Needs scrutiny: Editorial on rising heart disease risk among India’s affluent

A study published in the American Journal of Preventive Medicine, involving 65,364 Indians aged 45 and above, has found that sustained socioeconomic advantage is associated with higher odds of heart failure and heart attack than persistent economic disadvantage. The finding demands scrutiny of the relationship between prosperity and health. Sedentary lifestyles, abdominal obesity and unhealthy diets — the traits among the affluent? — explain why greater purchasing power can accompany higher cardiovascular risk. But the study, based on survey data from 2017-18, only establishes association. Factors such as access to diagnosis and affordable treatment can influence differences in survival. Affluent patients have greater access to investigations to screen for cardiovascular as well as other lifestyle diseases and also to get continual treatment; poorer patients often remain undiagnosed or die prematurely. Lower recorded disease prevalence among disadvantaged groups, therefore, offers little justification for complacency. For instance, an analysis of national survey data from 2019-21 shows that just 8.5% of Indians had the means to treat their blood pressure.

The expenditure associated with cardiovascular illnesses can also be prohibitive. A study published in 2026, covering 1,859 heart-failure patients across 21 hospitals, reported average annual out-of-pocket spending of Rs 1,06,566; for 37.7% of households, this was a catastrophic health expenditure. These findings demand financial protection being extended to outpatient medicines, investigations and follow-up care. Moreover, the conditions in which cardiovascular illnesses develop must also be considered. Air pollution accounted for about 31.1% of India’s cardiovascular burden from 1990-2016. Air pollution affects the poor more than the rich, as do adverse temperatures and polluting cooking fuels. Advice about diet and exercise is inadequate while affordable nutritious food, clean air and safe public spaces remain inaccessible. Public policy must integrate reliable primary care with emissions control, clean cooking, healthier food environments and protection from hazardous temperatures. Treating heart disease principally as a consequence of socio-economic status may lead to the exclusion of failures in healthcare financing and environmental regulation. The appropriate response should be prevention across income groups, with greater protection for those least able to secure treatment or absorb its costs.