The shocking death of the much loved Kannada film actor Puneeth Rajkumar at the age of 46, due to cardiac arrest, followed by deaths of some of his fans, also due to cardiac arrest triggered by extreme grief, has brought a bitter fact to the fore again: We are not over the ‘epidemic’ of predisposed and sedentary lifestyle-induced heart disease, which strikes silently, often with no symptoms to show. More worryingly, more younger adults are the victims.
According to estimates based on various studies across India, coronary heart disease (CAD) accounts for 60% of all deaths, and 47% of the disease burden, which is progressively increasing in rural populations in terms of absolute numbers. The CAD is characterised by build-up of plaque, which causes coronary arteries to constrict, limiting blood flow to the heart. Cardiologists say CAD can persist with no symptoms, to experiencing chest pain or even a full-blown heart attack that is often sudden and fatal.
According to experts, biological risk factors contribute significantly to the cardiovascular burden. Hence, researchers from Belagavi-based Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, conducted a study published in the Journal of Family Medicine and Primary Care, a little before the Covid-19 pandemic struck, to assess biological risk factors among adults in rural areas in North Karnataka and expose their vulnerabilities to cardiac problems.
Among the 980 men and women in their 30s and 40s who were assessed, prevalence of hypertension was found in 26.6%, self-reported diabetes mellitus among 6.3%, overweight 26.7%, and obesity in 7% — all invitations to cardiac problems. Men had higher prevalence of hypertension and overweight, while women had higher prevalence of diabetes and obesity.
The study, titled ‘Biological risk factors for coronary artery disease among adults residing in rural areas of North Karnataka’, cites the World Health Report–2002, saying cardio-vascular diseases (CVDs) will be the biggest cause of death and disability in India by 2020. Prevalence of CVDs is estimated up to 7.4% in the rural population and up to 13.2% in urban populations. And although the disease is presently more prevalent in urban populations, it is progressively increasing in rural populations.
THE FOOD FACTOR
Gadag district Indian Medical Association president Dr P K Noorani, says, “Food systems were once dominated by local production for local markets, with relatively little processing before reaching households. The shift to a global food system started in the US and other high-income industrialised countries, which has now invaded even rural areas in developing countries.
People’s eating habits have drastically changed and the pace of change in Low Middle Income countries — including India — is quickening. Snacking, eating out at fast food outlets, take-away meals is increasing, so is consumption of fried and highly processed food. “Indians (including in Karnataka) are genetically more prone to CVDs than Westerners. So, we need to be doubly cautious of our eating habits and keep up moderate exercises,” says Dr Noorani. “Post Covid (or long Covid), cardiac effects surfacing lately in the form of cardic arrests due to blood clots, myocarditis (inflammation of the heart muscle), coupled with our genetic susceptibility, along with bad food culture and high stress, disturbed lifestyle and bioclock are a byproduct of our IT revolution,” he says.
“Most processed foods contain unregulated amounts of saturated and trans fats which increase blood cholesterol. One must develop the habit of checking labels of processed foods like chips, cakes and cookies — not only do they contain trans fat, they are also low in nutritional value,” says Dr M N Ravi, Clinical Director and Senior Heart Specialist, Narayana Multispeciality Hospital, Mysuru. One must opt for salads with healthy olive oil sauce, non-greasy fish and white meats, Indian breads made from millets, dry vegetable preparations and lentils, and steamed rice, he says.
Dr Praveen Tamrolimath, a cardiovascular surgeon in Belagavi, says, “One must stop over-consumption of red meat, Indian desserts, and fried chicken. Dietary modification, stress management, control of blood pressure, regular practice of Yoga will help keep the heart healthy,”.
HABITS FOR SAFE GYMMING
Nutritionist and master trainer Dinesh Vernekar, says, “Fitness and health are different things. One must not work out excessively or indulge in physical activity far exceeding the heart beat rate, which is calculated as per age. Workouts should be done only under certified trainers. The safest are endurance activities like running, cycling, climbing and swimming.” He cites the example of former cricketers Kapil Dev and Sourav Ganguly, both great athletes, and Remo D’Souza, a master dancer, suffering heart attacks. “It is because of their diet in the last 30 years,” says Vernekar.
Indians consume more carbohydrates and relatively less protein. Carbohydrates (carbs) convert to glucose in the body and cause heart diseases and diabetes. “There needs to be a drastic change in dietary systems by increasing protein intake and reducing carbohydrates,” he says. Dr Ravi advises that about 50% of the calories should be from carbohydrates and the rest shared between proteins and fats. “Consumption of adequate carbohydrates by regular gym-goers and athletes ensures a higher amount of protein goes towards building and maintaining lean body mass,” he says, adding that there is no magic macro formula for muscle-building.
Dr Noorani points out, “Aggressive workouts in gyms can take its toll, probably because of high-protein supplements, enhanced with anabolics, taken without proper hydration or supervision, aiming for quick results.” Senior pulmonologist in Udupi, Dr G S Chandrashekhar, says in most patients, particularly youths, smoking has led to cardiovascular issues. Those who have diabetes, high stress levels and family history of cardiovascular issues must be careful. “They have to ensure they maintain ideal body weight. After 30 years of age, one must go for a heart check-up once in six months to avoid any future risk.” He advises against consumption of high-calorie foods containing more fat.
Shalini Nalwad of the International Critical Care Air Transfer Team, who also is involved in the world’s largest CPR (cardiopulmonary resuscitation) training programme, suggests a work-life balance with basic Indian diet, any traditional South or North Indian meal with the right mixture of carbohydrates, proteins, fat and fibres. “Meditation, Yoga, 30-minute brisk walk and relaxing with family and friends, good sleep is all we need to get it right. People look for quick and easy options for a meal. Due to migration of the rural population and urbanisation, eating habits have changed. Restaurants, roadside eateries, delivery apps have made unhealthy food easily accessible. People have less time to spend in the kitchen and more on work/entertainment,” she says.
At the population level, there are two approaches to reduce the risk of sudden cardiac arrests — smoking cessation and other lifestyle modifications; and screening and risk stratification to identify individuals who may benefit from clinical treatment. There is strong advocacy, communication and services available for screening and risk stratification in persons who can afford or have health insurance. Since cardiac surgeries are covered under PMJAY and state health programmes, there are efforts to utilize it by hospitals. It is time primordial, primary and secondary prevention of heart diseases and related deaths take centre stage in health services. Primordial to is to get rid of risk factors. Primary prevention involves preventing onset of disease in those who have risk factors. And secondary is to ensure people with diseases get adequate and timely treatment to prevent deaths or complications. For example, inform those who smoke even one cigarette a day that it is associated with approximately 50% increased risk of CHD and approximately 25% increased risk for stroke.
-Giridhara Babu, epidemiologist and public health expert
(With inputs from Chetana Belagere in Bengaluru, Sunil Patil in Belagavi, Raghu Koppar in Gadag, Prakash Samaga in Udupi, Arunkumar Huralimath in Hubballi, G Subhash Chandra in Chitradurga and Karthik K K in Mysuru)