Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject: Perception evaluation for managing Cardiovascular risk, dyslipidemia and clinical inertia study (ROSULEAD CA)

Cardiovascular diseases (CVD) are the leading cause of death and disability in the world. Global death counts due to CVD increased from 12.4 million in 1990 to 19.8 million in 2022 reflecting global population growth and aging and the contributions from preventable metabolic, environmental, and behavioral risks. It was responsible for 31.8% of all deaths and 14.7% of Disability Adjusted Life Years (DALYs) globally in the year 2017. According to the findings of the Global Burden of Disease study group, globally, there were an estimated 422 million prevalent cases of CVD in 2015, the largest contributor being the South Asian region. As of the year 2017, CVD was responsible for 26.6% (25.3%–27.4%) of total deaths and 13.6% (12.5%– 14.6%) of total DALYs in India, compared with 15.2% (13.7–16.2) and 6.9% (6.3–7.4), respectively, in 1990.

In accordance with the World Health Organization, India accounts for one-fifth of these deaths worldwide especially in younger population. The results of Global Burden of Disease study state age-standardized CVD death rate of 272 per 100000 population in India which is much higher than that of global average of 235. CVDs strike Indians a decade earlier than the western population. The direct as well as indirect effects of an improving economy and rapid urbanization have led to an increase in risk factors associated with CVDs including high blood pressure (BP), obesity, diabetes mellitus, dyslipidemia, decreased physical activity, stress, substance abuse and novel risk factors such as air pollution.

Serial epidemiological studies in India suggest a rapid rise in the mean levels of total cholesterol, low-density lipoprotein cholesterol, non–high-density lipoprotein cholesterol, and triglycerides. In the ICMR-INDIAB study, a large proportion of people had at least 1 lipid abnormality; only 20% had all lipid parameters (total cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol) within the normal range.

Despite overwhelming evidence, however, a large majority of eligible patients do not receive appropriate care for cardiovascular risk factors. In tertiary hospitals, the combination of 4 evidence-based medicines (aspirin, β-blocker, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins) was prescribed only to 54% of eligible patients with coronary heart disease, whereas the rates were despairingly low in secondary (28%) and primary care (7%) clinics. The PURE study, which involved 5650 self-reported IHD and 2292 stroke participants, observed noticeable underuse of proven therapies for IHD in low-income countries (83% of the low-income country participants in the study were from India). As many as 80% of the participants with CVD were not on any of the 4 evidence-based secondary prevention drugs (aspirin, β-blocker, angiotensin-converting enzyme inhibitors, and statins) in the low-income countries, in comparison with 11% of participants in high-income countries. In a cross-sectional study in India it was observed that awareness, treatment, and control, respectively, of hypertension were 79.9%, 48.7%, and 40.7% and those of hypercholesterolemia were 61.0%, 19.1%, and 45.9%, respectively.

The purpose of this survey is to understand the current perceptions on managing CV risk factors, dyslipidemia and perceptions driving clinical inertia and also help to address the current need gaps to look at potential interventions at patient level.

If you agree to participate, you will need to provide assessment response, on to the standard questionnaire form. A link will be provided for the same on your registered email address.

We trust you and we are partners in safe and effective drug therapy. In that spirit we hope you will consent to participate in this survey.

If you agree to participate in the said study, we would request you to sign and return the enclosed reply along with your visiting card for accuracy of records.