Identifying people who are at high risk of sudden cardiac death and myocardial infarction should be made mandatory in India because the mortality due to coronary artery disease (CAD) among youngsters in Indians is higher than in Western countries, says Dr PK Asokan, senior consultant cardiologist, Fathima Hospital, Kerala, in an interview with Anna Jose. Edited excerpts:
Are you seeing an increase in heart attacks in the younger population?
The World Heart Federation proposed a gender-neutral definition for premature heart disease, that is, heart disease occurring before the age of 50 years. Previously, it was defined as occurring before the age of 70 years. In Asians, especially Indians, the earlier onset occurs 5-10 years earlier than in the Western population.
What are the risk factors for the young population?
Lifestyle factors such as unhealthy diet, smoking, physical inactivity, along with metabolic factors including hypertension, diabetes, abdominal obesity and dyslipidemia, are contributing to premature coronary disease. We have also been identifying stress, social deprivation, sedentary lifestyle, air pollution and substance abuse as emerging or additional risks.
How cautious should the Indian population be?
In India, 25-30% of heart attacks occur at less than 45 years of age, lower than older counterparts in the West. Recurrent heart attack occurs in 25% of cases. Another thing is that 30% deaths in young people in India occur due to coronary artery disease, compared to just two per cent in the Western population. That’s very important. A study in North India showed the most common cause is smoking. Autopsy studies taken in different places reveal that 37% of young patients die from sudden cardiac death. So, among causes of sudden deaths in India, the common cause is coronary artery disease.
Once a young person has suffered a heart attack, what precautions are important to reduce the risk of another cardiac event?
We have to categorise the risk level of the patient and the severity of the disease. Accordingly, we have to start treatment. If a patient has an early stage of coronary artery disease with risk factors, we have to correct, treat and control all the risk factors, including diabetes, hypertension, hyperlipidemia, dyslipidemia, and weight management. The second one is to change the lifestyle and dietary pattern. Reducing stress and improving sleep patterns also play a crucial role.
How can heart attacks in the younger population be prevented?
We have to detect the risk factors early, change the lifestyle, and treat early. Rather than focusing only on incidence and prevalence, the most important thing is action. We should conduct surveys on the population under 40 years. Identifying people who are at high risk of sudden cardiac death and high risk for myocardial infarction should be made mandatory in India because the coronary artery disease death rate among young Indians is higher than in the US or Western countries.