Non-traditional Environmental and Cultural Determinants of Cardiovascular Disease in India: A Narrative Review.

This literature review identifies non-traditional environmental and cultural risk factors for cardiovascular diseases (CVDs) and explores their role in predictability. Available references are primarily concentrated on traditional risk factors for CVD, leaving a gap in understanding the role of new environmental and cultural variables that contribute to the disease, particularly in low- and middle-income countries (LMICs), like India. Identifying these risk factors can help focus on primordial prevention, leading to better health outcomes, lower healthcare expenditures, and improved quality of life. Given that CVD continues to be the world's leading cause of mortality and has a disproportionate burden in LMICs, the study holds significance within the larger field of epidemiology. The comparative focus is on India, where CVD mortality rates are notably high, and the interplay of cultural practices and environmental exposures is critical. An in-depth review was conducted using selected English articles published in databases such as PubMed, Scopus, and Science Direct over a period of 15 years, from 2010 to 2024. Terms associated with environmental and cultural risk factors for CVD were added to the search strategy. MeSH (Medical Subject Headings) terms, such as myocardial infarction (MI), heat shock, and heart disease risk factors, as well as indoor air pollution, and Boolean operators, were also used to improve the search outcome. Review articles and cross-referenced articles were also considered in the review to compile all possible risk factors. Major factors discussed under environmental factors were air pollution, noise pollution, artificial light exposure, and seasonal changes, whereas the cultural factors taken into consideration were food habits, cooking oil used, habitual tobacco use, western migration, and ethnicity. The review was conducted over a period of four months, from March to June 2024, and included both global and Indian articles, as evidence from the Indian context alone was limited. After removing duplicates and excluding articles without full text or relevance to the objectives, 97 articles were included in the final review. As suggested by the evidence from the references, there is a dose-response link between environmental variables, such as noise and air pollution, and cardiovascular disorders. The level of exposure is also increased by the use of biomass fuel and indoor cooking. Exposure to artificial light primarily alters the body's circadian rhythm, leading to imbalances in CVD-related risk factors over time. Although the impact of seasonal variations is unclear, it must be investigated. According to Indian culture, our dietary practices have a detrimental effect on direct risk factors for CVD, such as diabetes and hyperlipidemia. The type and high quantity of cooking oil used, as well as reheating and deep-frying cooking patterns, have also been linked to an increased risk of atherosclerosis and adverse cardiovascular outcomes. There is a critical gap in evidence generation regarding non-traditional risk factors in India, which emphasizes the need for more longitudinal studies and risk prediction models that incorporate environmental and cultural determinants of cardiovascular risk assessment in the Indian population.