days, coronary disease may occasionally strike a person in their 30s (Lippincott, 2003).Major risk factors that can be changed (modifiable risk factors) are green goddess Smoking increases the chance of developing CHD and the chance of dying from it.High cholesterol provenderetic sources of cholesterol are meat, eggs, and other animal products. There are other factors also that increase the cholesterol level such as age, sex, heredity, and diet affect ones blood cholesterol. Total blood cholesterol is considered high when it is above 240 mg/dL and borderline at 200-239 mg/dL.High blood twitch High blood pressure makes the heart doing harder, also increases the risk of heart attack, stroke, kidney failure, and congestive heart failure. A blood pressure of 140 over 90 or above is considered high.Lack of visible activity Lack of exercise increases the risk of coronary art ery disease. raze modest physical activity, like walking, is beneficial if done regularly (Lippincott, 2003).Diabetes mellitus the risk of developing coronary artery disease is seriously increased in diabetics. More than 80% of diabetics die of some type of heart or blood vessel disease.Chest pain (angina) is the main symptom of coronary heart disease but it is not always present. Other symptoms include shortness of breath, and chest heaviness, tightness, pain, a burning sensation, squeezing, or pressure every behind the breastbone or in the arms, neck, or jaws (Lindsay and Gaw, 2004). Many people have no symptoms of coronary artery disease before having a heart attack according to the American Heart Association 63% of women and 48% of men who died suddenly of coronary artery disease had no previous symptoms of the disease (Woods et al., 2001).THE COUNTRY PROFILE INDIA The bucolic IndiaIndia, situated in the South Asian region, is the seventh largest, and the second most thickl y settled, country in the world with a people of 1.103 billion (United areas Population Division, 2005) in 32 states and union territories covering about four thousand towns and cities and about half a dozen lakhs villages (Nag and Sengupta, 1992). The population distribution is 71% unsophisticated and 29% urban (United Nation Population Division, 2005).Initially, India was a cracker-barrel economy that subsequently participated in the industrial revolution with the help of colonial rule. After independence in 1947, the country followed socialist policies and hence large-scale infrastructure and industry development was carried out finished the public sector. By the early 1990s, the Indian economy was heart-to-heart up through liberalization and is now on the road to privatization through disinvestment policies. However, the frugal growth in India during the 1990s as a result of the 1991 economic reforms has also seen an increase in poverty and a pedestal transformation in the well-being of the bottom half of the population (Rajeshwari et al., 2005). The consequences of these economic and social changes have led to an epidemiological alteration (Joshi et al., 2006). An epidemiological transition is a focus on the complex changes in the patterns between the wellness and disease and the interaction between them and discordant other factors such as demographic, economic and determinants with their consequences (Omran, 2005).The urban population has increased by 4.5 times during 1951-2001 (WHO, 2000). The life expectancy from birth for males is 62 and females 64 (WHO, 2008). While the crude mortality rate is decreasing the percentage of children under 15 is declining (WHO, 2007).Total intake on health per capita (Intl $, 2006) 109. Total expenditure on health as % of GDP (2006) 4.9 (WHO, 2008). The leading cause of mortality after death during accouchement is cardiovascular disease, accounting for 188 deaths per 100,000 population (WHO, 2005).The hea lth tutorship system of India is overseen by two different bodiesThe Department of health Family Welfare.The Department of AYUSH (Ayurvedic, Unani, Siddha and Homeopathic Medicines). distributively state has a Ministry of wellness Family Welfare although their organization differs from state to state. Generally, in that location is a Directorate of Health Services providing technical assistance. Some states have a separate Directorate of Medical Education Research, and some have a separate Director of Ayurveda or Director of Homeopathy (WHO, 2007). In rural areas, Community Health Centres serve estimated populations of 100,000 and provide speciality service in general medicine, paediatrics, surgery and obstetrics gynaecology. However, on that point is still a shortfall in the number of community health centres in the rural areas of India. A Primary Health Centre (PHC) covers round 30,000 people (20,000 in hilly, desert or difficult terrain) and is staffed by a medical offic er, and one male and one female health assistant along with reenforcement staff. A sub-centre serves around 5,000 people (3000 in difficult terrain) and