Clamping down on tobacco use, with measures such as tripling taxes on cigarettes and bidis, could cut by a quarter the deaths from heart disease and stroke that occur in India over the next decade, according to a modelling study just published in PLOS Medicine.

Over nine million lives could be saved between 2013 and 2022 by vigorously implementing tobacco control policies in this country, say Sanjay Basu of Stanford University in the U.S. and his colleagues in their paper.

The burden of cardiovascular disease (CVD) has been rapidly rising in low- and middle-income countries, they pointed out. Over three-quarters of all deaths worldwide from heart disease and stroke already occur in these countries. Moreover, India was expected to contribute more than any other nation to the growth in such deaths during the current decade.

Dr. Basu and his fellow researchers used a mathematical model to examine what impact tobacco control measures and drug therapies could have on reducing deaths from heart attack and stroke in India. The model took into account not just different forms of tobacco use but also other risk factors that affect CVD such as high blood pressure, high cholesterol levels and diabetes.

The model simulated the effect of five control measures specified in the World Health Organisation Framework Convention on Tobacco Control (FCTC). One such measure was greater taxation. The WHO recommends that at least 70 per cent of the price of a tobacco product be made up by tax, which would require an approximate 300 per cent increase in the tax rate on cigarettes in India, the researchers noted.

Their model simulation indicated that a 300 per cent increase in both cigarette and bidi tax rates could by itself avert about three million deaths from heart attack and stroke over the next decade. Combining increased taxes with other control measures such as smoke-free legislation, advice from medical professionals to stop smoking, mass media campaigns and an advertising ban would greatly boost the lives saved.

“Our findings indicate that full implementation of key FCTC articles in India would yield substantial reductions in mortality from myocardial infarctions and stroke, despite projected increases in other risk factors for CVD such as hypertension and diabetes,” observed Dr. Basu and his colleagues.

Combining strong tobacco control policies with drug interventions that provided access to aspirin and medication to control blood pressure and cholesterol could prevent a third of all predicted deaths from heart attack and stroke between 2013 and 2022.

“Effective implementation of FCTC provisions remains a major challenge in India,” they pointed out. Smoke-free legislation was not comprehensive and was poorly enforced. Cessation advice given by health providers had to be strengthened and tobacco taxes in the country needed to be substantially increased.

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