Heart diseases are also increasing in our country and reaching epidemic proportions. We Indians are genetically more prone for heart disease than rest of the world. In addition to this risk westernization and changed food and activity patterns, increased levels of stress in our population is triggering the button in our population so that they suffer with heart diseases and strokes. In India there is rising epidemic of heart diseases noted to the tune of 4-8% in rural India and 8-12% in urban India. South Indians have double the incidence of Coronary Artery Disease compared to North Indians. Males have more disease in younger age group and as the females age and attain menopause their risk also becomes equal to men. In India disease occurs a decade early compared to West and the disease more malignant in nature with more diffuse disease involving multiple coronary arteries.
Risk Factors for Heart Disease:
- Age – Increasing age is a risk factor. But in India people suffer heart diseases and attacks in two peaks – one early in between 35-45 years of age and another peak after 55-60years of age. Smoking and Stress are the main causes for early disease and other standard risk factors like diabetes and hypertension, high cholesterol are the culprits in second peak of disease occurrence.
- Sex – Male sex confers additional risk than females. But as females attain menopause the hormonal protection is lost and they have same risk of developing heart disease as males.
- Diabetes – Fasting blood sugars values of >126mg/dl is considered as Diabetes. Incidence of Diabetes varies from 16-32% in various studies in India. South India has higher incidence than Northern India. In Indiawe have of high incidence of Impaired glucose tolerance (IGT) whose sugar levels will vary in between 100-126mg/dl. The incidence of overt diabetes varies from 8-16% and while IGT will be upto 16% in our country. These IGT population along with borderline blood pressure values, higher triglycerides and truncal obesity are considered as those suffering with “ metabolic syndrome” which is considered as one of the emerging risk factors of our country.
- Hypertension – Blood Pressure values of more than 130mmHg of systolic and more than 80mmHg of diastolic are considered as Hypertension. Earlier more than 140mmHg systolic and more than 90mmHg diastolic blood pressure were considered as Hypertensive patients. Recently this is modified by decreasing the cut off values down to 130mmHg and 80mmHg as significant proportion of population with values in-between above were developing strokes and heart attacks- so as to prevent this occurrence it is recommended now to act and treat at lower values especially if someone has evidence of target organ damage like heart hypertrophy or someone already suffered attack. The incidence of Hypertension varies from 30% in population more than 30years of age and it could increase to 40% if the cut off values taken are more than 130/80mmHg.
- Hyperlipidemia or Dyslipidemia – Hyperlipidemia is a condition in which the total cholesterol values are more than 260gm/dl in persons who don’t have any other risk factors, but if someone already has Diabetes or suffered an event any value as low as 130mg/dl also warrants treatment. Another major lipid abnormality pattern noted in our country is low HDL Cholesterol with high triglyceride levels with minimal increase in LDL Cholesterol – This combination is called Indian type of Dyslipidemia. The incidence of Dyslipidemia varies from 50- 70% but when Hyperlipidemia alone is considered the incidence could be inbetween 16-35%. Hyperlipidemia in combination with higher blood pressure and diabetes increases the risk many folds.
- Smoking – Smoking either active or passive is shown to increase the risk of getting heart attacks. Smoking or any tobacco related product usage like ghutka, thambaku(tobacco chewing) or Khaini, Zarda are all proven risk factors for heart diseases , stroke and cancers. Smoking affects all parts of the body whichever receives blood supply – in other words to say Smoking has ill effects on each and every body parts.
- Obesity – Higher body weight especially truncal obesity with higher waist to hip ratios are quite common in our country and is associated with increase risk. Any person with higher Body Mass Index is medically considered obese, but as a broad rule of thumb any person’s weight is more than their height in cms. substracted by 100 is supposed to be overweight or obese. The incidence of obesity varies from 10-30% depending upon the age group of analysis. The truncal obesity with abnormal fat deposits in tummy are supposed to be the culprit locations which cause Insukin resistance, abnormal substance production which are harmful for the body.
How to prevent Heart Disease
We can prevent our Heart Attack risk by 80% and remain healthy if you follow the following tips:
Eat Healthy – Avoid Junk foods, Sweets, Fats. Eat more fruits,vegetables and salads.
Being vegetarian is healthy. Eating too much rice or wheat or bread is no good. Nuts like wall nut and almonds are good for heart and brain. Maintain your ideal body weight.
Do Exercise, Yoga & Meditation – Brisk walking or yoga and meditation are scientifically proven to cause control of risk factors and cause regression of blocks in blood vessels. Exercise in any form for 30minutes or more a day for at least five days in a week is good for maintaining health. Yoga and meditation is India’s gift to world for positive health. Good and adequate sleep at least for 5-6hours at night is important for the body to recoup and become active again from day today stresses.
Control of Risk Factors – If we have any of the above mentioned risk factors we need to get tested and take treatment as per qualified and competent physician’s advise so as to get them under control and prevent heart attack and strokes.
Say No to Tobacco and Smoking – Smoking both active or passive to be totally avoided. Tobacco in any form is detrimental to our body.
Statin treatment – Lipid lowering treatment and control as per the guideline recommendations depending upon the clinical scenarios is proven beyond doubt for prevention of heart diseases and stroke. Not only people who suffered from heart disease or stroke but also all people who have above mentioned risk factors also benefit by these wonder drugs called statins. Statins have the potential to be molecules of this century for CAD control like Antibiotics for infections and H2 receptor blockers for ulcers.
Thus by following the above precautions we can prevent the occurrence of heart diseases by more than 80%. But the problem is that only 1% of the population only follow these healthy recommendations. We need to make many awareness camps and spread the messages that at least 50% of the population will follow the advises and we can become healthy, happy and prosperous nation.
(By- Dr A. Sreenivas Kumar, Sr. Consultant Cardiologist & Director, Cardiology & Clinical Research, Apollo Hospitals, Jubilee Hills)