title: Fatal and nonfatal cardiovascular disease and the use of therapies for secondary prevention in a rural region of India.
abstract: BACKGROUND
  The rate of cardiovascular disease is widely considered to be increasing throughout India. Precise and reliable data on fatal and nonfatal cardiovascular disease, however, are few, and little is known about the use of preventive therapies. This is particularly true for rural regions.
  
  
  RESULTS
  Data were collected from 53 villages in the Godavari region of Andhra Pradesh. Mortality data were obtained from a verbal autopsy-based mortality surveillance system during a 12-month period in 2003 to 2004. The prevalence of nonfatal cardiovascular disease and the use of preventive therapies were estimated from a stratified random sample of 4535 adults (> or =30 years of age) in 2005. Cardiovascular disease was the leading cause of mortality, accounting for at least 32% of all deaths. The average age at cardiovascular death was 65 years, and 51% of all cardiovascular deaths occurred in patients <70 years of age. Among adults, the prevalence of coronary heart disease was estimated to be 4.8% (95% CI, 4.1 to 5.5), and the prevalence of cerebrovascular disease was estimated at 2.0% (95% CI, 1.5 to 2.4). Among individuals with either diagnosis, 14% (95% CI, 10 to 18) reported taking aspirin, 41% (95% CI, 36 to 47) took a blood pressure-lowering medication, and 5% (95% CI, 3 to 7) reported using a cholesterol-lowering medication.
  
  
  CONCLUSIONS
  This region has a large disease burden attributable to cardiovascular disease with significant underuse of proven, low-cost preventive medications.
authors.affiliation: The George Institute for International Health, Lecturer, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. rjoshi@thegeorgeinstitute.org
authors.forename: Rohina
authors.initials: R
authors.lastname: Joshi
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.forename: P Krishnam
authors.initials: PK
authors.lastname: Raju
authors.forename: Rama
authors.initials: R
authors.lastname: Raju
authors.forename: K Srinath
authors.initials: KS
authors.lastname: Reddy
authors.forename: Stephen
authors.initials: S
authors.lastname: Macmahon
authors.forename: Alan D
authors.initials: AD
authors.lastname: Lopez
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal