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February 2012
Urbanisation and Cardiac Risks
Dr Kanwal Kishore Kapur & Dr Satyanarayana Upadhyayula
 
People tend to move from small villages and towns to large cities for social, economic, educational, vocational and cultural reasons, which in turn are influenced, by modernization, industrialization and sociological rationalisation.

Noticeable societal and environmental changes associated with urbanization have led to an increase in heart attacks. The biggest factor in this case is the lifestyle led in urban areas.

Urban Evils
  • Low physical activity
  • High levels of active as well as passive smoking
  • Increased intake of fat laden foods
  • High stress jobs/life

The rural lifestyle is a lot healthier with lower levels of stress, less smoking and healthier food intake, but most government policies affecting the life of the general populace are industry driven rather than health driven.

The transition from diseases from nutritional deficiencies and infections leading to chronic disease such as heart diseases is a global problem. There is no cut off basis on which the risks of heart attack can be determined.

The risks are widespread and some of the most common factors are:
  • High tobacco consumption
  • High levels of LDL (low-density lipoprotein); the bad cholesterol
  • Low levels of HDL (high-density lipoprotein); the good cholesterol
  • High blood pressure
  • High blood glucose levels
  • Lowered physical activity
  • Obesity
  • Improper/deficient diet
Disease indicators
  • Low socio-economic status
  • High levels of fibrinogen
  • High levels of homocysteine
  • High levels of lipoprotein
  • Psychological factors such as depression, anger or stress
  • A breakdown in social structure such as loss of social support
  • Cultural changes
  • Genetic factors

The variations in heart attack ratesdiffer in various parts of the world. For e.g. a Ni-Hon-San study revealed how the blood cholesterol levels and heart attack rates increased among Japanese migrants as they shifted from Japan to Honolulu and then to San Francisco, with the highest level being in San Francisco.

The variations of heart attack rates in different parts of the world can be attributed to:
  • Urbanization
  • Social structure
  • Cultural setup
  • Environmental differences
  • Economic affluence
Effective implementation of preventive strategies both at community-levels and individual-levels, customised according to country, community, and socioeconomic level can decrease or even reverse the heart disease epidemic.


    
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