RISING BURDEN OF HEART DISEASE IN INDIA Rising Burden of Cardiovascular Disease in India
The number of heart patients in India was roughly estimated as 1.5 crores in 1992 by the World Health Organization that increased to 5 crores by the year 2001. The same is expected to touch 10 crores by the year 2010. Although accurate figures may not be available due to a variety of reasons like non-reporting of deaths., lack of diagnosis in many who suddenly die or do government mechanism (who can collect data from the cardiologists) to count them and so on, the fact remains that the numbers are racing up. Few sample studies of small groups in Rajasthan, Delhi and Kerala show that number of coronary heart patients have doubled (2% to 4%) in villages whereas in cities there has been a three-fold increase (3.45% to 9.45%) from 1960-90. In Kerala the number of heart patient are even higher (13% in the cities and 7% in the villages). This is mostly due to high consumption of coconut oil. It is estimated that about 25-30 lacs of people die from heart attacks in India every year. The epidemiologists (those who study the trends of diseases and their causes in detail) have shown that Indians, more broadly South Asians (Indians, Pakistanis, Bangladeshis and Sri Lankans) settled in countries like USA, UK, Singapore, Canada, South Africa and Mauritus suffer much more from heart disease (coronary heart disease) compared to the local population.
One naturally wonders why the Indians are more prone to heart disease than others? The kind of research study or experiments that can be done to know the reasons is still not becoming clear to the epidemiologist. They cannot subject humans to artificial experiments also. The best method is to take a whole city, follow the entire population for 30-40 years and see what was going wrong. Such a study was done in USA (Framingham Study) in the last 45 years. This study brought out clues, which helped to cut down heart disease in that country. The same also applied to the rest of the world. However, based on the past research (some in India and some Indians settled abroad few reasons are very clearly evident in Indians that make them vulnerable to coronary heart disease. Some of these reasons are already well established, like high cholesterol in blood, whereas some reasons have been newly implicated as the cause of heart disease in Indians. The table mentions all these reasons, The aim of this issue is to highlight these reasons to the readers, make them take actions and ultimately spread the awareness to the population who may develop heart disease in future. Indians and Heart Disease
The increased incidence of Coronary Artery Disease in Indians is due to a combination of Nature (genetic predisposition) and Nurture (environmental factors). Because of the genetic predisposition the harmful effects of environmental factors are greatly magnified. Adverse lifestyle factors include those associated with affluence, urbanization and mechanism. When people move from the rural to the urban environment they tend to become sedentary. Decreased physical activity and increased consumption of calories and saturated fatty acids, insulin resistance and atherogenic dyslipidemia all add and have synergistic effect on the development of heart disease. 1. Indians around the globe have highest rate of heart disease, usually 2 to 3 times higher than Americans, Europeans, Chinese and Japanese. Indo-Americans are at a higher risk of heart
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disease in spite of the fact that half of them are vegetarians and lack many of the traditional risk factors related to the heart disease. About 25% of the heart attacks among the Indian descent occur when they are younger than 40, unheard of in other populations. Among those younger than 30 years of age, the coronary artery disease mortality is three fold higher than whites in UK and 10 fold higher than Chinese in Singapore. Delhi based study in late 90s revealed 9.5 percent prevalence of CAD, 10.2 percent among Indian immigrants in the US as compared to only 2.5 percent prevalence of Coronary Artery Disease in western based “Framingham study�. Coronary artery disease epidemic in India has entered into an epidemiological transition phase. At present 25 percent death among Indians are attributable to it. Coronary Artery Disease will increase by 103 percent in male and 90 percent in female from 1985 to 2015. By 2015, this disease will account for 34 percent all male death and 32 percent all female deaths in India. British Heart Foundation statistics show that the death rate from coronary heart disease is 46% higher in South Asian men than the UK population as a whole, for women it is 51% higher. India has not 4-times higher no. of heart patients than in United States, although the numbers were similar in 1968.
