Young Indians at Risk: Myths & Facts

Young Indians at Risk: Myths & Facts

THE SUNDAY EXPRESS, JULY 28,2024 (Page 5)

I’ve noticed that many young celebrities and individuals who go to the gym suddenly feel unwell or experience heart attacks or sudden death.

Is there a connection to this?
That’s a very important question. We are a young nation. India has a population of nearly 140 crore people, with approximately740 million being young, defined as the working force between 15-60 years. That’s about 60% of our population. Given these numbers, we see a lot more young deaths in our country, but it’s not related to COVID-19 or vaccines as some people believe. It’s simply a matter of lifestyle. A landmark clinical study, INTER HEART in 2004 showed potentially 9 risk factors which may lead to heart at tacks.

■ Diabetes
■ Hypertension
■ Smoking
■ Abdominal obesity
■ Raised/abnormal cholesterol (ApoB/ ApoA1 ratio)
■ Psychosocial factors
■ Lack of regular physical activity
■ Inadequate consumption of fruits and vegetables

Indians are at much higher risk of cardio vascular disease as compared to western counterparts. Global Burden of Disease study has reported that cardiovascular disease (CVD) mortality has increased by 34% in the last 25 years in India. Indians get heart attacks or strokes at least 15 years before the western population. The fact that in India, at present,25% patients aged below 40 years and 50% aged below 50 years are at in creased risk of heart attacks only bolsters this notion that we are truly amidst an epidemic of cardiovascular disease or CVD (heart attacks and strokes).

The PURE sub study analysed 33 583 individuals (35-70 years of age) from India,Bangladesh,or Pak istan,shows CVD being the most common cause of death (35.5%) in South Asia.Rural areas and men had a higher incidence of CVD and death.Largest contributors to CVD and death were hypertension,high non-HDL cholesterol,diabetes, low education, abdom inal obesity, household air pollution, poor diet, and tobacco use.

It’s NOT Covid… We must be aware of these risks. The public per ception that this could be happening due to COVID-19 or post-COVID vaccination is not accurate. Regarding your question about very fit in dividuals experiencing sudden cardiac death and heart attacks,it’s crucial to note that ex treme levels of sports or strenuous exercise can predispose individuals to heart attacks by causing plaque rupture.

COMMON CAUSES :

■Younger athletes (age <35 years):Usually hereditary/genetic (abnormal electrical ac tivity of heart like Long QT syndrome /channelopathies,or coronary anomalies)

■Older athletes (age >35 years):Heart at tacks (coronary artery disease),arrhyth mias,such as ventricular tachycardia or

fibrillation,abnormally thick heart muscles (hypertrophic cardiomyopathy). These conditions can cause sudden cardiac
death in the young. To what extent do lifestyle choiceslike diet and exercise influence a per son’s heart health?
If I were to put it in plain language,diet and exercise are almost 50% as important as medications in preventing heart attacks and strokes.

Home-cooked food,which includes balanced meals like chapati, rice, dal, vegetables, eggs, meat, and  fish, is very acceptable. Problems arise when we binge on excessive sugar and unhealthy foods. In India, for example,we have rich sweets like mithai, and high-calorie foods like parathas, puris, samosas, and kachoris. The younger generation is also consuming more burgers, fries, and pizzas,which have high carbohydrate content,saturated fats,and a high inflam
matory index.These foods cause inflammation in the body, which is a key factor leading to plaque ruptures in the coronary or brain arteries, resulting in strokes or heart attacks.

Reducing inflammation in the body depends on what we eat.Consuming heavy saturated fats and high-calorie foods increases free radical injury and inflammation.

Exercise is another critical intervention for preventing cardiovascular disease (CVD). It improves mental and physical health, helps with weight loss,and regulates blood sugar levels,thereby reducing the risk of diabetes.
Overall,combining a healthy diet with reg ular exercise can reduce the risk of heart disease and strokes by nearly 30%.

