Hearts and heart ailments: India

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Hearts, Indian

‘Indian hearts age faster, prone to early disorders’

Times of India

Chennai: In India, the figurative term ‘young at heart’ could be just that — figurative. An Indian’s heart ages much faster than a Westerner’s, a study by Apollo Hospitals has found.

The results — compiled from cases the hospital group has been treating across the country — would be used as the baseline for a larger study the group is planning to undertake in association with the Indian Council of Medical Research (ICMR), group chairman Dr Prathap C Reddy said.

‘‘We have found that some heart disorders including blood vessel blocks found in a 35-year-old Indian are similar to those found in an average 60-year-old in the US. Indians are not only predisposed to heart diseases, but the progression of the disease is also faster in Indians. Considering that the incidence of heart disease in Indians is itself four times more than their Caucasian counterparts, this is disturbing,’’ Dr Reddy said.

Moreover, diagnosis of heart diseases happens late in India. Analysing data from more than 10,000 people who underwent CT scans at the group’s hospitals across the country, he said that many Indians in the age group of 35-60 years, who assume themselves to be healthy, may have cardiac problems. ‘‘Today, we know that nearly 10% of Indians develop heart diseases without having any risk factors like high blood pressure or diabetes. Scans have revealed a heart disease acting as precursor to diabetes and hypertension in these people. Since most heart diseases show no symptoms, young patients come to us only after the damage is done,’’ he said.

Senior cardiologists say the incidence of heart diseases is not confined to cities. ‘‘We are increasingly seeing rural people with heart diseases because their diabetes remains undiagnosed for a long time,’’ says Dr S Thanikachalam, head of cardiology, Sri Ramachandra University.

Cardiac disease: India


Prevalence of heart disease in India- 1990-2016
From: September 13, 2018: The Times of India

See graphic:

Prevalence of heart disease in India- 1990-2016

Cardiac stents


The Times of India Feb 16 2015

2008-13: number of cardiac stents implanted in India

Rema Nagarajan

Patients spend Rs 2,500cr on stents every year in India

Rs 1,500cr could be saved if govt pricing norms were followed

Patients spend about Rs 2,500 crore on cardiac stents alone every year in India even by conservative estimates, the bulk of it being paid from their own pockets. This does not include the cost of blood tests, angiography, procedures, charges for hospital stay, doctor's charges and so on. An estimated four lakh stents were implanted in India in 2014. Of this, over 85% were drug eluting stents (DES), for which most patients pay anything between Rs 55,000 and Rs 80,000. Annually, the stent market is estimated to grow by about 15%, with the growing incidence of cardiovascular diseases. Hence, the market is expected to grow steadily .

Industry sources estimated that though the share of DES was around 78% in 2013, it would have gone up to over 85% in 2014. In that case, the total number of DES sold in 2014 would be about 3.5 lakh.If the average price being paid by patients for a DES is taken at about Rs 65,000, the total expense on DES alone would have been approximately Rs 2,275 crore.

The Union health ministry had fixed Rs 23,625 as the price of a DES under various government schemes. If DES was available to everybody at this price, that would cost just Rs 827 crore, a saving of almost Rs 1,450 crore each year.Even if they were all priced at the imported price of about Rs 40,000, the total expense would be just Rs 1,400 crore, a saving of over Rs 800 crore.

Stent manufacturing companies pointed out that what patients pay is based on what hospitals are charging and that it is not the amount the companies are making, which they say is much lower.While Prime Minister Modi talks of `Make in India', when it comes to stents, more than 60% of the market is with just three US-based multinational firms -Abbot, Medtronics and Boston Scientific, which import the stents.

The rest of the market is divided between various Indian device companies like Vascular Concepts, Shahajanand, Meril Life Sciences, Translumina and others who charge Rs 12,000-30,000 for a DES.Their share of the market remains low despite these firms selling their stents in many European and South East Asian countries. Dealers for several multinational companies are known to offer hefty amounts as incentives to doctors and hospitals for every stent used to retain their market share. The margin between the import price and the final price paid by patients is huge enough to accommodate the cost of these large `incentives'.

Approximately , 40,000 bare metal stents (10% of the stent market) were sold at an average cost of Rs 6,000-10,000, which works out to a market of about Rs 32 crore. The Cardiological Society of India's National Interventional Council registry says 8,500 bio-absorbable stents were implanted in 2013. Industry sources claim that this segment of the market has shrunk a bit. Even assuming just 8,000 bio-absorbable stents -the most expensive variety with prices ranging from Rs 1.75 lakh to Rs 2 lakh plus -are sold in India, at an average price of Rs 1.75 lakh, the spending on such stents would amount to about Rs 140 crore. Add the numbers up and the total spending on stents of all kinds would be at least Rs 2,500 crore.

If we were to add the costs associated with hospitalization, sundry tests and so on for each angioplasty , the total amount being spent on angioplasties would be at least twice as much, if not more.

German study, 2018: Indian stents as good as US stents

Rema Nagarajan, It’s official, Indian-made stents as good as the best, November 15, 2018: The Times of India

Study Calls Out MNCs On Demand For Better Price For ‘Quality’

After much controversy regarding the quality of stents manufactured in India, yet another study comparing an Indian stent with the foremost foreign stent brand has concluded it is just as good. On Monday, the results of a 10-year study comparing clinical outcomes of the Indian stent Yukon Choice PC with those of the market leader, Xience stents from the American company Abbott, showed that they were equally good. A study presented two months back had also concluded that another Indian stent, Supra Flex was as good as Xience.

