Investigating Heart Disease:
The burden, costs, and early risk

The share of patients in each of the five non-communicable disease (NCD) groups, by quarter from 2023-Q1 to 2025-Q4. Each quarter's shares are taken from the running total of unique patients in each group since 2023-Q1.

Key insight: Heart disease consistently accounts for ~46% of all chronic NCD patients — nearly double the next largest category (cancer at 24%). This share has remained stable across 3 years.

The 14 condition groups in the edition's heart-related claims, sized on the page by share of claims, with the figures the chart's side panel gives for each: share of claims, median age, the share that required ICU care, and the cost of routine and of ICU treatment.

Sub-conditions, shown when a group is opened (21 sub-conditions in 7 groups):

What each condition group is, with the risk factors and key biomarkers the chart lists for it:

• Ischemic Heart Disease: Reduced blood flow to the heart due to blocked or narrowed coronary arteries from atherosclerotic plaque buildup. This is what most people mean by 'heart disease.' Risk factors: Smoking, Diabetes, High BP, High LDL, Obesity, Family history. Key biomarkers: Troponin-I/T, LDL-C >100 mg/dL, HbA1c >6.5%, hsCRP, Lp(a), ApoB. • Stroke (Cerebrovascular Disease): Brain attack from disrupted blood supply. Second leading cause of death globally, top cause of adult disability. Risk factors: High BP (strongest), Atrial fibrillation, Diabetes, Smoking, High cholesterol. Key biomarkers: BP >140/90, INR, HbA1c, Lipid panel, D-dimer, Carotid IMT. • Hypertensive Diseases: Chronic high blood pressure causing heart strain and organ damage. 'Silent killer' — often no symptoms until damage occurs. Risk factors: High sodium, Obesity, Inactivity, Alcohol, Stress, Family history. Key biomarkers: BP ≥130/80, Serum creatinine, Microalbuminuria, Potassium, ECG for LVH. • Venous Disease: Disorders of veins including blood clots (DVT) and valve dysfunction (varicose veins). Often affects leg veins. Risk factors: Prolonged sitting/standing, Obesity, Pregnancy, Oral contraceptives, Surgery. Key biomarkers: D-dimer, Venous duplex ultrasound, CEAP classification. • Other CVD: Other cardiovascular conditions including non-rheumatic valve disease, endocarditis, lymphatic disorders. Risk factors: Varies by condition. Key biomarkers: Varies by condition. • Arrhythmias: Abnormal heart rhythms — too fast, too slow, or irregular electrical activity. Risk factors: Age, Hypertension, Heart disease, Thyroid disorders, Alcohol, Sleep apnea. Key biomarkers: ECG/Holter monitor, TSH, Electrolytes (K+, Mg2+), BNP, Echocardiogram. • Heart Failure: Heart cannot pump enough blood to meet body's needs. Usually results from damage by IHD, hypertension, or valve disease. Risk factors: Prior MI, Hypertension, Diabetes, Obesity, Valve disease, Alcohol abuse. Key biomarkers: BNP/NT-proBNP, EF <40% (HFrEF), Troponin, Creatinine, Chest X-ray. • Aortic Aneurysm & Dissection: Abnormal dilation/bulging of the aorta or tearing of its wall layers. Life-threatening if ruptures. Risk factors: Hypertension, Atherosclerosis, Smoking, Connective tissue disorders, Age >60. Key biomarkers: CT/MRI angiography, Surveillance imaging, D-dimer. • Arterial Disease (PAD): Atherosclerosis affecting arteries outside the heart — primarily legs (PAD) and other peripheral vessels. Risk factors: Smoking (strongest), Diabetes, Hypertension, High cholesterol, Age >50. Key biomarkers: ABI <0.9, CT angiography, LDL-C, HbA1c, Homocysteine. • Conduction Disorders: Electrical system problems causing slow heartbeat or blocked signals. Often requires pacemaker. Risk factors: Age, Prior MI, Cardiac surgery, Lyme disease. Key biomarkers: ECG (AV block, BBB), Electrophysiology study, Lyme serology. • Cardiomyopathy: Primary heart muscle disease. Heart becomes enlarged, thick, or rigid. Risk factors: Genetic mutations, Viral infections, Alcohol abuse, Pregnancy, Chemotherapy. Key biomarkers: BNP, Troponin, Echocardiogram, Cardiac MRI, Genetic testing. • Rheumatic Heart Disease: Valve damage from untreated strep throat (rheumatic fever). Preventable but still affects young populations in developing countries. Risk factors: History of rheumatic fever, Poverty, Overcrowding, Limited healthcare. Key biomarkers: ASO titer, Anti-DNase B, ESR, CRP, Echocardiogram. • Pulmonary Heart Disease: Right heart failure caused by lung disease or pulmonary hypertension. Risk factors: COPD, Pulmonary embolism, Sleep apnea, High altitude, Pulmonary fibrosis. Key biomarkers: BNP, D-dimer, ABG, Chest CT, Echocardiogram. • Cardiac Arrest: Sudden loss of heart function. Medical emergency with high mortality if not treated immediately. Risk factors: Prior MI, Coronary artery disease, Cardiomyopathy, Arrhythmias, Drug overdose. Key biomarkers: Troponin, ABG, Lactate, Potassium, Toxicology screen.

