Cardiovascular Disease | History in Nepal

Last updated on September 10th, 2020 at 08:40 am

Overview

Heart problems and disease, technically termed as Cardiovascular disease (CVD) are one of the leading causes of deaths in Nepal and globally.

According to the data published by WHO (World Health Organization), a total of 17 million deaths were attributed to (CVD) in the year 2015, among which three-quarters were found in middle and low-income countries across the globe.

Moreover, the age-standardized death rate due to heart disease has been estimated to be 152 per 1,00,000 people in the year 2008 in Nepal.

These numbers speak volumes on the prevalent precarious situation on the global and national health conditions that we are facing and likely to face if not acted upon in its prevention and control.

History and epidemiology of Cardiovascular disease in Nepal

According to the author Abhinav Vaidya (2011), the first documented case of myocardial infarction (heart attack) in Nepal was observed in the 1970s. But this is not to say that Cardiovascular disease did not exist in Nepal before that.

Lack of proper registry and documentation has been a limiting factor to elucidate the proper course of the historical development of (CVD’s) in the context of Nepal.

Nevertheless, the last decade has been vital in publication and therefore revealing various studies regarding the situation of heart problems and diseases in Nepal, including hospital audits on (CVD’s) and biochemical studies.

Analysis of various reports indicates that not only there is a huge prevalence of (CDV’s) in the Nepalese population, the trend is increasing.

This is evident by the fact that the number of (CVD) cases in “Gangalal National Heart Centre” the main referral cardiac hospital in Nepal has doubled within the span of 7 years, from 2001 to 2008.

Similarly, the reports of the main central hospital of Nepal, “Tribhuvan University Teaching Hospital” reveals that out of 20% of their admitted patient comprise of (CVD’s).

Additionally, “Nepalgunj Teaching Hospital” that serves primarily for western hilly district regions account for 20-40 (CVD) patients daily. And finally, at a national level, (CVD’s) comprises 38% of all the non-communicable disease (NCD) of Nepal as shown by the hospital-based prevalence study in 31 hospitals across Nepal.

These data are evident to confirm the adequate prevalence of (CVD’s) in the context of Nepal and also to indicate its increasing trend.

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The risk factor of Cardiovascular disease in Nepal

But to have a grip on (CVD’s), we should understand that onset of heart disease depends upon the multiplicative and cumulative effect of a wide range of risk factors.

Thus, mitigation of these risk factors will consequently affect lowering the chances of a person suffering from CVD’s.

According to an article published by (WHO), one such big risk factor and its contribution to the development of (CVD) in the context of Nepal includes hypertension 26-39% during the last three years (2015-2018).

Similarly, other risk factor includes diabetes that is observed in (8.4%) of the Nepalese population.

While STEPS survey of Nepal in 2013 have detected hyper cholesterol (23%), smoking (19%), over-weight (21%), raised blood glucose (4%), physical inactivity (3%), and harmful use of alcohol (2%) in Nepalese population.

These risk factors in essence cluster together, interact, and multiply to develop heart disease.

Types of Cardiovascular diseases in Nepal

Amongst various kinds of (CVD’s) prevalent around the world, some that are pertinent to Nepal as with the number of patients visiting the hospital are listed below.

1. Coronary Heart Disease (CHD)

These are the types of (CVD’s) where the supply of blood to the heart is interrupted or blocked due to the deposition of fatty substances on the coronary arteries (arteries that supply blood to the heart).

According to National Health Services (NHS), the main symptoms of (CHD) include chest pain, heart attacks, and heart failure.

This condition is mainly related to unhealthy lifestyle choices such as smoking and consumption of an excessive amount of alcohol.

2. Rheumatic Heart Diseases (RHDs)

According to the newsletter on John Hopkins Medicine, this is a condition and thereby a type of (CVD) where there is permanent damage of heart valves due to rheumatic fever (acute fever accompanied by pain and inflammation in the joints).

This is primarily due to the body’s immune response especially inflammation against fever that causes the valve damage.