is supported by one male and one female multipurpose health worker. These workers and health assistants have different designations in different states.Playing an equally important role in curative and preventive care in urban areas is the private sector. A large number of private practitioners exist and in that location are many large and small hospitals and nursing homes along with a large number of voluntary organizations providing health care (Bhat, 1993).Chapter One lit Review AimsThe aim of this check into isTo read the prevalence of CHD in IndiaTo analyze the mortality rates related to CHDTo sympathize the aetiology of CHD in IndiaThis appraise will also include a comparison require of the prevalence of coronary heart disease among unsettled Indians and the natives of the particular migrant ending countries.Reason f or the selection of the topicCHD remains the largest cause of death worldwide. deathrate rates from cardiovascular disease have been known to increase from five-fold to ten-fold around the world ( subject field Institute of Health, National Heart, Lung and Blood Institute, 2000). A World Health Organisation (WHO) Multinational monitoring of trends and determinants in cardiovascular disease (MONICA) test crushd the event rates of CHD among 38 populations between the age group 35-64years, and ready variations in CHD prevalence and mortality rates among different ethnic groups (Tunstall-Pedoe et al., 1994).India is a developing country which is seeing an increased rise and prevalence of CHD (Reddy, 2004). While the incidence of coronary artery disease (CAD) has decreased by 50% over the past 30 years in developed countries, in India it has doubled (Kasliwal et al., 2006). Prevalence is an epidemiological measure to determine a how usually disease or condition occurs in a population , whereas incidence is other epidemiological measure that measures the rate of occurrences of new case of a disease or condition (Le and Boen, 1995). The prevalence of CHD is seen mostly from the age of 35 years and over (Kasliwal et al., 2006).CHD is the second leading cause of mortality in Indians (Patel et al., 2006). Joshi et al., (2006) conducted a scan in the rural areas of Andhra Pradesh, India, the results of which suggested that vascular diseases (including ischemic heart disease and stroke which accounts for 32%) are the main cause of mortality in India when compared to other chronic conditions such as infectious and parasitic diseases, tuberculosis, enteral conditions, HIV, neoplasm and diseases of the respiratory system.However, CHD mortality rates have decreased in by 50% in most industrialised countries since 1970s (Unal et al., 2004). In United States the decline was seen during the 1980s (US Department of Health and Human Services, 2000), while in the United Kingd om the decline saw a unhurried pace (British Heart Foundation, 2003). In the United Kingdom the death rates fell by half in the 55-64 age group and around less than 40% in men aged 35-44. In women death rates fell by half and a third in those aged 55-64 years and 35-44 respectively (British Heart Foundation- BHF, 2004). However, even though the mortality rates from CHD have fallen it does not suggest that the prevalence has also fallen. The reasons for the decline are not clearly understood but some hypothesise that a reduction in fastball management for lipoid and blood pressure control modern care for acute coronary syndrome and secondary prevention has contributed (Luepker, 2008).The increased incidence of CHD has led to the increase in number of Coronary Artery Bypass Grafts ( coronary bypass) and other cardiac surgeries. It is estimated that 25,000 CABG surgeries are carried every year in India (World Health Organisation statistical Information System, 2003). Hence, it coul d be storied that in a highly populous country like India with its increased prevalence of CHD that the estimated CABG surgeries reaching to the public is actually very few. Therefore, there could be considerable gap between the public need and treatment.Therefore, the reason for this thesis is to help us understand that there is high prevalence in CHD in the Indian population the specific reasons for this increased epidemic and how can it be managed so the population can remain healthy.Search strategyThe books was searched with the specific intention of examining the most up-to-date info concerning the prevalence of CAD in India. The search was performed by accessing specialised scientific medical and nursing infobases carrying articles regarding the specified subject field area (Craig and Smyth, 2002). The databases accessed included the Cumulative Index of Nursing and Allied health care Literature (CINAHL), Cochrane Database of taxonomical Reviews, Cochrane Central Registe r of Controlled Trials, and MEDLINE and EMBASE using the Ovid SP interface. The keywords used for the search were coronary artery disease, ischemic heart disease, and coronary heart disease, South