Smokers and drug users, both recreational and addicts, are at a very high risk of heart attack even if they do not have any other risk factors such as high blood pressure, obesity, diabetes, or high cholesterol and triglycerides. “Heavy smoking and drug abuse, especially cocaine, increase the risk of clot formation — thrombosis — in the blood. This may precipitate a heart attack even in those who do not have blocked or hardened arteries — atherosclerosis — which is the leading cause of heart attacks in people over 40 years,” says Dr Ashok Seth, chairman and chief cardiologist at Max Heart and Vascular Institute in Saket.
The records at Max Heart show that 25 per cent people under 30 years who have a heart attack do not have any risk factor other than smoking. “The youngest patient who has undergone an angioplasty here has been a 19-year-old smoker, and he, like most people in their 20s who undergo a heart attack, find it impossible to believe they have had a heart attack even when presented with medical evidence,” says Dr Seth.
Going by the rising obesity among children, cardiologists predict matters will get worse in the future. “Obese children are three to five times more likely to suffer a heart attack or stroke before they reach the age of 65. Given the rise in the numbers of overweight and obese children, the situation is likely to get a lot worse over the next two decades,” says Dr Kasliwal, director of cardiology, Escorts Heart Institute and Research Centre.
All cardiologists emphasise that behaviour modification is the key to preventing heart attacks. “Genes only increase your propensity for heart disease, it is an unhealthy lifestyle that adds layers of risks that ultimately cause the disease,” says Kasliwal. Genetic predisposition — if someone in the immediate family has had a heart attack before the age of 60 years — increases the risk of a heart attack by 10 to 15 per cent. What can actually tilt the balance are the modifiable risk factors such as smoking, diabetes, high triglycerides, high cholesterol, high blood pressure, obesity and smoking.
Quitting smoking halves the risk of heart attack. “Smoking is top risk factor for people under 40 years and is the biggest cause of sudden cardiac death,” says Dr Seth. A Cleveland Clinic study reported in the Journal of the American Medical Association (JAMA) found that almost 90 per cent patients with coronary heart disease have at least one of four major risk factors common among Indians — diabetes, high cholesterol, high blood pressure and/or smoking.
The study of over one lakh heart patients concluded that controlling these risk factors can dramatically reduce the risk of heart disease. The JAMA study also noted that smoking decreased the age of heart attack by nearly a decade in all risk factor combinations. Smoking further increases the potency of each risk factor individually.
Indians, however, have to two other added risk factors: low HDL or good cholesterol and high triglycerides. “While total cholesterol is a major risk actor in the West, high triglycerides and low HDL are a greater risk factor for Indians,” says Dr Kasliwal.
Though the female hormone estrogen protects women against heart disease, what works against them is diagnosis. Detecting heart disease in women is more difficult because women’s symptoms are not typical — instead of angina, they may report breathlessness, giddiness or neck and shoulder pain. Traditional heart function tests such as the treadmill test is also less sensitive for women and may give false results, so early angiography, perfusion scans and stress echocardiography are preferred.
Aggressive use of preventive drugs — such as cholesterol-lowering statins and blood-thinning aspirin — is both beneficial and cost-effective, but experts emphasise that lifestyle remains a big part of the prevention strategy. “Lifestyle changes must be the foundation for everything we do,” he says. “That means getting people to stop smoking, eat right, and exercise. We have to make sure that patients know that lifestyle is still as important as ever.”
Not everyone may be able to take statins due to other medical conditions such as liver disease. Side effects may include abnormal liver function, muscle aches, muscle damage, allergic reaction, dizziness, abdominal pain, or constipation.