Onset may usually involve streptococcal infection for example strep throat but it may take years to develop and result in heart failure.

Children from (5-15) age groups are the most vulnerable, especially in developing countries.

Fever, painful joints, shortness of breath, chest discomfort, and nodule under the skin are major symptoms of rheumatic heart disease.

3. Hypertensive Heart Disease

This category of heart disease occurs because of high blood pressure. Article on Medline Plus quotes that, the pressure inside the vessels is too high which consequently makes the heart work harder overtime against this pressure causing heart muscles to tighten.

This can make heart muscles so thick over time that it remains deprived of oxygen causing chest pain (angina) or heart failure.

4. Arrhythmia

This is a kind of heart disease that affects the rate of the rhythm of a person’s heartbeat.

In other words, the heartbeat of the patient may be too slow (bradycardia), too fast (tachycardia) or irregular (atrial fibrillation). This may be due to various reasons such as preexisting medical conditions with heart problems including heart attack, smoking, stress, and medications.

Similarly, dizziness, shortness of breath, chest pain, and sweating are the tell-tell symptoms. Medications and pacemakers can be used to cure arrhythmias. 

5. Congenital heart diseases

Congenital heart defects are the kind of (CVD’s) that are present at birth when the baby is born.

According to the Centre of Disease Control (CDC), these heart defects may constitute (mild) forms such as a small hole in the heart to severe cases including missing part or poorly formed heart.

In general, 1 out of 4 newborns with congenital heart defects are associated with severe defects and these can be life-threatening since it primarily relates to how blood flows through the heart.

5. Infective Endocarditis

According to the author Janelle Martel on (Health line Newsletter), this is a kind of heart problem that has its root on infection in the heart valves or endocardium (interior surfaces of the heart chamber).

While the usual cause of infection is bacteria, but fungi and other micro-organisms can also sometimes be the source.

Generally, the mouth, skin, intestine, respiratory system, or urinary tract becomes the gate away for the micro-organisms.

If not well attended, this can lead to stroke, damage to other organs, heart failure, or even death. 

Statistical signature of the prevalence of Cardiovascular diseases in Nepal:

As with the reports supplied by “Gangalal National Heart Centre”, Coronary Heart Disease (CHD) contributes the most number of patients (37-43%) seeking treatment for (CVD’s) in Nepal.

This is followed by rheumatic heart diseases (RHDs) (20-28%), hypertensive heart diseases (7-9%), arrhythmias (4-11%), Congenital heart diseases (4-7%) and infective endocarditis (0.5-2.5%) in descending order to account for the number for (CVD’s) cases in Nepal.

Similarly, a population-based study reveals the occurrence of rheumatic heart disease (RHD) is 1.2 per 1000 school children in the capital while 1.35 per 1000 in rural children.

While congenital heart disease accounts for the most number of cases for open-heart surgery in children followed by (RHD) in Nepal.

Conclusion

Thus, as different reports suggest, it is evident that the trend of Cardiovascular disease (CVD) is increasing in Nepal.

And the situation needs immediate attention on government level while making policies to address various ways by which to tackle this problem. 

By Clinic One Team
14/07/2020

References:

Abhinav Vaidya (2011), Tackling cardiovascular health and disease
in Nepal: epidemiology, strategies and implementation,
BMJ Heart Asia, pp-(87-91)

Mahesh Kumar Khanal et al, (2018), Prevalence and clustering of
cardiovascular disease risk factors in rural Nepalese population
aged 40–80 years, BMC Public Health, volume 18, pp-677

National Health Services (2020), Coronary Heart Disease, Newsletter

MedlinePlus (2016), Hypertensive heart disease, Arrhythmia, U.S. National Library of Medicine

Janelle Martel (2018) Infective Endocarditis, Health line Newsletter

John Hopkins Medicine, Rheumatic Heart Disease, Newsletter
Centre for Disease Control (CDC) (2019), Congenital Heart Defects, CDC Website