Heart attack in Indians

Heart attack in Indians — an emerging epidemic

Causes & Prevention

Introduction : Cardiovascular diseases are the commonest cause of death globally. During last 20 years a large decline in mortality from CVD has been in observed in developed nation but a substantial increase has been experienced by developing nation like ours. It is estimated  that India has largest burden of Cardio Vascular Disease in the world more so in younger population. Approximately 14-16 lakh people die every year because of cardiovascular diseases in our country. It is projected that if not controlled now, it will increase in an epidemic form by 2015. The increasing evidence of heart attacks in younger population resulting is increase cost of evaluation and treatment (PTCA & Bypass surgery) & loss of working days – will affect the family, society & nation as a whole. In other words medical, and economic consequences will be substantial for our country. An understanding of the risk factors causing premature CVD will be essential to develop strategies for prevention of Heart attacks & its epidemic in future.

Is CVD different in our population? : It affects individual on an average 10 years earlier & incidence is 2-4 fold more than other ethnic groups. Coronary Artery Disease (CAD) in Indians is found to be extensive, rapidly progressive and carries high mortality.

 Why are we getting more Heart attacks?

1.         Increase in risk factors like high blood pressure, Diabetic mellitus, obesity & metabolic syndrome has been observed in our country during last few years.

2.            Life span of individual is increased due to better control of infections and nutritional diseases, resulting in increased exposure to risk factors (HT, DM)

3.            Rapid urbanization and industrialization leads to affluence and adoption of unhealthy life style such as smoking & tobacco consumption, excessive intake of alcohol, sedentary habits, increase intake of saturated fats (dairy products, junk & fast food etc.) & increase in psycho social stress (due to lack of social security, loss of joint family system, lack of religious affiliation & occupational stress etc).

4.             Genetic predisposition may be playing an important role along with environmental factors. There is an increase in incidence of Metabolic Syndromes in our population.

5.            Metabolic Syndrome : Is the most important cause of  premature CVD in our country. This includes cluster of risk factors like truncal obesity (potbelly – or apple shape obesity) along with  Insulin resistance, Lipid abnormality, high blood pressure, impaired glucose tolerance, & increased clotting factors. Patient with metabolic syndrome are more poor for Cardiovascular disease and Diabetes.

To diagnose metabolic syndrome central obesity (Waist circumference > 36” for men >32” for women) & 2 of the 4 following criteria should be there.

(1)      BP - >130/85

(2)      Fasting Blood sugar >100mg/dl

(3)      Triglycerides >150 mg/dl

(4)      HDL- cholesterol <40mg/dl

Rising incidence of Metabolic Syndrome in our population (1.5—2 times more than other ethnic population) is probably because of genetic predisposition along with sedentary habits (lack of exercise) and increased consumption of saturated fats particularly dairy products.

How to prevent Heart diseases?

Population based societal changes aiming at lowering the risk factors through life style modification will be a key factor. This approach is simple, affordable and effective but population needs to be educated by health care providers.

a)            Exercises – Regular moderate intensity aerobic (isotonic) exercise like brisk walking, Cycling, Jogging, Swimming for 4-5 days a week helps in reducing heart attacks by 30%. It reduces BP, weight & controls Diabetes & Lipids. We should encourage children to play outdoor games rather than spending time in front of the TV & Computers. Occupational exercise and less dependency on servants is recommended.

b)            Healthy diet – Clinical research has shown that two to three servings of fruits and vegetables everyday reduce heart attack by 30%. Less consumption of saturated fats (animal products & plant products like – coconut oil) and diet rich in cholesterol (Dairy products, eggs & meats etc.) will reduce the average cholesterol level of population. One should avoid transfatty acids  (partially hydrogenated vegetable fats) used in fast food center, cookies, chips etc. – as they are more dangerous than saturated fats (they increase bad cholesterol — LDL-cholesterol and decrease good cholesterol — HDL-cholesterol.) One should avoid overheating & reuse of cooking oil. Olive oil, mustard, soyabean, sunflower & kardi oil are good.

In spite of majority of our population being vegetarian, we are having highest burden of cardiovascular diseases in the world. We should change myth in society that milk & milk products are essential for human beings and are complete food. Ideally one should use a small quantity of low fat dairy products. (in fact no mammal drinks others milk except human beings!) Milk is high in cholesterol, animal proteins (can cause allergic diseases) and lactose (intolerance cause for abdominal diseases). One should substitute milk with Soya products which are rich in vegetable proteins, and have less fat, no cholesterol, and rich in calcium & minerals. There are many good alternative source of calcium other than  milk, like green vegetables, Soya, nuts, fruits etc. Another myth in society is that NUTS are rich in cholesterol. In fact in my view nuts are best & complete food for normal person as they contain vegetable protein, fat, carbohydrates, minerals, vitamins, iron, calcium, fibre with no cholesterol. They contain mainly mono unsaturated fatty acids & very less saturated fats.

c)            Stop using Tobacco products – Smoking is the single most preventable cause of heart attack and many other diseases like COPD (lung disease), cancers, stroke & sudden death. Government has to play an important role to ban smoking, impose more taxes, prevent media publicity and promote anti smoking measures.

d)            Reduction of Psychosocial stress- Meditation, various types of yoga exercise and prayers will help in reducing stress level. We should follow the good moral values of our traditional culture. One should try to reduce gap between “desire and need” – a key to happiness. Government should pay attention to provide social security to every individual.

            Since blockage of arteries (Atherosclerosis) begins in childhood, preventive strategies should also begin in childhood. We should learn from Scandinavian countries – how societal changes have reduce incidence of heart attacks (used to be highest in the world 25 years ago) & increase the life span of the population. Education of population regarding Life style modification beginning in childhood (chapters of prevention should be added in school curriculum) is important in preventing Cardio Vascular Disease in our country.