Countless actors have hammed death by clutching their heart in imagined pain before collapsing, yet this Bollywood overkill has had no effect on most Indians, who remain oblivious to the threat of cardiovascular disease (heart attack and stroke) till it comes knocking at their door.
One in two Indian smokers don’t know their tobacco addiction causes stroke, while 38% — more than one in three — don’t know it causes heart disease, shows data from the Indian Heart Watch, the country’s largest ever heart risk survey of 6,000 men and women from 11 cities.
While people in smaller cities smoked and ate more fatty food and less fresh fruits and vegetables, metro-residents tended to be less active. Obesity, high blood pressure and high cholesterol were uniformly high, with people doing little to lower their risk.
Even among literate middle-class urban Indians, awareness and control rates of risk factors was low, For example, roughly one in three people surveyed had hypertension, of which only 57% knew they had high blood pressure. Among those with diagnosed hypertension, 40% were on medicines to lower it but 25% had it under control.
In comparison, high-income countries, 60% people with diagnosed high blood pressure have it controlled, reported researchers at the World Congress of Cardiology last month.
Bolt from the blue
“Roughly half of all heart attacks and strokes come out of the blue in people with no diagnosed heart disease, so identifying risk factors early in healthy people is a must to delay disease and prevent death,” says Dr Ravi Kasliwal, chairman, preventive and clinical cardiology, Medanta.
A study in Lancet this week said millions of people over 50 years could safeguard their health by taking LDL-lowering statins, which, claims the study, also benefits healthy people with no heart problems. Using data of 175,000 patients from 27 previous randomised trials, the study concludes that even for people with no record of heart problems, taking statins can reduce their risk by a fifth.
“International criteria says cholesterol-lowering statins should be prescribed to people who have diagnosed heart disease or those with at least a 20% risk of suffering a non-fatal heart attack or stroke within the next decade.
“Unless risk factors such as blood pressure, cholesterol levels, diabetes, weight and smoking are actively tracked, lifestyle changes alone after diagnosis are not enough to control disease. Blood-thinners like low-dose aspirin and statins should be prescribed to aggressively lower risk,” says Dr Purshottam Lal, chairman and chief international cardiologist at Metro group of hospitals.
Muddying the waters further are “silent” heart attacks that occur without sudden chest pain. A study of 1.1 million people in the Journal of American Medical Association, 42% of women and 30.7% of men admitted to hospitals for heart attack never had chest pain. Women were also more likely to die after a heart attack; the mortality rate for women in the study was nearly 15%, compared with 10% for men. Studies in the past have shown that older patients, women and diabetics are less likely to have chest pain.
Though another study, also in Thursday’s Lancet, says there is no evidence to show that higher levels of good cholesterol (high-density lipoprotein, or HDL) reduces the risk of a heart attack, cardiologists insist its too early for the findings to reflect in prescriptions. HDL is monitored as much as low levels of bad cholesterol as a yardstick of dangerously clogged arteries, with doctors prescribing medication to push up dangerously low levels.
“This study’s been questioned and till the jury is out, we recommend patients to have high good cholesterol, because it has no negative effect on heart,” says Dr Kasliwal.And healthy levels of LDL should be a priority. "LDL remains an accurate marker of cardiac risk, so the old taboos - of avoiding animals fats found in meats, butter and eggs remain. That, coupled with exercise, weight control and eating high-fibre foods, are a must to prevent high cholesterol," says Dr Lal.