Asians, prevalence, mortality rate, British white, Caucasians and India. The Boolean term AND was used simultaneously.The date range of the studies targeted was set between 1991 and 2009 and was chosen so the most recent register could be drawn on, although articles outside this date limit were also bodied into the search so as to be able to compare whether there have been any changes in the literature over time. To focus the search more strategically the following inclusion and exclusion criteria below were applied.cellular inclusion and exclusion criteria used to narrow the searchThe inclusion criteria include prevalence of CHD in both rural and urban areas in order to compare the prevalence of CHD, the date range was set from 1991-2009 so that the recent endorse could be drawn on. Th e other inclusion criterions were British Indians, American Indians, migrant Indians and South Asians. The patient age group considered was from 35 years over as this matches the known incidences of coronary artery diseases (Kasliwal et al., 2006). The exclusion criteria were other cardiovascular studies such as peripheral artery disease since the literature review focussed on CAD only.Search ResultsInitially the search revealed 78 potentially relevant papers however 48 did not conquer data pertinent to the inclusion criteria or were not credible sources. The 30 papers that were used for the review included both qualitative and decimal studies. They included a wide range of international literature to resign a comparison of the prevalence of CHD between British Indians and British whites. The literature that provided evidence from the Indian health care system were all medical journal articles by authors such as Bhardwaj, 2009 Mandal et al., 2008 Kamili et al., 2007 Chow et al., 2006 Patel et al., 2006 Kuppaswamy and Gupta, 2005 Patel et al., 2005 Sharma and Ganguly, 2005 Ward et al., 2005 Indrayan, 2004 Pinto et al., 2004 Gupta et al., 2003 Gupta and Rastogi, 2003 Gupta et al., 2002 Singh et al., 1997 Gupta et al.s 1997 Dhawan, et al 1996 Gupta et al., 1995 Gupta et al., 1993 Kutty et al. 1992. Journals from UK include Zaman et al., 2008 Whincup et al., 2002 Bhopal et al., 1999 Cappuccio et al., 1997 and Journal from Singapore are Mak et al., 2004 Tai and Tan, 2004 Kam et al 2002 Lee et al., 2001.From the analysis of the above literature the following themes were formulatedThe prevalence of CHD in the mother country, India, both in rural and urban areas.The reasons for the increase in CHD in India.A comparison of CHD prevalence and mortality rate between British Indians and British whites.Credibility of the LiteratureIn order establish the evidence of increased prevalence of CHD in India it is necessary to analyse a wide range of literature. To assess the credibility and reliability of the evidence, the strengths and limitations of the texts were identified. Systematic reviews were used to determine the strength of the evidence. In the hierarchy of evidence, systemic reviews are considered the golden standard. This is because systemic reviews draw on Statistical procedures for combining data from a number of studies and investigations in order to analyse the therapeutic lastingness of specific treatment or interventions. (Helewa Walker, 2000, p.111).There was only one positive review available for this literature review (Bhopal et al., 2000). This investigate paper has a clear search strategy stated, limits, and selection criteria. The search was special to English research papers, however one exception was that only published studies report original comparative data were included. Unpublished studies and studies only reported as abstracts were not included, which ensures rigour in the analysis of the data by having a complete recount of the different studies this also ensures that the studies had gone through an rating committee before being published. The conclusions reached in the systematic reviews support the conclusions reached crossways the other literature sourced (Mandal et al., 2008 Gupta et al.,1997).Observational studies are considered a good source of evidence, and are similar to Randomized Controlled Trials (RCTs) in terms of effectiveness, appropriateness, and feasibility of the evidence (Craig Smith, 2002). The studies learnd as part of this essay also described the setting, location, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection, thereby increasing their robustness (STROBE checklist, 2008). There was one observational memorize that mentioned its location, time period and setting, and therefore provided credible evidence for the literature review (Wilkinson, 1996).Most of the studies analysed for the literature review were population found surveys, while some studies were clearly addressed and statistically analysed (Mandal et al., 2008 Zaman et al., 2008 Chow et al., 2006 Patel et al., 2005 Mak et al., 2003 Whincup et al., 2002 Lee et al., 2001 Bhopal et al., 1999 Cappuccio et al., 