Heart disease is Multi Factorial
High Cholesterol High Cholesterol is one of the most important causes of coronary heart disease. With more and more research data coming in, it has become evident that the blockages are formed in the heart arteries by deposition of cholesterol. Cholesterol, besides being produced in our liver is additionally obtained in our food from animal sources like ghee, buttermilk, cheese, meat etc. The normal level of cholesterol is 130200mg/dl. Obviously higher cholesterol intake can only add to the blockages! High Triglyceride It is a fat derived from the plant sources. All cooking oils are triglycerides irrespective of being saturated or unsaturated. All of them lead to blockages. The normal level of triglyceride is 60mg/dl – 150mg/dl. Saaol recommends less than 130 mg/dl. Low HDL HDL cholesterol is the good cholesterol. Since it has a very high affinity to bind cholesterol. It removes cholesterol from the blockages. Saaol recommends a HDL cholesterol of above 40mg/dl. Smoking People who smoke are four times more prone to develop heart disease as compared to the non smokers. Tobacco that is inhaled while smoking is the major cause of erosion of inner lining of the coronary arteries. Nicotine, tar, alkaloids etc. causes this damage and make the layer more susceptible to cholesterol and sticks it on the wall. High BP High blood pressure puts an extra strain on the heart and the arteries supplying blood to the other organs of the body. Many diseases are caused due to high blood pressure such as heart attack, heart failure, kidney failure, stroke (damage to the brain) etc. Higher the blood pressure greater are the chances of getting the above disease. Normal blood pressure is 120/80 mmHg. Diabetic Mellitus Normal level of fasting blood sugar is 80-120mg/dl. If the fasting level is more than 110 mg/dl and after meal is more than 160mg/dl, it is called diabetes or high blood sugar. Diabetes patients have a higher chance of developing coronary blockages. They are also prone to several other disease like kidney damages, as well as damages of nerves and eyes. Lack of Physical Activity Lack of physical activity in our daily life has become the most important reason of heart disease in modern life. Regular exercise can break fats, decrease cholesterol, reduce blood sugar, control blood pressure, reduce overweight by consuming stored fat in the body and make the heart more healthy and stronger.
New Risk factors
Lipoprotein (a) The high rates of heart disease, despite lesser risk factors, suggests the possible risk of a genetic risk factor, which is uninfluenced by even maximum modification of lifestyle. LP (a) is such a risk factor, since it’s levels are genetically determined and not influenced by diet or exercise. It is 10 times atherogenic as low-density lipoprotein(LDL) and has significant thrombogenic (clot forming) and antifibrinolytic (anti clot dissolving) properties due to its structural similarity with plasminogen. PAI-1 There is increasing interest in thrombotic (clot forming) factors in the etiology of coronary artery disease. Plasma plasminogen activator inhibitor 1 (PAI-1) levels are high in Indians. Indians have lower fibrinolytic (clot dissolving) activity with an increased likelihood of clot formation. Obesity
Obesity is a risk factor for heart disease as it can lead to hypertension, diabetes and dyslipidemia. Overweight persons have 15 times greater chance to have a heart attack. Low Fibre Intake Fibres have a net like structure (like a dry leaf). Fats in our food get stuck in this mesh work. Since fibres, don’t get absorbed, these fats are excreted along with them. So low intake of fibre is another cause of heart disease. Vegetable, fruits and whole cereals are good sources. Prolonged Cooking Prolonged cooking of vegetables is common in India which can destroy up to 90% of the folate content. It leads to the deficiency of folate in the body. This leads to increased levels of a protein called homocysteine which is an important cause of heart disease. Stress Stress can lead to hypertension, diabetes and low HDL cholesterol . Stress increases the secretion of adrenaline in the body which raises the heart rate and work load of the heart. This in turn can lead to heart attack. Genetics Most of the hereditary effects in people come through excessive production of Cholesterol and Triglyceride in the body. These people even if they restrict their diet, may still have high cholesterol/triglyceride. Thus their chances of having a heart disease will multiply. Low Birth Weight Low birth weight, where babies weigh lower than 2-5 kg and of short body length at birth are at higher risk of coronary artery disease in adult life. Hope you liked this article! This article is written by Dr. Bimal Chajjer (India’s best cardiologist)