Doctor Agrawal,what about post menopausal women?
During reproductive years,premature or early-menopause (before 40 years or 45 years of age,respectively) may be induced by poor management of cardiovascular risk factors like diabetes,high blood pressure, obesity,cigarette smoking and possibly genetics. Postmenopausal symptoms canmimic heart attack or stroke too. Vasomotor symptoms (VMS) like palpitations/feeling your heart racing,hot-flushes,chest discom fort or aches and pains,forgetfulness, brain fog,extreme tiredness,breathlessness, etc. are common symptoms in postmenopausal women.Preventing heart disease in post
menopausal women requires a sustained change in lifestyle,weight loss achieved through regular walks,by eating right (more fruits,vegetables,beans and whole grains, salads, fish, low fat dairy, unsalted nuts, minimising sugar and salt, saturated fats, junk food and alcohol), regular medical checks to monitor your blood pressure, cholesterol and
blood sugar levels and treating them promptly if abnormal and getting enough sleep.Mental health is equally important
with greater emphasis on being productive, having a routine and avoiding social isolation. Hormonal Therapy (HT) after medical consultation can be beneficial. HT is appropriate for younger, healthy, menopausal womenwith lifestyle-imiting, bothersome vasomotor symptoms.

” In the ever-evolving landscape of healthcare, understanding the nuances of heart health is crucial. We had theprivilege to sit down with Dr.VinayakAgrawal, Senior Director and Head Clinical Cardiology and Advanced Cardiac Imaging Fortis Memorial Research Institute, Gurugram with over 25 years of experience in cardiology. Dr. Agrawal has been instrumental in advancing heart health awareness and treatment methodologies. His insights into the importance of lifestyle choices, technological advancements, and preventive measures offer a comprehensive guide to maintaining heart health in today’s fast-paced world. This interview delves deep into the various aspects of heart health, providing invaluable information for anyone looking to improve their cardiovascular well-being.p apnea contribute to heart disease?”

Doctor Agrawal, how do obesity and sleesp apnea contribute to heart disease?

We have to understand that obesity has become more of an epidemic now, world wide.If you look at the numbers,Globally, > 1.9 billion adults are overweight; 650 million are obese with over 2.8 million deaths oc
curring due to being overweight or obese. In India,In India, > 135 million are affected by obesity.According to the ICMR-INDIAB study 2015, the prevalence rate of obesity varies from 12-30%.

Obesity causes upper airway restriction, as obese people tend to have narrower air ways due to excess “Pharyngeal fat”. This condition,called obstructive sleep apnea (OSA),is common among obese people. In OSA,the airway flow gets affected,leading to loud snoring and intermittent pauses in breathing.These pauses make the person
wake up briefly,often multiple times a night in severe cases,more than 30 times a night. As a result,the person does not get restful sleep and feels tired and sleepy the next day. They may doze off while sitting,talking,or even driving.OSA has significant health implications. It’s related to sudden cardiac death, atrial fibrillation or rhythm disorders,hyper
tension,resistant hypertension,metabolic syndromes,and more.

“Syndrome Z”: it’s a deadly combination of metabolic syndrome (quartet of hypertension,glucose intolerance,hypertriglyc eridemia and central obesity) with obstructive sleep apnea (OSA).
NOOSA:Even the lean individuals may have OSA.In an Indian study published in the journal Sleep Breath in 2022, approxi mately two-thirds of non-obese patients with OSA (NOOSA) had hypertension and the half had impaired fasting glucose.

What can a person do to control or overcome sleep apnea? Is it only through exercise and dietary
changes,or are there medications in volved as well?

That’s a very good example of how apnea can impact our lives.Unfortunately, there are no specific medications for sleep apnea itself. The treatment for OSA involves weight loss,dietary control,and regular exercise. In some cases,we prescribe a BiPAP or CPAP machine after conducting a sleep study. In rare cases,we may perform surgeries to ad
dress the upper airway,such as uvula surgeries, to treat the condition. There is a need for increased awareness at a population level to identify and treat this condition early. Recently published studies SELECT, STEP and SURMOUNT-OSA highlight the exponential rise in the use of new drugs like semaglutide and tirzepatide which are a rage in the USA
for treating Obesity and OSA.

What about bodybuilders and weightlifters taking supplements and steroids? Can these practices lead to
health issues?

Yes,absolutely .Many patients who are weightlifters or bodybuilders take a lot of supplements and anabolic steroids. Unverified performance enhancing drugs and supplements are often abused by body builders worldwide.Very often,anabolic steroids are detected in bodybuilding dietary supplements, which poses a significant risk to pub
lic health.It can cause cardiomyopathies, heart attacks,arrhythmias,bone loss, early cataracts,l iver and kidney damage and gastric ulcers. So, keep it simple, and consume natural sources of proteins, calcium and other nutrients.