At the scientific session of the American Heart Association held in Chicago, cardiologists from Germany presented the results of an extended follow up of 2,603 patients who were randomised to treatment with two new generation stents — everolimus eluting Xience and sirolimus eluting Yukon Choice — and a first generation sirolimus eluting Cypher stent. Cypher is not in the market any more. The study published in the journal of the AHA showed there was no difference in outcomes between the two new generation stents.

In February 2017, the government had capped the price of stents leading to a three-fourths reduction in the prices for drug eluting stents. Several multinational stent companies had threatened to withdraw their stents from India claiming that they were superior to Indian ones and hence deserved a higher price. Several cardiologists too had questioned the quality of Indian stents. However, with studies showing that Indian stents are as good as foreign ones, cardiologists appear to have changed tack.

“These are the kind of studies we need — large, randomised, long-term studies. More Indian companies should do such studies to establish their credibility internationally. Every stent needs to be proven,” said Dr Ashok Seth, head of cardiology for the Fortis Group of hospitals. He added that the study also showed there was no difference between stents with biodegradable polymer coating and permanent polymer coating putting paid to the argument that biodegradable polymer coated stents should get a higher price.

Dr Upendra Kaul, chairman of Batra Heart Centre, who initiated the earlier one-year study comparing Supra Flex to Xience along with Prof Patrick Serruys from the Netherlands, pointed out that even with good newer generation stents, 3% of patients still had heart attacks and needed restenosis each year. “Further research is being done to bring down this 3%,” said Dr Kaul.

Yukon stents are made in India from German technology, while Supra Flex is a fully indigenous stent, pointed out Dr Kaul. In an editorial in the journal Euro Intervention last year, Dr Kaul had written: “There is a perception in the minds of cardiologists, which gets passed on to the patients, that imported stents are superior.” He had added that it was time for Indian companies to prove to cardiologists and patients that their products were as safe and effective as those of multinational companies.

So far, no brand of drug eluting stents anywhere in the world has been shown to be superior to other brands in the market, both Dr Kaul and Dr Seth pointed out.

Experts said the perception that imported brands are superior gets passed on from cardiologists to patients. So far, no brand of drug eluting stents has been shown to be superior to others in the market

Heart attacks


Dipak Dash, September 4, 2020: The Times of India

Heart attacks in India, 2014-19
From: Dipak Dash, September 4, 2020: The Times of India

The number of people killed in heart attacks has been increasing since 2014, according to the National Crime Records Bureau (NCRB). While in 2014, a total of 18,309 people died due to heart attack, the number increased year after year and claimed 28,005 lives in 2019, up by 53% in five years.

The data also show there has been a steady increase in such cases across different age groups barring those below 14 years and in the age bracket of 14-18 years. NCRB started providing the age group wise details of such deaths from 2016.

The comparative analysis of the past four years of NCRB reports show that fatalities due to heart attacks in the age group of 18 to 30 years increased from 1,940 in 2016 to 2,381 during the last year. The trend was similar in the 30-45 age group. While in 2016, a total of 6,646 people died in this age bracket due to heart attacks, this touched 7,752 during 2019. In the 45-60 age group, the fatalities increased from 8,862 in 2016 to 11,042 during last year. In the 60 plus age group, 6,612 people died last year compared to 4,275 in 2016.

Dr Ashok Seth, chairman of Fortis Escorts Heart Institute, said the increase in deaths due to heart attacks may be reflective of better data collection. “The incidence of heart attacks has certainly gone up, but so has the infrastructure. Ideally, the number of deaths should go down.”

Dr Viveka Kumar, principal director, cardiac sciences at Max Hospital, Delhi, said: “The mortality data from Registrar General of India shows 33% adult Indians died due to heart attacks. The major driver of increased mortality are conditions such as diabetes, smoking, BP and unhealthy lifestyle.”


COBL region increases rise in strokes

DurgeshNandan Jha, Oct 4, 2022: The Times of India

New Delhi : A genetic region previously known to increase the risk of Alzheimer’s disease in African Americans, has been linked to an increased risk of stroke. Also, a new study published in the journal Nature suggests, the frequency of this genetic region called COBL is higher in persons suffering from the neurological disease in south Asians, including Indian patients.

According to Dr Kameshwar Prasad, former head of neurology at AIIMS, who is currently director of Rajendra Prasad Institute of Medical Sciences (RIMS), Ranchi, the finding suggests that the presence of COBL increases risk of stroke in south Asians. “Similar studies in other ethnic groups like Europeans, Africans, etc did not confirm its role in theseethnic groups,” Dr Prasad said. He was the lead researcher from India in the Nature study which involved approximately two million stroke patients and two million individuals who were free from stroke. The individuals studied were from five different ancestries namely European, Africans, Hispanics, East Asians and south Asians. Dr Prasad said their team contributed data of 4,088 individuals — 1,609 stroke cases and 2,479 controls — which were part of the south Asian group. “This study led to identification of 89 genetic regions of which 61 were novel regions identified for the first time for stroke while 28 were confirmation of signals that were identified by previous studies,” he added.

The discovery of such genetic regions may pave the way to more targeted discovery of drugs likely to be more effective in specific populations like south Asians. It can also be used to predict stroke and help develop targeted therapy for the disease, the neurologist said.

In 2019, the estimated number of incident cases of stroke in India was 1. 29 million, and the number of deaths due to stroke was 6,99,000. The treatments available so far are mechanical removal or chemical dissolution of clots.

Prevention is also based on the ‘one size fits all’ principle. “Discovery of genes responsible for stroke in our population will allow precise identification of people at high risk, and therapy targeted to neutralise the gene may allow targeted prevention and specific treatment,” Dr Prasad explained.

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