Decoding the causes of a heart attack when young Indians are at risk

Amit Kumar, a journalist with an international news agency, was only 29 when he survived a heart attack.

Like many others, Kumar mistook the chest pain for hyperacidity from a heavy dinner. Taking some antacids didn’t give him much relief. In fact, his family doctor did not initially examine him for a heart condition.

But he found an abnormality in his electrocardiogram (ECG) and advised him to go to the tertiary hospital immediately.

“He didn’t say anything to me, assuming I would panic. He just told me to put all my plans on hold,” Kumar said on a phone call, recalling how shocked he was five years ago.

When he reached the hospital with moderate but persistent chest pains, he was told he was having a heart attack. “It was literally a body punch. I could hardly believe what I was told. I was too young to have a heart attack, I thought.”

Kumar’s body mass index (BMI) was well in range and he had no history of diabetes, high blood pressure or other diseases.

“I smoked and ate in the hostels. But I was young and generally at that age you’re ready for anything.” He added, “I admit, life has changed and so has the lifestyle.”

After the death of the popular singer KK, the discussion about the increase in heart disease and cardiac arrest gained momentum. Previously, several other celebrities including Kannada superstar Puneeth Rajkumar, TV actor Sidharth Shukla and director Raj Kaushal have died due to cardiac arrest at a young age.

However, the trend is not limited to young celebs. In fact, ordinary people like Kumar struggle with it.

On-site medical experience

Example: At KMC Hospital, Mangalore, 150-175 angioplasties are performed every month. Angioplasty is a procedure in which a small metal mesh tube is inserted into the heart’s artery to widen the interior (of the artery) and allow blood to flow more easily (in the heart).

More than 55-60 patients fall into the category of primary angioplasty, i.e. patients who have suffered a heart attack.

“This alone demonstrates the burgeoning increase in the incidence of coronary artery disease (CAD) in our patients,” Dr. P. Kamath, Interventional Cardiologist at KMC Hospital. “Of these 60 patients, more than 40-45% are under the age of 40, again illustrating the enormous scope of the problem among adolescents.”

according to dr Deepak Krishnamurthy, Chief Interventional Cardiologist, Sakra World Hospital, Bengaluru, has a large proportion of his patients under the age of 50 who can technically be termed “young patients” due to heart conditions.

“Of all my patients, 30-40% are younger than 50 years. At least 25-30% of them are under the age of 40,” he said, adding that the youngest cardiac patient he treated for a heart attack was a 19-year-old obese boy with a history of diabetes.

“Next was a 23-year-old girl with a history of smoking. She worked in IT and was diagnosed with Triple Vessel Disease. She underwent major bypass surgery.”

And the list goes on…

What’s happening?

Coronary heart disease deaths in the Indian subcontinent have doubled since 1990 and are expected to increase by another 50% by 2030, according to a study. In fact, around 2.63 million Indians died from cardiovascular disease (CVD) in 2017. also the leading cause of death in the country.

There are many factors that contribute to the development of heart disease.

These include type 2 diabetes, insulin resistance and associated metabolic disorders, which are more common in Indian Asians than in Europeans and have been proposed as key determinants of higher risk of CHD in Indian Asians.

A new US study by researchers at Massachusetts General Hospital has found that Indians and other South Asians are twice as likely to develop heart disease as people of European descent.

The researchers compared the rate of development of cardiovascular disease, including heart attack and stroke, in people of South Asian descent versus those of European descent.

They found that 6.8% of participants of South Asian descent had cardiovascular disease, compared to 4.4% of participants of European descent.

In fact, other statistics paint too much of a picture that younger Indians are prone to heart disease.

According to the World Health Organization (WHO), India is responsible for a fifth of all noncommunicable disease (NCD)-related deaths worldwide, and most of these deaths are attributed to the younger population.

The Global Burden of Disease study found that the death rate from cardiovascular disease in India is 272 per 1,00,000, which is well above the world average of 235.

India could soon become the heart attack capital of the world

Doctors agree with the results of the studies. “Indians are genetically more predisposed to heart disease at younger ages compared to other countries around the world,” Krishnamurthy said.

“People in South Asia are likely to develop heart disease at least 10 years before their peers in other countries. While India is already the diabetic capital of the world, it could soon become the heart attack capital,” he predicts.

Heart disease is more common in men before the age of 40, Dr. Kamath. The reasons can be multifactorial, including smoking, stress, and genes. “After age 40, however, this gap narrows and the incidence is equal in postmenopausal women and men after age 50.”

according to dr Sunil Dwivedi, board-certified cardiologist at Manipal Hospitals, middle-aged people silently develop heart problems because they are unaware of what regular health checks and physical activity are. “Then they either suddenly start doing heavy physical activity or exercise to reduce weight and fitness, or they go into stressful sessions or programs.”

During such periods, the stress hormones can cause a sudden rupture of cholesterol plaques in the heart’s blood supply. Combined with the increased tendency for blood to clot, a sudden blood clot leads to a heart attack.

awareness of early detection

Early diagnosis and timely medical intervention could help to better treat the condition.

A Lancet study published in 2018 showed that the proportion of those who died from coronary artery disease with a diagnosis of pre-existing heart disease increased between 2001 and 2013. However, at least half of these people were not taking any regular medication.

It turned out that it could be the combination of poverty, ignorance and lack of access to sound medical advice that is leading to heart disease-related deaths in the country.

“We need to educate the public about the early signs of heart disease, and there should also be a focus on prevention,” said Kamath, who has run an NGO called Cardiology at Doorsteps (CAD) for the past five years, where she teaches EKG machines has given more than 700 PHCs across Karnataka.

dr Anand Kumar Pandey, chief of cardiology at Dharamshila Narayana Superspeciality Hospital in New Delhi, reiterated similar points.

He stressed that awareness of the symptoms of a heart attack or cardiac arrest should be raised so that lives can be prevented in time.

For example: Excessive sweating can be a sign of a heart attack and people need to be vigilant. “At the time of a heart attack, your heart is slowing down and it becomes difficult to circulate blood throughout the body. It actually happens when the coronary artery becomes blocked and this cuts off the supply of oxygenated blood to your heart muscle. Therefore, the body expends extra energy pumping blood and cooling itself, which makes you sweat.”

Sweating more than normal days, especially when you’re not exercising or being inactive, can be an early warning sign of heart disease.

Missing heart health concept in India

In India, the concept of a healthy heart is absent. According to health experts, very few young or middle-aged people have regular health screenings, even though they are genetically more prone to heart disease.

Also, the Indian diet lacks nutrients like vitamin D and essential fatty acids, including omega 3 and omega 6, which are essential for maintaining a healthy heart and lowering triglyceride and cholesterol levels. On the contrary, the consumption of sugar and salt is high, which is not recommended above a certain threshold.

Mere exercise and fitness alone aren’t enough to have a healthy heart, experts say. The increasing burden of career, professional life and lifestyle also plays a central role.

“We have seen that the most important risk factor in these young patients is stress,” said Dr. Avinash Singh, Cardiologist at Medanta in Lucknow. “Removing stress from our brains and bodies is one of the most important tools, among other lifestyle interventions, to prevent such life-threatening events. We should learn to protect our bodies from stress.”

Experts expressed similar views on reducing stress, aside from physical grooming.

“In addition to physical health, mental health is also of paramount importance. Celebrities go through many psychological swings, which plays a big part in their heart health,” added KMC’s Kamath.

Additionally, Manipal Hospitals’ Dwivedi added that “from the early 30s, regular physician-led health assessments should be followed, followed by a healthy lifestyle and medication.”

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