KOCHI: India is witnessing nearly two million heart attacks a year and majority of the victims are youngsters. Men living in cities are three times prone to heart attacks than people living in villages. The study from Sree Chitra Thirunal Institute of Medical Sciences and Technology in Thiruvananthapuram published recently in Lancet reveals that among total deaths in India, 28 percent are due to heart attacks. The health facility in Kerala is supposed to be the highest in India and comparable to that of developed countries like United States and Western Europe which is why one would naturally expect a significantly lower incidence of heart and other lifestyle diseases in Kerala. Ironically, it is the highest in Kerala compared to other states of India.
The incidence of heart disease in Kerala is above 14 percent, while the national average is 10 percent. In 1960s and 70s, heart attack before the age of 40 was extremely rare and by 1990s it increased 40 fold with at least 20 percent heart attacks occurring before the age of 40. 50 percent of these attacks occur before the age of 50 years. The average age of a first heart attack decreased by at least 10 years in Kerala, while in many industrialized countries it increased by 20 years. People of Kerala exhibited peculiar features of heart disease. The urban-village difference of disease prevalence is much lower in Kerala compared with northern states of India.
Many observational studies have shown high prevalence of risk factors leading to heart ailment in urban and rural settings. This is largely due to the higher prevalence of major risk factors like High BP (42 per cent), Diabetes (20 per cent), High Cholesterol (45-72 per cent, smoking (42 per cent), obesity (40 per cent), physical inactivity (41 per cent), and unhealthy alcohol consumption (13 per cent) among population of Kerala.
The Kerala Paradox
Kerala has high literacy, high life expectancy and other socioeconomic progress including access to state of the art medical care for those who can afford it. One would expect a lower prevalence of heart disease and diabetes. Kerala Paradox refers to the unexpectedly and paradoxically high prevalence of lifestyle diseases – heart disease, diabetes, high blood pressure, and obesity resulting in very high death rate from heart disease.
The dramatic increase in premature heart disease in Kerala is due to a corresponding increase in the modifiable risk factors related to lifestyle at a young age – many of which are unrecognized, untreated and uncontrolled despite the wealth of knowledge and the availability of safe and effective medications at reasonable cost. The contributing factors include unhealthy diet, sedentary life, high consumption of alcohol, lack of physical activity, air pollution, along with very high intake of saturated fat and trans fat – a cultural norm dating back to several millenniums. Keralites have the highest cholesterol level in India that ranges from 197 to 229 mg/dl compared to 157 to 180 mg/dl nationally. Total fat intake in Kerala is 30 percent of energy with 70 percent of that coming from saturated and trans fat.
‘Share the Power’
The World Heart Federation is dedicated to leading the global fight against heart disease with a focus on low- and middle-income countries via a united community of more than 200 member organizations across the globe.This year’s heart day message is “share the power”. Your heart powers your whole body. That is why it’s so important to look after it. Heart disease is the number one killer of the world taking away the life of 17.5 million people every year. By 2030 this number will rise to 23 million. But the good news is that it is a preventable disease. The popular INTERHEART study has shown that by modifying 9 risk factors (smoking, high BP, diabetes, poor food, abdominal obesity, inactivity, alcohol, dyslipidemia and stress) you can prevent heart disease by at least 90 percent. The rest 10 percent are nonmodifiable risk factors like hereditary and genetic disposition.
Risk factors for heart disease begin accumulating at a young age, often while individuals have no symptoms and unaware of the untoward consequences. The scientific evidence of the structural changes of the heart vessels leading to block later, can be identified soon after risk factor onset.
However, one need not unnecessarily fear about this mortal disease if you are ready for undertaking the preventive measures that are quite simple.
The author is the senior consultant cardiologist,Lourdes Hospital Cochin
(The views expressed in the article are those of the author)