Psychosocial stress is an important risk factor for cardiovascular disease and adversely affects the prognosis of patients with established heart disease. According to WHO, chronic stress is rapidly rising globally, and by 2030, it is expected to be the leading cause of disease burden, eclipsing even cardiovascular diseases (CVD). However, psychosocial stress has not received adequate attention as other conventional risk factors such as
hypertension, obesity, smoking, etc.
Recently, a scientific statement from American Heart Association after reviewing 53 individual studies and four meta-analysis has concluded that there is a consistent association between depression and adverse cardiac events after ACS. They recommended that depression should be considered as a major risk factor for adverse cardiovascular events in patients with ACS. In this issue of the journal, there is an extensive review of treating
stress, depression, and anxiety in patients with CVD to improve health outcomes. This article outlines the magnitude of the problem, diagnostic features, and adverse outcomes of psychosocial stresses in cardiac patients and modalities of treatment. It covers not only the psychological and pharmaceutical management but also emphasizes a lot on mind–body medicine techniques such as meditation. Yoga meditation, which originated in India, may be a simple cost-effective technique to control stress and also has been shown to
improve cardiovascular health especially in Indians.
Another article in this issue discusses escalating risk for cardiovascular disease in rural Indian adolescents. Risk factors in rural Indians have recently been increasing, but have not been adequately studied. This article demonstrates that rural adolescents also have significant risk factors, which should be addressed to control the cardiovascular epidemic, especially in India where a large population resides in rural areas and it appears that
rural–urban gap is narrowing.
Another article is on prevalence of prehypertension and hypertension in pregnant women in Punjab, which emphasizes the need for early detection and monitoring of blood pressure in pregnant females because a significant number have prehypertension.
In the Profiles in Preventive Cardiology section, bio data of Sir Michael Gideon Marmot, Professor of Epidemiology and Public Health at University College of London, has been presented. Sir Marmot has done outstanding work on social determinants of health. His landmark White Hall 2 studies in British civil servants suggested that psychological distress is an important independent risk factor for coronary heart disease, thus
re-emphasizing that stress is an important determinant for cardiovascular health.
Because statins have been found to be extremely useful for primary and secondary prevention of cardiovascular disease, we have decided to start a new section on statin update. The recent landmark HOPE-3 trial, which showed benefit of statins in intermediate risk patients, has been summarized in this section.
I hope this issue will be of immense use to the practicing physicians.
Dr. S. C. Manchanda
Senior Consultant Cardiologist
Sir Ganga Ram Hospital, New Delhi, India