Young Hearts are Under Attack

What is causing considerable concern to cardiologists in recent years is the observation that young, apparently healthy men in their 30s and 40s are falling prey to heart disease. Once considered a malady of the elderly, it is emerging as a major health problem in young Indians.

When Shailender, a cheerful 41-year-old clerk of our department complained of “gas” and heaviness in the upper abdomen one morning 2 years ago, he was prescribed the customary Digene tablets. When he insisted on showing the cardiologist, his colleagues called him a hypochondriac. A day later, we were startled on hearing that he had to undergo an emergency angiography and stenting the previous evening for an acute myocardial infarction!

There are 9 conventional risk factors for heart disease that cardiologists talk about: obesity, diabetes, smoking, high blood pressure, alcohol, lack of physical exercise, abnormal blood lipids, strong family history of heart disease, and stress. The interesting fact is that the risk increases from 2 fold for 1 risk factor to 300 fold for all 9, implying that as risk factors get added, the actual risk literally multiplies! The optimist would however realize that with the exception of family history, all the other risks could be controlled with life style changes or medicines!

 There were however no obvious risk factors in Shailender’s case. He looked and weighed normal (Body mass index 23), had a normal blood pressure, was a vegetarian and did not have diabetes. Like many, he had been a smoker for 5 years but had quit since marriage. His blood lipids were normal. Why then did he have a heart problem?

The rather common occurence these days of heart disease in young people without any of the conventional risks is challenging this neat theory of 40 years. The country was shocked a few months ago on the sudden death of one of the youngest CEOs and health freaks Mr Ranjan Das at 42 in Mumbai. He ate right, was a marathon runner, had regular executive health check-ups and was considered a model of perfect health in the corporate world.

Indian cardilogists admit that the frequency of heart disease in India is one of the highest in the world; further, it occurs around 10 years earlier, is more often fatal at 1^st presentation, and tends to be more severe (all 3 coronary arteries affected).

Three theories are doing the rounds. Some “pundits” are driving down the upper limits of lipids, claiming that blood levels of cholesterol and triglyceride exceeding 160 and 150 could damage Indian hearts. Also an LDL-Cholesterol of more than 70 or a HDL-Cholesterol of less than 40, or increase apolopoprotein A could be damaging.

Physicians that are more pragmatic have however started to look beyond. Stress and sleep deprivation are emerging as a major contributors, with lack of reliable methods of quantifying them posing major hurdles to scientific research. 7 hours of sleep every night might help the stress related body changes to revert to normal, and protect our hearts. It is time we got ourselves more sleep!

As published in HT City ( Hindustan Times)