International Perspectives on Cardiovascular Research
Cardiovascular research in India: A perspective

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With cardiovascular disease (CVD) emerging as a major cause of mortality in India, clinical research in CVD is becoming increasingly important. There are several favorable factors that offer robust growth of clinical research infrastructure in India: well-established system of governance, a large investment in medical education infrastructure, growing interest in building capacity in clinical research, the presence of regulatory mechanisms governing clinical research, a large pharmaceutical industry, and a highly developed information technology and data processing infrastructure. However, the lack of trained research manpower, inadequate public spending on health, uneven distribution of health infrastructure, and the large prevalence of pretransitional diseases are major weakness in undertaking high-quality clinical research in CVD. Analysis of the contemporary scenario reveals that there are 3 important opportunities for clinical research in India: the need to identify low cost but cutting edge and context-specific interventions to address the health needs of India's large population, the potential for high-quality research, and the high degree of interest (domestically and internationally) in investing in clinical research education and infrastructure.

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CVD in India: the scenario

Cardiovascular disease has reached epidemic proportions in India and is estimated to result in more than 3 million deaths each year.4, 5, 6 Although CVD burden is high among Indian urban residents, in certain regions even in rural populations, CVD has emerged as the leading cause of death.7 Estimates from the World Health Organization (WHO) show that by 2030, CVD will be the main cause of death throughout India as a whole, accounting for more than 35% of mortality cases. Compared with Western

Strengths

The potential strengths of clinical research in India include (1) a well-established system of governance, (2) a large investment in medical education infrastructure, (3) a growing interest for building capacity in clinical research, (4) the presence of regulatory mechanisms governing clinical research, (5) a large pharmaceutical industry, and (6) a highly developed information technology (IT) and data processing infrastructure.

Opportunities and threats to clinical research in CVDs

The 3 most important opportunities for clinical research in India are (1) the country's large population and its health needs, (2) the potential for high-quality research, and (3) the high degree of interest (both domestic and international) in investing in research.

With an estimated 1.123 billion citizens as of 2007, India is the second most populous country in the world, accounting for one sixth of the global population and growing at a rate of 1.4% annually.34 Despite enormous achievements

Threats

The several threats to the emerging clinical research enterprise in India are largely related to issues of governance and the balance of commercial interests of commercial research organizations (CRO) and the need for an independent voice of practitioners and academics representing the public health and the well-being of individual research participants. Chief among these concerns is the relatively low level of education among many Indian patients, which threatens to compromise the informed

What is the future?

Clinical research in cardiovascular health is critical to addressing the complex array of social, financial, behavioral, and organizational barriers to high-quality CVD care that the population of India currently faces. Thus, there is a clear need to design and conduct research studies that are context-specific and socially relevant. We have argued earlier that through careful planning and shared partnership among sponsors, host-country research practitioners, government agencies, and the

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