Beware: Heart disease is getting younger

It's never too early to start following a healthier lifestyle in order to minimise the risk of heart disease. Here's why.

The night of November 25, 2006 is one that 39-year-old Vivek Kadam will not forget easily. It was 4 am when this sales professional from Mumbai woke up with severe pain in the back, which extended to his shoulders and hands. This was followed by a burning sensation in the stomach, vomiting and the need to evacuate his bowels. Recognising the symptoms he had seen in his father earlier, he realised he needed to get to a doctor, fast.

The problem was that Kadam was new to Mumbai and had no idea about hospitals in the area. In desperation he drove down to a chemist shop some distance away, only to find the shutter down. Luckily for him, his wife called up their son's paediatrician and got the reference of a nearby nursing home, to which he then rushed. A cardiologist was called in and he confirmed that Kadam had suffered a massive heart attack. Doctors at Mumbai's Asian Heart Institute -- where he was subsequently admitted -- gave him a 10 percent chance of survival. But extensive treatment, which included an angioplasty, helped him survive his ordeal.

Kadam was 36 at the time he suffered a heart attack.

Dropping ages

He is not alone. Balchandra Nambiar, employed in a media firm, was diagnosed with heart disease at 35. Finance professional Ashok Mathur initially ignored his chest pain due to acidity. When it continued, he went to a specialist who told him he had suffered a mild heart attack. He was 34 then. Increasingly, it seems, heart disease is targeting more and more young people.

Dr Aashish Contractor, head of preventive cardiology and rehabilitation at the Asian Heart Institute confirms, "There is a marked increase in the incidence of heart disease among younger people. Indians especially are known to get heart disease almost a decade earlier than others."

In fact, the Medwin Heart Foundation based in Hyderabad estimates that almost 50 percent of heart attacks in Indians occur before the age of 50, and 25 percent, before the age of 40.

Changing lifestyles

What could be behind the decreasing age for heart disease?

Dr Contractor explains, "The fact is, we are today leading less active lives. Also, we tend to eat food that is oily and increasingly, more refined and processed. These lifestyle habits lead to obesity and other complications, and trigger the risk of heart disease."

Smoking is an important accepted risk factor. "Many with heart disease, especially among the younger age group, tend to be smokers," points out Dr Contractor. Rising stress levels today are also responsible, he says, though exactly to what extent would be difficult to measure or quantify.

A profile of most young sufferers provides evidence of one or more of these factors at play. Businessman Sunil Fadia, who suffered a heart attack at 41, had a weakness for cheese, chocolates, sweets and dry fruit. His eating patterns were rather erratic and as a result, he kept putting on weight.

Suresh Shinde, who suffered a heart attack at 38, works as a computer operator. "I used to remain desk bound for eight hours every day and got no exercise. Lunch timings were not fixed and I often made do with an oily snack from the canteen, which I gulped down while working," he says.

Nambiar too attributes his condition to the job stress he was coping with. "I am into space selling for the print media. It is a high pressure job that involves hectic hours on the move and continuing pressure to achieve targets and so, there is a lot of stress," he explains.

Genetic predisposition

Another reason for the early onset of heart disease in Indians could lie in their genes. A recent study in the journal Nature Genetics reported how a genetic mutation responsible for heart disease, occurring in one percent of the global population, is, in fact, found in 4 percent of Indians. "Indians are known to have a genetic predisposition towards heart disease," Dr Contractor agrees.

Kadam was a vegetarian who never smoked and only occasionally drank at parties, though he did lead a rather sedentary life. Mathur smoked and drank only occasionally, but otherwise maintained healthy habits, including starting his day with a round of surya namaskar or sun prostrations. In both these cases, the typical risk factors associated with heart disease were absent. However, both had a family history of heart disease and their doctors put this down as the reason for being affected.

Road to recovery

Timely medical attention helped these young men fight their odds to survive. What is in store for them now? Dr Contractor says, "With treatment, most people who have survived heart attacks recover and go on to lead normal lives. However they need to be consistent with their medication and take life-long care as regards a proper diet and exercise."

Following angioplasty at the Asian Heart Institute, Kadam joined the hospital's cardiac rehab programme. Slowly his health improved as his Ef (ejection fraction that indicates heart health) went up from a mere 15 to 35 percent (above 55 percent is normal). "The rehab programme really helped me to regain my self confidence and ability to function," he says. Today, although busy with work again, he finds the time to make it to the rehab programme thrice a week, and plans to start walking on other days.

Fadia recovered after a coronary artery bypass graft, and works to maintain his weight. He has six, regular small meals a day, has cut down on milk, sugar and salt, and given up chocolates, sweets and cheese. He too attends the cardiac rehab programme thrice a week, and walks or jogs on other days. Perfectly fit now, he enjoyed participating in the Dream Run at the 2010 Mumbai Marathon.

Nambiar also watches his diet carefully; earlier he did not think twice before ordering a vada pav whenever he felt like it, but now he eats home cooked food and happily digs into a good helping of salads every day. Every morning he practices yoga following what he was taught at the IPC Heart Care Centre in Mumbai where he was treated. At work, he sets realistic targets for himself and has started delegating tasks.

Based on the diagnosis following his attack, Mathur was advised against angioplasty. Instead, non-surgical procedures such as external enhanced counter pulsation (EECP) and arterial clearing therapy (ACT) that he underwent at the IPC Heart Care Centre helped him return to normal. Today he does yoga regularly, watches his diet carefully and has given up smoking completely. Like him, Shinde too has started taking a regular morning walk. He has completely cut down on oily food and has his meals on time.

Heart disease remains a real threat, but prevention is always better than cure. Dr Contractor says, "The best advice against getting heart disease is to eat right, exercise and manage stress wisely. You must also regularly screen your blood pressure, blood sugar and cholesterol levels, especially if you are at higher risk because of smoking, obesity or a family history of the disease."

Simple tips when you consider that it is your heart that is at stake.

Some names in this article have been changed upon request.