Reference: GBD 2019 Diseases and Injuries Collaborators. The Lancet, 2020.

For each heart condition, the percentage of its claims that fall in each age band.

For each condition these age-band percentages add up to less than 100%, from 42.9% (Ischemic Heart Disease) to 88.2% (Heart Failure); the edition does not show where the rest of the claims fall.

Chart summary, as shown on the page: peak age range 51-70; average share of a condition's claims at ages 51-70: 33.9%; highest cell: Heart Failure at 61-70, 33%; early onset (more than 5% of a condition's claims at ages 21-30 or 31-40): 6 conditions.

Key insight: Heart disease is becoming a young person's disease. The 31-40 age band shows significant incidence across nearly all cardiovascular conditions — with some conditions like pulmonary heart disease and venous disorders hitting hardest in the 30s.

The odds ratio of each condition in men compared with women, adjusted for the baseline gender skew in claims, with its 95% confidence interval. An odds ratio above 1.0 means the condition is more common in men and below 1.0 more common in women; if the confidence interval crosses 1.0, the difference is not statistically significant.

The two age columns are the ages the chart prints beside each row for women and for men.

Key insight: Only Ischemic Heart Disease is statistically male-predominant (OR 1.58). Hypertensive Diseases, Arrhythmias, and Heart Failure all skew female after controlling for baseline gender distribution. Most other conditions show no significant gender difference.

Heart disease hospitalisations are classified into four severity levels based on clinical complexity, interventions required, and resource utilisation.

TIL stands for Treatment Intensity Level. LOS is length of stay in days; P85 is the 85th percentile of cost; PCI is percutaneous coronary intervention (angioplasty).

Key findings:

• 8% of cases are Severe or Critical, but consume disproportionate resources • Critical hospitalisations cost 11× more and last 4× longer • 13+ years of savings can be wiped out by a critical cardiac event

Years of household savings that one heart-related hospitalisation would use up, by severity level: the median, with the interquartile range. The chart notes that this is based on average Indian household savings rates.

The cost of one heart-related hospitalisation by severity level: median, interquartile range, and the lowest and highest cost.

Length of hospital stay by severity level. On the page, the violin shapes are drawn from these summary values.

The overall median cost per claim for each condition, and the range in which the middle 50% of costs fall (25th to 75th percentile) at each treatment intensity level: TIL 1 is routine care, TIL 2 procedures, TIL 3 surgery and TIL 4 ICU care with complex surgery.

IHD is ischemic heart disease. For Venous Disease TIL 3, Venous Disease TIL 4, Arterial Disease TIL 4, Arrhythmias TIL 4 and Heart Failure TIL 4, the source data gives the lowest and highest cost instead of the 25th to 75th percentile. Rheumatic Heart TIL 4 is a single claim, shown as ₹9.6L+.

Key insight: Treatment costs vary dramatically by condition and intensity. TIL 4 cases can cost 10× more than TIL 1 cases.

How far each claim's cost sits above or below the median cost for its condition group. Deviation from median (%) is the claim's cost minus the median, divided by the median. The chart plots individual claims as dots; this table gives the statistics the chart shows for each condition filter, not the individual claims.

The All CVD statistics cover all 8,941 claims, including Other Heart Disease (145 claims) and Other Circulatory (88 claims), which have no filter of their own and are not plotted in the All CVD view. The All CVD median is the median of all 8,941 claims, while its shares above 2× and 5× compare each claim with the median for its own condition group.

Key insight: 34% of all CVD claims cost more than 2× the median, revealing a substantial long-tail of high-cost treatments.

How the people in the health checkup data are spread across risk levels for five biomarkers, one for each risk domain, with the cardiovascular risk the chart gives for each level.

Atherogenic Risk (Non-HDL Cholesterol). 24% have high atherogenic burden, placing them at 2-3× higher risk for heart attack and stroke. Atherogenic particles are lipoproteins that penetrate the arterial wall and initiate plaque formation. The more particles, the higher the risk of Coronary Artery Disease (blocked heart arteries), Heart Attack (Myocardial Infarction), Ischemic Stroke (blocked brain arteries), and Peripheral Artery Disease (blocked leg arteries).

Protective Function (HDL Cholesterol). 61% have suboptimal HDL levels, reduced ability to clear cholesterol from arterial walls. HDL particles perform 'reverse cholesterol transport' — they remove cholesterol from arterial plaques and transport it back to the liver for disposal. Low protective function means reduced plaque clearance, accelerated atherosclerosis progression, and higher risk of cardiovascular events even when "bad" cholesterol is controlled.

