A few decades ago the obvious cause for a broken heart in a young individual was romance and love. But with the epidemic of coronary artery disease (CAD) hitting India hard, the scenario is changing rapidly and with it, the meaning and cause of a ‘broken young heart’. CAD refers to disease of the coronary arteries. Coronary arteries carry blood and oxygen to the heart; therefore any disease which affects the coronary arteries deprives the heart of oxygen — the extreme form of this deprivation occurs during myocardial infarction (heart attack).

The precious asset of our nation is its young population; ironically, it is becoming the most vulnerable to CAD and myocardial infarction (MI).

Four people die of heart attack every minute in India and the age group is mainly between 30 and 50.

Twenty-five per cent of heart attack deaths occur in people less than 40.

Nine hunderd people under 30 die due to heart disease in India every day.

Let us look at the most common causes being attributed to heart attack in young persons.

Smoking

What begins as a fashion statement in college days later turns out to be an indispensable addiction. It is the single largest risk factor for a young individual developing MI.

Smokers not only develop MI earlier but are at a two-fold increased risk compared to non-smokers and at a four-fold-increased risk of sudden death due to MI. The corresponding risks are higher in smoking women.

Not only smoking, all forms of tobacco consumption are equally dangerous. Tobacco causes the blood vessels to be stiff and less elastic, increases the tendency for blood clot and blocks the flow in the coronary arteries. A common misconception is that people who smoke occasionally are not at risk. Once a person quits smoking, it will take three years for the body and heart to recover from the effects of tobacco, so you can imagine the consequences of the person continuing to smoke.

High cholesterol levels

While some cholesterol is necessary for good health, too much cholesterol is bad. Excess cholesterol deposits enter the inner lining of the coronary arteries gradually, building from tiny crystals into larger deposits making the arteries narrower and consequently blood supply to the heart gets obstructed leading to MI.

Though the total cholesterol levels are a predictor of heart disease, many Indians who develop MI have normal cholesterol levels. This is because even though their total cholesterol levels are normal, they have low levels of good cholesterol (HDL cholesterol) and a very unique, dangerous type of bad cholesterol (LDL) which has a higher blood clot forming tendency.

Diabetes Mellitus

The rampant rise in the incidence of diabetes is a major factor in youngsters developing MI. Compared to non-diabetics, a diabetic with myocardial infarction develops a large MI (a larger portion of the heart is affected), has the risk of sudden cardiac death, responds poorly to treatment and has a higher risk of developing re-infarction.

Diabetics have an increased tendency to form blood clots (similar to smokers), have multiple blocks and may also have involvement of blood vessels supplying the brain and legs.

Hypertension

Changing food habits leading to increased salt consumption, stress and a sedentary lifestyle have all contributed to the rise of young hyper-tensives. Most of us grab snacks such as namkeens and samosas between meals when hungry… not only do they have a high salt content but they are also sources of trans-fat. People with high blood pressure are likely to develop CAD because high BP places an added force on the artery walls and over time, the extra pressure can damage the arteries. These injured arteries are most likely to become narrowed and hardened by fatty deposits.

Obesity

We are in the grip of an obesity epidemic. Sadly, the divide between the overnourished and the malnourished is deepening in India. Obesity is a combination of poor physical activity, stress and an unhealthy food culture. With obesity comes the risk of developing diabetes, high blood pressure and high cholesterol. Indian obesity is different. We may not be obese overall, but have abdominal obesity… excess fat deposit around the belly. Unfortunately, it is this belly fat, also called ‘apple type obesity,’ which is dangerous because all metabolic byproducts of visceral fat cells easily enter the liver and get stored as fat.

Unhealthy food habits

Junk food joints have become hang-outs for college students and young professionals. We are always under the impression that Indian food is healthy because Indians are largely vegetarians. However, the Indian vegetarian recipe calls for liberal use of milk, ghee, oil and decreased intake of fruits and vegetables, leading to a higher intake of refined carbohydrate, saturated fat and trans-fat.

Physical inactivity

Physical inactivity not only causes heart disease but also hypertension, diabetes and obesity. Physical inactivity starts from school as modern day teaching hardly stresses the importance of physical education.

Eighty per cent of our young population is physically inactive; the remaining 20% that frequents the gyms concentrates on muscle building rather than aerobic training.

Youngsters have to undertake aerobic physical activity for 30-60 minutes a day for at least five days a week.

Stress

Many studies reveal that the recent stress in personal or professional lives leads to MI. With most of the work happening from the desk and at unearthly working hours and due to poor sleep quality, young IT professionals and BPO employees have high stress and run the risk of developing heart diseases if they also possess any of the above mentioned risk factors. Management of stress is very often preached, but hardly practised and is difficult to implement.

Genetics

Indians are genetically prone to heart disease. Even NRIs living abroad for many generations continue to have the risk because of their genes. Indians have relatively small coronary arteries, making them more vulnerable to the disease even with less severe atherosclerotic disease than our western counterparts. The gene, if any, that is responsible for CAD is yet to be decoded.

Lack of awareness

The rural and urban poor are more susceptible because they tend to ignore the disease due to poor access to health care, high cost of treatment, social stigma and illiteracy. Seeking treatment will also mean missing wages and reduced productivity.

The statistics in our country may represent only the tip of the iceberg. Because of poor reporting of cases and incomplete collection of statistical data, the actual figures for young Indians suffering from coronary artery disease may be much more than that reported in studies.

The numbers are not going to decrease and unless drastic steps are taken at collective and individual levels, the future will be bleak. The theme for this year’s world heart day was prevention of cardiovascular disease in the young and in women. Hope the theme served as a wake-up call for the government, NGOs, and medical and paramedical colleagues.

(The writer is consultant and interventional cardiologist, Apollo Hospital, Tiruchi. Mail id: drkader_sahib@yahoo.co.in)

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