ISCHAeMIC HEART DISEASE IN INDIA

Abstract

A statistical study of 5615 cases of ischemic heart disease, observed over a 15-year period in private and hospital practice, in Bombay, India. Of these, 3833 cases were seen in private practice and 1782 in hospital practice. The incidence of ischemic heart disease in a total cardiac population of 21,065 cases was 26.6%. The clinical material of 5615 cases included 78.8% men and 21.2% women, with a sex ratio of 3.7 to 1. The ratio of men to women was 2.9 to 1 for elderly subjects over 60 years, and as high as 12.8 to 1 for subjects under the age of 30 years. Although ranging in age from 7 to 96 years, as many as 54.6% of the patients were between 41 and 60 years, the peak incidence being observed in the fifth decade of life, a decade earlier than in Western surveys. As many as 166 patients were under the age of 30 years. The incidence of ischemic heart disease was relatively higher among Parsees, Jews, and Christians than among Hindus and Muslims. Ischemic heart disease occurred more commonly among non-vegetarians than among vegetarians. The incidence of antecedent hypertension was 60% for men and 66% for women of all ages. For subjects over 60 years of age, however, the incidence was 66% for men and 81% for women. Of the 2519 cases of acute myocardial infarction studied, as many as 20% were below the age of 40 years and only 10% over the age of 70 years. The high incidence of youthful subjects in our series appeared noteworthy. The relative preponderance of men is reflected by the sex ratio of 3.6 to 1 for cases of myocardial infarction. A relatively higher incidence of acute myocardial infarction was seen among the professional, executive, and business classes, these 3 occupational groups being jointly responsible for 61% of all male subjects. An incidence of 63% of heart attacks was found during mild or routine physical activity or at rest. The ecg localization of infarcts in 1360 acute cases was as follows anterior infarcts: 48%; posterior infarcts: 29%; multiple or anterior and posterior infarcts: 9%; subendocardial infarcts: 7%; and indeterminate types: 7%. In view of the world-wide interest shown recently in the prevalence and epidemiology of ischemic heart disease, the results of the present investigation undertaken in India are offered as a contribution to the growing body of knowledge on this most important subject.