|Year : 2017 | Volume
| Issue : 4 | Page : 143
Vascular disease in Asia and India - In need of a paradigm shift
Narayana Institute of Vascular Sciences, Mazumdar Shaw Medical Centre and Narayana Hrudayalaya, Bommasandra, Bengaluru, Karnataka, India
|Date of Web Publication||31-Oct-2017|
Narayana Institute of Vascular Sciences, Mazumdar Shaw Medical Centre and Narayana Hrudayalaya, Bommasandra, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
George R. Vascular disease in Asia and India - In need of a paradigm shift. Indian J Vasc Endovasc Surg 2017;4:143
As the opening batsmen for vascular surgery in India, the senior vascular specialists in India have laid the foundations for building a long and successful innings of treating vascular disease. However, we have a long way as the next generation tries to build on this expertise.
Vascular pathology is common world over with large variations in the epidemiology of the disease. Extensive work in the field of vascular biology, pathology, and treatment, whether open repair or endovascular has been carried out in western and largely Caucasian populations.
Many of us in India have largely learnt our surgical craft from the experience of treating disease in a different population. It is not uncommon to find Indian vascular and endovascular specialists commenting on the different challenges in treating vascular pathology in India.
A case in point is aortic pathology. The Caucasian population is affected largely by occlusive and aneurysmal disease. The pattern of disease in Asia as a whole appears to be different with a further difference seen between the Indian subcontinent and the rest of Asia. It is of interest to note the widespread prevalence of throracic aortic disease, especially dissection in southeast and far east Asia. It certainly appears to be more common than what is seen in western populations. The proportion of infrarenal aneurysmal disease to thoracic aneurismal disease also appears to be significantly different. Aortoarteritis is a problem that exists to a significant degree in Asian populations but is uncommon in the west. Similarly, we also see a high incidence of aortic occlusive disease at a young age.
The Indian subcontinent that is home to more than sixth of the world's population appears to have an entirely different disease pattern. Aneurysmal disease certainly appears to be treated less commonly in India than in the western world. Whether this is a consequence of inadequate awareness, failure to diagnose or a difference in biology and etiology is yet unknown. The influence of the difference in genetics, environmental factors, such as diet, smoking, and hypertension and exposure to various kinds of infections, is just some of the unknowns. It is quite likely that multiple factors are at play.
Given that this population group constitutes more than half the global population there is an urgent need to better define the vascular system, its disease profile and requirements for this population subgroup.
It is essential that we try to answer some basic questions of epidemiology, anatomy, biology, incidence, prevalence, and pattern of disease to adequately prepare for an epidemic of vascular disease that we will likely face as our population ages. Diseases such as Buergers and Takayasus still remain orphan diseases in terms of research and advancement of knowledge.
It is imperative that we recognize, identify, and study the significantly different spectrum of vascular disease that we encounter in the subcontinent and the find answers to these questions and arrive at Indian solutions to Indian problems. It is a challenge that we must rise to.
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Conflicts of interest
There are no conflicts of interest.