and rural India. No matter how old you are, how rich you are or where you live, heart disease — which causes heart attacks and strokes — is more likely to kill you than any other disease.
There are subtle variations, though. It is more likely to kill men than women: 20.3% of all male deaths are caused by heart disease and stroke as compared to 16.9% deaths in women, shows data from the Registrar General of India’s study of One Million Deaths in India, which uses country-wide Sample Registration System and verbal autopsy — asking the family about the sickness, symptoms and treatment, especially if the death took place at home — to identify the cause of death. Then there are regional variations, with deaths being the highest in the more affluent states of Goa, Tamil Nadu, Andhra Pradesh and Punjab, compared to Uttar Pradesh, Madhya Pradesh, Bihar and Rajasthan.
The projected cumulative loss of national income due to loss in productivity because of early death from non-communicable diseases for 2006-2015 is $237 billion. By 2030, this productivity loss is projected to double. This is far greater than the corresponding loss in the US, which has a population a fourth the size of India’s. Add to this India’s expenditure on healthcare — around 4.1% of its GDP, only 26% of which was government funding — and you have millions of people pushed to poverty just to pay healthcare bills.
The sliver of hope in this litany of bad news is that over 90% of heart disease depends on how we live our lives, our stresses, what we eat and how active we are. Of course, genes have some role to play, but nine in 10 heart attacks can be prevented by controlling blood pressure, cholesterol and diabetes; eating high fibre-low fat food; staying fit; not smoking; and managing psychosocial factors such as stress. Early detection and treatment of hypertension (chronic high blood pressure), for example, reduces death from heart attacks by 35-60%.
And it’s never too late to start. Even adopting four healthy behaviours — eating at least five fruits and vegetables daily, exercising for at least 2.5 hours a week, maintaining a healthy weight, and not smoking — after 45 years reduces the risk of heart disease by over one-third, reports a study in The American Journal of Medicine. The study found that these changes lowered heart attack risk by 35% and death from heart attacks by 40% in people between 45 and 64 years. The benefits were there even for those who lived a decadent life till they decided to turn over a new leaf and tread the path to health.
The heart-protective benefits begin the moment you make healthy choices. The nutritional plan for a healthy heart is eating less of saturated fats like butter and more of oils such as olive and mustard oils, eating five or more servings of fruits and vegetables a day; six or more servings of wholegrains such as wheat and brown rice; low-fat milk products; legumes and beans; and fish and lean meats.
But making diet changes alone are not enough to keep the heart healthy and people need to have high activity levels, keep weight in check and not smoke. Smoking is the biggest cause of heart attack in young people with no other risk factors because it increases the risk of clot formation in the blood, which can block arteries and cause a heart attack even in healthy people. A review of heart disease incidence in 21 countries reported in the journal Tobacco Control showed that smokers had a five times greater risk of heart attack than non-smokers.
Obesity also perpetuates a chain of risk factors such as diabetes, high blood pressure and high cholesterol, each of which individually boosts the risk of heart disease. Keeping the body mass index (BMI) between 22 and 23 — a little lower than the internationally recommended cut off of 25 — lowers a person’s heart risk substantially. BMI is calculated by dividing a person’s weight in kilogrammes by the height in metres squared.
The reason why Indians need to keep their weight lower than Caucasians is our warped fat distribution. A Canadian study of four ethnic groups — South Asians, Chinese, aboriginal populations and Caucasians — showed that for the same level of body mass (weight), South Asians had more body fat. All South Asians also accumulate fat around their abdomen, which is the worst possible place to put on weight. A waist size larger than 38 for men and 35 for women may be a sign of the metabolic syndrome, which is characterised by a group of risk factors such as diabetes, high blood pressure, elevated trigycerides, low good cholesterol (HDL) and high bad cholesterol (LDL), and a pro-inflammatory state (elevated levels of C-reactive protein in the blood), showed study on ‘Waist circumference cutoff points and action levels for Asian Indians’ in the International Journal of Obesity.
With diseases outpacing government spending on health by giant leaps, prevention is the only practical way to save the country from an avalanche of medical bills.