Lipid Balance (ApoB/ApoA1 Ratio). 80% have unfavorable ApoB/ApoA1 ratio, indicating net cholesterol deposition in arterial walls. ApoB/ApoA1 Ratio measures the balance between atherogenic particles (ApoB) and protective particles (ApoA1). Instead of looking at 'bad' and 'good' cholesterol separately, the ratio tells you whether you're net depositing (atherogenic) or net clearing (protective) cholesterol from arteries. The INTERHEART study found ApoB/ApoA1 ratio to be the strongest lipid predictor of heart attack, superior to LDL, HDL, or total cholesterol. Reference: https://pubmed.ncbi.nlm.nih.gov/18640459/

Inflammation (hs-CRP). 73% show elevated inflammatory markers, among patients with suboptimal metabolic health. Chronic low-grade inflammation is now recognized as a key driver of atherosclerosis. Inflammation damages the arterial endothelium (inner lining), promotes plaque formation and instability, and increases risk of plaque rupture. The landmark JUPITER and CANTOS trials proved that reducing inflammation (even without lowering cholesterol) reduces cardiovascular events. C-Reactive Protein (CRP) is a protein produced by the liver in response to inflammation. hs-CRP detects low-level chronic inflammation that standard CRP tests miss. The AHA and CDC classify hs-CRP as a marker for CVD risk stratification as elevated levels doubles CVD risk, independent of cholesterol. Note: Data filtered to patients with High LDL OR Low HDL OR Elevated HbA1c.

Metabolic Health (HbA1c). 21% are pre-diabetic or diabetic, each 1% increase in HbA1c associated with ~15% increased CVD risk. The metabolic-diabetic spectrum represents a progressive continuum of insulin resistance that accelerates cardiovascular damage. Elevated triglycerides lead to the formation of small, dense LDL (more atherogenic). High glucose levels cause direct endothelial damage, resulting in easier plaque deposition. Insulin resistance translates to chronic low-grade inflammation, and advanced glycation leads to arterial stiffening and dysfunction. Each 1% increase in HbA1c is associated with ~15% increased CVD risk.

For five biomarker domains, the share of people tested in each age band who are at high risk (high or very high, shown in red) and who are at suboptimal or worse levels (yellow and red). The chart shows one domain at a time.

What the chart says for each domain:

• Atherogenic (Non-HDL Cholesterol): Atherogenic damage accelerates in your 30s. Risk nearly doubles from 18% to 31% between 20s and 30s, then plateaus. • Protective (HDL Cholesterol): Low HDL is everyone's problem — not age-related. 38-43% have very low HDL across all ages. This is a population-wide issue. • Lipid Balance (ApoB/ApoA1 Ratio): Lipid imbalance starts in your 20s. 55% of 21-30 year olds already have unfavorable ratios — the strongest predictor of heart attack. • Inflammation (hs-CRP): Chronic inflammation builds over decades. Suboptimal levels climb from 66% to 79% between 20s and 50s. • Metabolic (HbA1c): Diabetes risk climbs steeply with age. High-risk jumps from 2% (20s) to 47% (60s+). Classic late-onset pattern.

The share of men and of women at high or very high risk in each risk domain, the chart's default view. The chart marks a gender as meaningfully higher when the gap is more than 5 percentage points.

Key insight: Men accumulate atherogenic cholesterol faster (29% vs 15%), while women struggle more with protective HDL (52% vs 33% at risk) and inflammation markers.

Key findings:

• 29% of men have elevated Non-HDL cholesterol vs only 15% of women — nearly double the rate. • Women struggle more with protective HDL: 52% fall below thresholds vs 33% of men. • Women show higher inflammation: 13% have elevated hs-CRP vs 8% of men.

The share of men and of women at suboptimal or worse levels in each risk domain, the chart's second view. The chart marks a gender as meaningfully higher when the gap is more than 5 percentage points.

Key insight: At suboptimal levels, 61% of men show concerning Non-HDL cholesterol vs 42% of women. The protective HDL deficit in women persists (68% vs 57%).

Key findings:

• 61% of men have suboptimal Non-HDL levels vs 42% of women — a major gender gap. • 68% of women have suboptimal HDL levels vs 57% of men, confirming the protective deficit pattern. • Most of the population (79-82%) shows unfavorable ApoB/ApoA1 ratios regardless of gender.

For each risk domain, the age at which at least half of the people tested show suboptimal levels (risk onset), the median age of a heart-related hospitalisation in the claims, and the years between the two (the prevention window).

Note: Inflammation filtered to patients with suboptimal lipid OR metabolic markers. Risk onset = first age where ≥50% of cohort shows suboptimal biomarkers.

Key insight: Lipid and inflammation risk appears by early 20s. Metabolic risk surfaces in 40s. All converge at hospitalization around age 59.