A young body, but an ailing heart

The average age of those afflicted by cardiovascular diseases is falling by the day. Even students, who are as young as 22-year-olds are falling prey to it. On World Heart Day, doctors say that 40-50 citizens have a heart attack on an average every day in the city. Lifestyle changes, lack of exercise, unhealthy eating habits, obesity and long working hours are some factors which trigger heart ailments.

Twenty-year-old engineering student, Ganesh (name changed), weighing 92 kgs, was recently admitted to Sri Jayadeva Institute of Cardiovascular Sciences and Research after suffering a heart attack. “Besides him, a young medical student too was admitted at our hospital after he had a heart attack,” says Dr CN Manjunath, senior cardiologist and director, Sri Jayadeva Institute of Cardiovascular Sciences and Research.

On an average some 40 to 50 people have a heart attack daily in the city, according to him. “Of those coming to us with heart attacks, 25 per cent are below 40, which is extremely worrying,” adds the doctor. The government-run hospital sees some 1200 patients on an average coming to it with various cardiovascular problems. “Sixty per cent of the cases are related to heart attacks and 15 to 20 per cent to heart failure. We have many patients walking in with high blood pressure as well,” he reveals.

Noting that the incidence and prevalence of cardiovascular disease has been steadily rising in India, Dr Ravi Kumar, managing director, RV Metropolis Healthcare Ltd, says the major contributory factors  are changes in lifestyle, lack of exercise, consumption of non-nutritious food, increased stress level, smoking and irrational use of tobacco. “Prolonged working hours, hectic commute and growing incidence of obesity along with a sedentary lifestyle is also one of the reasons for Bengaluru’s population being more prone to heart ailments,” he explains.

Symptoms
Listing the symptoms, doctors says should someone have chest pain radiating to the left arm, or even in the jaw or in the middle of the back or interscapular area, he should immediately seek help. “Any person who has pain in these parts along with shortness of breath, followed by profuse cold sweating in which the skin becomes cold and blood pressure drops and the pulse rate increases, shouldn’t waste time in seeking help as either in isolation or a combination of one or two of these symptom suggests a heart attack,” says Dr B Ramana Rao,consultant physician and cardiologist, revealing that on an average he sees some eight patients walk in with chest pain daily and needing further care.

“We conducted a study which showed that 12 per cent of heart attack patients had a strong family history. So if someone died at a younger age  because of a heart attack, the following generations could be more prone to having one. Other added factors are stress, smoking, junk food and lazy living. Diabetics or people with strong family history should get a health check up done yearly and others once in two years,” advises Dr Manjunath.

Prevention
Stressing on the need for healthy eating, Dr Priyanka Rohtagi, Chief clinical nutritionist and head of nutrition, Apollo Hospital, Bengaluru says a healthy lifestyle is the key to a healthy heart. “Some small healthy changes in life can give you great dividends. Eat healthy food. Add more whole grains, fruits, vegetables and nuts to your plate and avoid fast foods. Spare time for physical activity, recreation and sleep well to enjoy a healthy lifestyle,” she underlines.

Dr Vivek Jawali, chairman, Cardiovascular Sciences and Medical Advisory Council, Fortis Hospital too believes the time has come to make changes as India is a big and complex country with many lifestyle challenges taking place all over. “Adding to that is the pollution and lack of effort to create awareness and strategies to combat the disease.  It will take years to see some change in these circumstances,” he warns.

Make CVD a disease of importance: Experts
Despite the rising cases of cardiovascular disease in the country as a whole, the city does not have proper data on its prevalence. The fact that it constitutes a huge proportion of the non-communicable diseases and is the  most common cause of death world-wide, has made no difference. Presently, the approximate estimate of heart failure patients in various stages of the disease in India is 1.3 to 4.6 million, but the data is incomplete owing to lack of surveillance.

Experts are now keen on making CVD a notifiable disease and a disease of national importance to see that steps are taken to combat its spread. “There should be some kind of data on it, just like we have for dengue or other diseases and it should be recognised as a disease of national importance. Only then we can get some funding from the government to control the growing numbers,” says Dr B Ramana Rao, consultant physician and cardiologist, stressing that CVDs must be given their due importance as on an average one Indian has a heart attack every six seconds.

“Making cardiovascular diseases and heart attacks notifiable would help allocate funds and resources,” agrees Dr Ranganath Nayak, medical director and senior consultant cardiologist at Vikram Hospital. Stressing on the need for declaring cardiovascular diseases as a disease of national importance, Dr CN Manjunath, senior cardiologist and director, Sri Jayadeva Institute of Cardiovascular Sciences and Research says, “We need a proper database as currently we all go by the data shared by hospitals which does not project proper incidence. The state health department needs to track the incidence of heart attacks. Only then will we get proper funding to prevent the problem.”

India’s heart attack fatalities higher than global average: Dr Srikanth K V, senior interventional cardiologist, cardiac transplant, heart failure specialist, Narayana Institute of Cardiac Sciences
Cardio vascular diseases are disorders of the heart and blood vessels. They are a common cause of death, disability and lost man hours in India. Statistics from the WHO and Ministry of Health and Family Welfare show that non-communicable diseases account for more than 53 per cent of deaths in India and of these, CVDs have a major share of 24 per cent. They  also rank first among the top five causes of death in the Indian population. In fact, one-fifth of deaths in India are due to CVDs. By 2020, India will have the largest burden in the world with one-third of all deaths in the country caused by CVDs.

The country’s CVD death rate of 272 per 100,000 population is higher than the global average of 235 per 100,000 population.  Worryingly, the CVD epidemic in India is marked by accelerated build-up,  early age of disease onset in the population, and  high case fatality rate. The growth of heart disease is dependent on a number of interlinked factors such as ageing, changing lifestyles, unhealthy eating habits, tobacco use and rapidly evolving socio-economic determinants such as access to health care A recent Indian study conducted under the guidance of Dr Prof Upendra Kaul, cardiologist, showed that the top three risk factors for heart attacks(acute coronary syndromes) were dyslipidaemia or high lipid levels (58.1%) hypertension (53.2%) and smoking (45%).

In an emerging country like ours, we need to understand that prevention of heart disease is the way forward as it is both a cost effective and efficient way of combating the problem. Control of risk factors like smoking, hypertension, diabetes, high lipid levels, abdominal obesity, and psycho-social stress, should be a priority for a country like India .

Patients undergoing dialysis should better watch out: Manoharan, Consultant nephrologist and medical director, NephroPlus Dialysis Centre
Dialysis patients are extremely prone to cardiovascular diseases (CVD). Research has shown that about half the deaths among dialysis patients occur due to CVD. And a quarter of dialysis patients succumb to sudden cardiac death.
The main cause of the high incidence of CVD among dialysis patients is  the build-up of fluid and toxins in the blood between dialysis sessions. Most  deaths are reported during longer gaps between  sessions since there is a dangerous build-up of excess fluid and toxins during this period.

The best way to prevent CVD among dialysis patients is to ensure that the gap between dialysis sessions is reduced and they go in for it at least thrice a week.  They could even consider every other day dialysis, short daily or daily nocturnal dialysis. Daily dialysis helps to prevent calcification of blood vessels, which is another important factor in CVD among dialysis patients.

Apart from this, certain medications such as ACE inhibitors, ARBs or Beta-Adrenergic blockers also help in preventing CVD among dialysis patients. Patients must ensure regular review of their dialysis prescription to ensure their dialysate potassium level is adjusted as needed. Avoiding low potassium dialysate is an important way to prevent sudden cardiac death during a dialysis session. More research is needed on this important cause of mortality among dialysis patients so that the causes can be understood and  prevented.