Young Indians must be careful. Cardiac diseases, sudden deaths are rising

Updated on Nov 02, 2021 09:39 PM IST

In the last 20 years, heart attacks along those below the age of 50 have doubled in India. Twenty-five per cent of heart attacks occur among those below 40

Indians are genetically three times more likely to get CAD and heart attacks at a younger age compared to white Americans (Shutterstock) PREMIUM
Indians are genetically three times more likely to get CAD and heart attacks at a younger age compared to white Americans (Shutterstock)
ByAshok Seth

The untimely demise of the 46-year-old actor Puneeth Raj Kumar, reportedly from a heart attack after a two-hour workout, has triggered a question. How can someone so young, fit, with a daily exercise regimen, and no symptoms of ill-health, have a heart attack and die?

His death is a grim reminder of how coronary artery disease (CAD) — which refers to cholesterol deposits or plaques causing blockages in the arteries supplying oxygenated blood to the heart muscle — is affecting young Indians increasingly.

When, suddenly, blood clots develop in these partially-blocked arteries, the blood supply to the heart stops, and a life-threatening situation of a heart attack occurs, often manifesting itself in severe chest pain. While most have time to seek medical help, in approximately 10% of the cases, the heart immediately either stops beating or the heartbeat becomes extremely fast, uncoordinated and ineffective. This is termed cardiac arrest. If immediate resuscitation, termed cardiopulmonary resuscitation (CPR), is not provided to revive the heart within a few minutes, the person does not survive, resulting in sudden cardiac death (SCD). The most important cause of SCD, of those above the age of 30 years in India, is CAD leading to a heart attack. Hence, there is a need to train people in basic CPR to be able to save lives in case anyone around them has a heart attack.

Indians are genetically three times more likely to get CAD and heart attacks and also at a much younger age compared to white Americans. In the last 20 years, heart attacks along those below the age of 50 have doubled in India. Twenty-five per cent of heart attacks occur among those below 40. Both men and women are at risk of CAD and heart attacks, and it is the most common cause of death.

In the presence of the known-risk factors — smoking and tobacco ingestion, obesity, diabetes, high blood pressure, unhealthy lifestyle, excessive stress, sedentary habits — the possibility of a heart attack multiplies manyfold. But why would someone who exercises regularly suffer from a heart attack suddenly?

First, CAD can be asymptomatic and undiagnosed. 25% of people with CAD, even with severe blockages, are asymptomatic and, therefore, seemingly fit and well. Second, even non-severe blockages, which do not usually manifest themselves in symptoms, can lead to major heart attacks if not diagnosed and treated in time especially in smokers. In essence, CAD can be a “silent killer”.

Third, severe and prolonged exercise can occasionally lead to rupture of these non-significant blockages with blood clots, obstructing heart arteries, precipitating a heart attack and, at times, leading to cardiac arrest and death. Indeed, this is the reason why many who have suffered from Covid-19 are advised not to do severe exercise for three to six months.

In general, moderate exercise (brisk walks, light jogging, swimming, and cycling, for approximately 40-45 minutes five times a week) is beneficial and decreases the risk of heart attacks. But severe exercise protocols and endurance sports may sometimes be detrimental to heart and require regular cardiac check-ups.

So, what precautions can be taken? The answer lies in a check-up for the identification of risk factors early in life. Most Indians should undergo a check-up by the time they are 40. Those with a family history of either a parent or sibling suffering from CAD, heart attacks or sudden death at an early age, should undergo a cardiac check-up by 20. Those planning to take up extreme or competitive sport, endurance sport or severe fitness regimes, at any age, should also undergo a cardiac check-up. The tests are non-invasive, and inexpensive and include measurement of blood pressure, blood tests for lipid profile and sugar, ECG, Echo Doppler (ultrasound of the heart), and if needed a TMT (treadmill test).

For those at very high risk, a CT coronary angio, a simple though more specialised and expensive investigation, is advised. It remains the best test to diagnose CAD at an early stage so that appropriate precautions, lifestyle modification and drug treatment as needed can be started.

Controlling risk factors, preventing CAD and protecting ourselves is largely in our own hands. We can save many young lives in India, with just a little more sense of responsibility.

Dr Ashok Seth is chairman, Fortis Escorts Heart Institute, and president of Asian Pacific Society of Interventional Cardiology

The views expressed are personal

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