How India Can Battle the Rising Burden of Coronary Artery Disease

With the 1.4 billion population size, world’s 20% people live in India. Coming to people with heart diseases, world’s 60% live in this subcontinent. With its rapidly increasing disease burden and mortality rate, coronary artery disease (CAD) - the most widely seen cardiovascular disease (CVD), is the growing scourge in India. The medical community is concerned by the rapid progression and high mortality rate from CVD plus the early age of onset (50% of heart attacks striking those under 50, 25% below 40). With the mortality rate in Indians with CAD being 20–50% higher than in any other country in Asia, there is a pressing need to take the bull by its horns. We must understand the risk factors linked to myocardial infarction (heart attack) and begin preventive screening early, leveraging modern technology like genetic screening tests.

The Heavy Toll of CAD in India

The prevalence of CVDs in India is around 54.5 million. Cardiovascular disease is the leading cause of mortality in the country (25% of all lives lost). The CVD death rate in India is 272 per 1,00,000 compared to the global average of 235 per 1,00,000.  What’s more it can also burden the economy - the estimated losses from productivity dip and healthcare spending to treat CVD over 10 years is an estimated $237 billion.

Major Risk factors

Coronary artery disease is the result of multiple factors - from lifestyle to medical history, to your genes. Being overweight, eating an unhealthy diet, smoking, sedentary lifestyle, and regular stress are common risk factors associated with CAD.

Other disease conditions such as diabetes, hypertension etc. as are also risk factors for developing CAD.

Is Your Lifestyle and Doing You In?

A diet that’s rich in saturated fats and trans fats, sugar, and salt and low on fresh produce and fibre puts you at greater risk. The convenience of processed foods is outweighed by the damage they do - research shows that a 10% increase in the ultra-processed food intake in your diet, raises risk of a cardiovascular event by 12%.

Regular exercise decreases the risk for getting CAD in two ways: a) It can make your heart muscle stronger b) It will have positive impact on your high-cholesterol, high blood pressure, diabetes, stress which are the known risk factors for developing CAD.

The Genetic Factors Affecting CAD - Could You Be At Risk?

An individual’s risk for getting a heart disease can be caused fully or partially due to the genetic factors. The genetic reasons can be of two types: Monogenic (one or few genes/genetic variants) or Polygenic (up to several thousands of genes/genetic variants). The monogenic cause for developing CAD is extremely rare. So practically, the polygenic risk score addresses the most genetic risk of developing CAD. Recent developments in precision medicine have given rise to the development of a genetic risk score, known as Polygenic Risk Score (PRS), which can estimate the genetic risk of developing a CAD. Tests such as Kardiogen from MedGenome screens more than 6 million genome-wide genetic markers and indicates if you’re at a high, moderate, or average genetic risk for developing CAD, with an accuracy close to 90% for those under 45 years (young onset CAD) and with 75% accuracy across all age groups.

But how could such genetic screening tests help you? Take the case of a 30-year-old male from Bangalore who experienced a heart attack and had to be rushed to hospital where he underwent a bypass surgical procedure for CAD. He had no prior history of diabetes or hypertension. However, he did have a strong family history of CAD. As a result of his experience, his siblings underwent genetic screening for CAD. They found that his younger brother had a higher PRS score than the patient himself, while his sister did not have those risk markers. This result and genetic counselling allowed the family to properly understand their risks and plan an appropriate individual healthcare regimen.

You should get tested if you have a family history, lifestyle factor related risk, pre-existing comorbid conditions like diabetes, or are over 45 years old.

Management of CAD and Prevention of Myocardial Infarction

If you are at high risk for CAD based on lifestyle factors, the good news is that you can make a change starting today. A healthier diet, exercise, and other lifestyle modifications can help lower your risk.

A genetic testing on the other hand offers a means to get a complete picture, alongside traditional tests that assess other CAD risk factors. Until recently, genetic tests weren’t considered in preventive disease management. With the advent of technological advancements, these scientifically well-validated tests are becoming more affordable and popular. A genetic test is a once in a lifetime test and does not need to be repeated. These breakthrough tests offer the opportunity for high-risk individuals to nip the problem in the bud and take corrective and preventive action before problems escalate.

With so many preventive screening options at our disposal we’re more than equipped to turn things around - prevention really is better than cure.

Dr. Ramesh Menon, Associate Director - Genomic Medicine, Personal Genomics Division, Bioinformatics Department, MedGenome