1997, Gupta et al., 1997 Singh et al., 1997 Kutty et al., 1992) estimable issues were mentioned (Cappuccio et al., 1997 Kutty et al., 1992). Some studies however did not explain their statistical analysis (Bhardwaj, 2009 Pinto et al., 2004), and without discerning the specific characteristics of the statistical analysis, the studies cannot be replicated as evidence in this literature review.In regard to qualitative research, a great deal of reason is still going on regarding how to assess the quality of such work (Sandelowski, 1986). In particular, researchers suggest that it is difficult to develop a single bench mark against which the true value of claims can be judged (Craig Smith, 2002). Even though qualitative studies are n ot considered excellent or even good sources of evidence, based on evidence-based hierarchy, they can address questions that cannot be answered using other data-based methods (Green Britten, 1998). One qualitative study in the literature was used to examine and compare the illness beliefs of South Asian and European patients with coronary heart disease (CHD) about causal attributions and lifestyle change. The method of sampling and data analysis was appropriate.Although the reviews of the literature accessed for this literature review did not prove as rigorous as other sources of evidence, because they did not draw on trial-and-error data, they were used to support the findings of other more robust forms of evidence, which were generated from systematic reviews, observational studies and survey. Reviews of the literature carried out by Goyal and Yusuf, 2006 Kuppaswamy and Gupta, 2005 Sharma and Ganguly, 2005 Tai and Tan, 2004 Barakat et al., 2003 Yusuf et al., 2001 Reddy et al., 1 998 provided evidence, however the paper fails to present a search analysis.Evaluation of key studies The prevalence of CHD in IndiaCoronary heart disease has emerged as an epidemic in India (Gupta and Rastogi, 2003). According to the National Commission and Macroeconomics and Health, Government of India the total number of CHD patients in India by the end of the century was around 30 million (5.3% ) of the adult population this is betoken to increase to up to 60 million cases (7.6%) by the year 2015 (Indrayan, 2004). Although there are various comparative studies showing the burden of cardiovascular disease among Indian immigrants in Western countries, there has been less attention give to CHD in India itself (Goyal and Yusuf, 2006, Reddy et al., 2004, Yusuf et al., 2001, Anand et al., 2000). Hence, this section of the literature review will focus on the prevalence of CHD in India.In developed countries, there are no rural-urban differences in the prevalence of CHD (Feinleib, 199 5). However in India there is marked difference between the prevalence of CHD in the rural and urban areas with surveys showing that the prevalence rate of CHD in urban areas is about double that rural areas (Gupta et al., 2006 Reddy, 1998 Singh et al., 1996 Singh et al., 1997).Studies have been done in various states of India of the prevalence of CHD in the country. For example, Mandal et al., (2008) conducted a cross-section(a) survey among the urban population of Siliguri in West Bengal, from a haphazard sample population aged greater than or equal 40 years, to determine the prevalence of ischemic heart disease and the associated risk factors. The results showed that 11.6% had ischemic heart disease (IHD) and 47.2% had hypertension. Males had a higher (13.5%) prevalence of IHD than females (9.4%). About 5% of the patients had asymptomatic IHD. However, this study had a small sample size, which could limit the generalisability of the findings and is limited by the fact that other risk factors like diabetes and lipids were not included.On the other hand, Kutty et al. (1992) conducted a survey among the rural population of Thiruvananthapuram district in Kerala state, to analyse the prevalence of some indicators of coronary heart disease. The indicators included in the study were electrocardiogram changes and well-known risk factors such as obesity, hypertension, smoking and diabetes. From the above criteria it was found that rural Thiruvananthapuram has a lower prevalence of coronary heart disease when compared to urban centres like Delhi. However there were drawbacks to this study too, such as the fact that people were sampled on the basis of mob list from the punchayet office (panchayat is south Asian rural semipolitical system) so anyone who did not belong to the house list in the panchayat was not included in the study. This could have caused a limitation in the generalisability of the results as there was bias in sampling technique.Similarly, Singh et al., (1997) conducted a cross- sectional survey in two villages in Northern India, which showed a significantly higher and increased prevalence of CHD in urban areas compared to rural areas. Reddy also (1998) conducted a cross-sectional survey which found the prevalence rate of