Overview of Cardiovascular Diseases in India

Prevalence and Mortality Rates

Cardiovascular diseases (CVDs) represent the foremost cause of non-communicable disease (NCD) fatalities in India, contributing to nearly 48% of all NCD-related deaths. The risk of developing CVD is notably higher among Indians, estimated to be 3–4 times greater than that of White Americans, six times higher than Chinese individuals, and twenty times more than the Japanese population. Furthermore, Indians typically experience CVD at a younger age, underscoring the importance of addressing factors beyond merely modifiable risk factors. Consequently, it is essential to manage cardiovascular risk more vigorously for Indian patients.

Inherited and Causal Cardiovascular Risk Factors

Family History of Atherosclerotic Cardiovascular Disease (ASCVD)

Inherited factors, including a family history of ASCVD, significantly contribute to India’s residual cardiovascular risk profile. A family history of ASCVD can independently elevate the risk of CVD by approximately 40% if a sibling is affected, and by 60–75% when one or both parents have the condition. Data from the LASI Wave 1 study, involving 58,734 participants, indicate that CVD incidence nearly doubles among individuals with a family history when combined with hypertension (18.6% with family history versus 11.3% without) or diabetes (20.5% with family history compared to 5.0% without).

Impact of Premature ASCVD

A family history of early-onset ASCVD, defined as occurring before age 55 in men and before age 65 in women, is associated with an increased risk of recurrent cardiovascular events. Research from the SWEDEHEART registry, which included 25,615 participants, found that such a family history correlates with a 22% higher adjusted risk of recurrent ASCVD following a myocardial infarction. Additionally, studies in India suggest that a family history of premature ASCVD can increase the risk for the next generation by 2–7 times.

High Lipoprotein (a) Levels

High levels of Lipoprotein (a) [Lp(a)], specifically those exceeding 50 mg/dL, are present in approximately 25% of the Indian population and are known to heighten the risk of premature ASCVD by 30% for each 50 mg/dL increase in Lp(a) levels. The upcoming ESC 2025 guidelines recognize elevated Lp(a) as a causal factor for cardiovascular disease, bolstered by increasing evidence linking it to adverse cardiovascular outcomes. Research presented at the ESC Congress 2025 further emphasized the significance of Lp(a) in cardiovascular risk assessment, revealing that a retrospective study involving 3,710 participants showed 30–40% higher Lp(a) levels in patients with coronary artery disease compared to those with normal levels (13-14 mg/dL versus 10 mg/dL, p).