Does stress also play a part in heart health?
Absolutely.Psychosocial stress is a major risk factor for heart disease. INTERHEART study identified psychosocial stress as one of the nine key risk factors for heart attacks and cardiovascular disease.Chronic stress has important pathological consequences,including cardiovascular disease (CVD).
Stress also increases the severity of several risk factors,including hypertension, diabetes mellitus,and obesity.Stress induces behavioural and cardiometabolic changes, unpredictable nervous system activity and immune dysregulation. Youngsters today face im mense pressure to succeed quickly, which, coupled with sedentary lifestyles,poor diet, and lack of sleep,significantly increases their risk of heart disease. Regular exercise, adequate sleep,and digital detox practices can help mitigate the harmful effects of stress on heart health.

So,doctor,what are the best ways for individuals to assess their heart health today?
It’s a very straightforward approach. First, it’s essential to understand your personal and family medical history.For example,if someone is 20 years old and their father or mother had a heart attack or heart surgery, such as bypass or stenting,at an early age, they should be aware.Early age is defined as less than 55 years for men and less than 65
years for women.If there is a family history of heart disease,it means you are genetically predisposed and more likely to develop heart disease in the long run.

Next, it’s important to know if there have been cases of sudden cardiac death in your family,particularly in first or even second-degree relatives at a young age,say around 20-25 years old, due to unknown reasons. This is another significant red flag.

Third, regularly check your blood pressure, blood sugar,and lipid profile.Start this at around 20 years of age and continue to check these parameters every two to five years.These tests help detect conditions like familial hypercholesterolemia,a genetic condition leading to very high cholesterol levels without symptoms,which can cause heart
attacks or strokes.If you develop diabetes, hypertension,or other ailments,you should monitor these parameters more frequently, such as annually or biennially. Fourth,specific tests can be performed based on symptoms.For instance, if you
experience palpitations, breathlessness during exertion,or chest pain that radiates to the arms,jaw,or back,this could indicate angina or heart pain. In such cases,tests like echocardiography (an ultrasound of the heart),a treadmill test, or
a stress echocardiogram can be helpful. A simple CT coronary calcium score can assess calcium deposits in the arteries and is extremely useful for risk stratification.

Additionally, non-invasive tests like carotid intima-media thickness (an ultra sound of the carotid arteries) can measure
the thickness of the artery linings. Based on these assessments and individual risk factors-such as blood pressure,sugar levels, smoking,and sedentary habits-questionnaires like the QRISK-3 score can help determine your ten-year risk of heart at tacks or strokes.This comprehensive approach helps in effectively assessing heart health.

What do you think about the trend to do CT coronary angiograms to detect blockages?
Misinformation regarding CT coronary angiography is being perpetuated by some medical professionals/ hospitals and lay public. CT coronary angiography can detect blockages in appropriately chosen select cases,but should not be used as a routine screening test for everyone.Please remember, it’s not the blockages that we seek but the vulnerability and propensity of the plaques to rupture which is the mechanism of heart attacks and strokes.Stable blockages ,even if
80-90% can remain quiescent for many years on good lifestyle and medical manage ment.The PCI (percutaneous coronary inter vention) ballooning/stent or CABG (Coronary artery bypass grafting of surgery) is usually done in symptomatic patients or those with extensive coronary blockages with signs of Ischemia (low blood supply to
heart muscles) or heart dysfunction (low pumping or ejection fraction) on testing.

Recent technological advance ments have improved heart health monitoring and treatment. Can you
elaborate on this?
Absolutely.One major advancement is the increased awareness about heart health, largely driven by the media.Since COVID-19, people have become more health-conscious and are aware of the risks of sudden cardiac
events.This awareness has led to more people seeking regular check-ups and monitoring their heart health closely.
Telemedicine has also become significant. Before COVID,teleconsultations were not legally permitted.However,the pandemic necessitated this mode of consultation, and now,with appropriate protocols,we can offer teleconsultations.
Additionally,the rise of wearable technology, like Fitbit bands and Apple Watches,has revolutionised heart health monitoring. Al though not perfect,these tools keep people connected to their health and prompt them to
seek medical advice when necessary. At Fortis,my team is launching a cardiac rehab program which is heavily supported
by a hybrid model of digital handholding of a cardiac patient and periodic home visits by mtrained medical personnel for best overall care and troubleshooting.

What message would you like to give about maintaining heart health?
In my 25 years of practice, I have learned that health is like an SIP (Systematic Investment Plan).Investing 30 to 45 minutes daily  in exercise and eating a balanced diet consistently over the years will yield excellent health dividends in future.There are no shortcuts to maintaining heart health;it requires dedication and a disciplined lifestyle.