CHD as being 6% in the rural areas of Haryana, India. Another study conducted was in the rural areas of Northern India in Himachal Pradesh which showed a CHD rate of 4.06% among the whole rural population in the age group between 50-59 years with a slightly higher incidence in men than women (Bhardwaj, 2009). However these research papers failed to set out their statistical analysis or research analysis, meaning that the reliability of the papers cannot be measured. Nonetheless, it can be noted that the prevalence of CHD was lower in the rural areas and also that the prevalence rates varied in different states of India.Chow et al., (2006) conducted a survey in the rural areas of Andhra Pradesh to investiga te the prevalence of cardiovascular disease and levels of managing the major risk factors. Their results showed that cardiovascular disease is highly prevalent and the community knowledge about cardiovascular disease is quite good. However, the results also pointed out that even though people have the knowledge, their management for risk factors remains suboptimal. Hence it could be suggested that even though the people had good awareness regarding CHD the care provided for them was insufficient.to boot there were a number of studies done to determine the increase in CHD prevalence in urban areas compared to rural areas of India (Pinto et al., 2004 Gupta et al., 2002 Gupta et al., 1995). However there are limitations to these studies, including such factors as small and variable samples, low response rates, improper diagnostic criteria, non-specific electrocardiographic changes, a lack of standardization, or incomplete results.Gupta et al.s (1997) survey in a rural area (Rajasthan) found that even though the prevalence of CHD was lower in the rural areas, it had nevertheless increased (to 3.4% in males and 3.7% in females) when compared to previous studies. The study was carried out with a detailed questionnaire brisk according to guidelines from the World Health Organization (WHO) the United States Public Health Service and a based on a review of previous Indian studies. The Performa elicited family history of hypertension and CHD social factors such as education, housing, type of job, stressful life events, depression, participation in religious prayer and yoga along with conventional risk factors such as smoking, alcohol intake, count of physical activity, diabetes, and hypertension. Blood pressure measurements and a 12 lead cardiogram using proper standardization were performed on all participants. Earlier studies from India used different criteria and showed higher CHD prevalence. When the diagnostic criteria in the present study are extended to inclu de past documentation, response to WHO-Rose Questionnaire and ST-T wave changes in ECG as done in previous studies, the prevalence rises to a rate higher than those found in previous Indian rural studies. However, the results cannot be validated. For example, some of the previous studies from India included ECG criteria as the presence of left hand bundle branch block, complete heart block and presence of ST ingredient and T wave changes while some studies suggest that these findings are not reliable enough to diagnose CHD, especially so in females where ST-T changes may be non-specific (Reddy et al., 1996 Gupta et al., 1993). That said, it is clear evidence that there is still an increasing prevalence of CHD in India.Heart diseases are also occurring in Indians 5 to 10 years earlier than in other populations around the world (Dhawan, et al 1996). According to the INTERHEART study, the median age for frontmost presentation of acute Myocardial Infarction (MI) in the South Asian (B angladesh, India, Nepal, Pakistan, Sri Lanka) population is 53 years, whereas that in Western Europe, China and Hong Kong is 63 years, with more men than women affected (Yusuf et al 2004) (the INTERHEART study was a standardized case-control study that screened all patients admitted to the coronary care unit or equivalent cardiology ward for a first MI at 262 participating centres in 52 countries throughout the world).Epidemiological studies have shown that immigrant Indians share a significantly higher incidence of CHD than the native populations (Enas et al., 2005 Gupta et al., 2002). The first evidence of this was found in a 1959 study among expatriate Indians in Singapore (Kuppaswamy and Gupta, 2005). Similarly many studies have been done in various other countries to corroborate these findings (McKeigue, 1991 Enas et al., 2005). However, in the UK it is only recently that the importance of ethnicity and disparities in regard to CHD has been realised (British Heart Foundation, 2 004). Several studies have reported that there is increased prevalence of CHD in British Indians when compared to British Whites (McKeigue, 1991 Bhopal et al., 1999 Enas et al., 2005).Hence, the review of the literature clearly shows the prevalence of CHD among the urban and rural populations in In