Young India’s Heart Health: Cardiologist Dispels Myths around Cardiac Activity

India has experienced a major epidemiological shift over the last few decades. The most common cause of mortality in India is now cardiovascular disease (CVD), surpassing cancer, as per the World Health Organisation (WHO). Despite the considerably varying frequency of risk factors across regions, CVD is the main cause of death in all of India.

With CVD accounting for virtually every fourth death by 2030, India is predicted to have the unfortunate distinction of having the most cardiac mortality worldwide, according to renowned cardiologist Dr C N Manjunath who made the statement while addressing the ‘HAL Medicon 2022.’

“Heart issues are growing among the young and middle-aged population and this is alarming,” he said.

His statements are further corroborated by a study published in the National Centre for Biotechnology Information titled, ‘Cardiovascular disease in India: A 360 degree overview,’ which throws light on how Indians will be affected by CVD ten years sooner than their western counterparts.

WION spoke to Dr Vineet Bhatia, MD, DM, DNB (Cardiology), MNAMS, FESC, Associate Director, Cardiac sciences, Max Hospital, Patparganj, New Delhi, to comprehend young India’s cardiovascular health and the reasons behind an increase in heart attacks.

Here are the excerpts.

Q. Firstly, What is the difference between a heart attack and a cardiac arrest?

A. A heart attack also known as Myocardial Infarction occurs when one of the blood vessels (called coronary artery in medical terms) carrying blood to the heart muscle gets suddenly blocked completely.

As we age, the blood vessels on their inner side develop deposits called “plaque.” These plaques are rich in cholesterol and other substances (notorious to promote clotting when exposed to circulating blood) and are covered by a cap. The plaque gradually increases in size and encroaches on the vessel lumen (the inside space of a tubular structure). This process is accelerated by risk factors like diabetes, high blood pressure, deranged lipids, smoking etc.

These risk factors are also associated with a high risk of a phenomenon called “plaque rupture” in which disruption of the cap leads to the plaque material getting exposed to the blood flowing in the vessel.

This sets into motion a rapid sequence of events which result in the formation of a clot at the site of rupture resulting in a complete blockade of blood flow beyond that point.

Since the blood and oxygen supply is cut off, the muscle cells of the heart begin to suffer damage and start to die. Irreversible damage begins within 30 minutes of blockage.

Prompt recognition of the problem and early aggressive measures to restore blood flow in the occluded vessel help prevent muscle damage. This forms the basis of the popular saying in cardiology that states “Time is Muscle”- the faster you move the more muscle you can save.

Cardiac arrest on the other hand occurs suddenly and often without any warning. It usually follows an electric malfunction in the heart causing a sudden cessation of electrical activity or irregular heartbeat (referred to as arrhythmia).

With its pumping action disrupted, the heart can not pump blood to the brain, lungs and other vital organs. The individual loses consciousness and is detected to be pulseless and in shock. Unless prompt resuscitative measures are instituted, death may result within minutes. A heart attack may precipitate a cardiac arrest.

Q. What is the most common reason why young Indians are falling prey to heart attacks?

A. The high incidence of heart attacks in India is not of a unifactorial origin but of a multifactorial one. While the prevalence of smoking has declined in the west, there has been a rise in its prevalence among Indian youth.

India has emerged as the diabetes capital of the world and this is a major risk factor for premature cardiac disease. Unhealthy eating habits coupled with lack of exercise have been contributing to it too.

Furthermore, uncontrolled hypertension, reliance on alternative schools of medicine, stress, obesity and air pollution also play a role in the occurrence of heart attacks.

Q. Why are “seemingly fit” people experiencing heart attacks more frequently now?

A. Lately, we have come across several incidences of cardiac arrest while exercising in gyms raising several concerns.

Chronic and monitored exercise training has shown several physical and mental benefits including a healthy heart.

Regular structured exercise regimens help control risk factors like diabetes, blood pressure and high cholesterol levels.

However, research has found evidence that sudden and high-intensity exercises (especially in people who exercise infrequently) can acutely increase the risk of sudden cardiac arrest in individuals with underlying cardiac disease like coronary artery disease (recognised or unrecognised) or cardiac muscle disorders like hypertrophic cardiomyopathy.

Exercise may increase the sheer stress in the blood vessel leading to plaque rupture.

Proper warm-up and cool-down periods (pre and post-exercise) and a gradual build-up of exercise time and severity over a period of time may be helpful in preventing unwanted cardiac events.

In-depth research on active gyms and the credentials of supposedly qualified trainers is also essential. The bulk of so-called self-styled trainers lack degrees in physical education and instruct according to their own whims and fancies because there are no guidelines in place.

Q. Can health supplements lead to unusual cardiac activity?

A. Protein supplements are the in thing among gym goers these days. They overlook the fact that a smart diet plan and using existing protein sources can build muscle, strengthen bones and power our body functions.

However, wanting quick and overnight results and most often peer pressure prompts people to use over-the-counter supplements available in an unregulated market.

The manufacturers package what they feel is safe. For the sake of palatability, they may add sugars, artificial flavours, thickeners and calories with detrimental effects. Many protein powders labelled herbal, ayurvedic and safe may in fact contain heavy metals like cadmium, lead, arsenic or mercury) leading to toxic effects.

Fat-burning supplements are popular as they help you lose weight in a short span of time. However, they can also occasionally have damaging side effects on our bodies. They may lead to a variety of side effects such as psychological alterations like nervousness, aggressive behaviour, anxiety and mood swings, loss of appetite, and dehydration, which may affect heart rate and blood pressure.

These may in turn trigger cardiac events. In fact, many dietitians and nutritionists recommend not taking any fat burner during your phase of weight loss.

Q. COVID-19 and heart attacks: Is there a correlation?

A. The Smidt Heart Institute at Cedars-Sinai, United States, recently reported that deaths from heart attacks rose significantly during pandemic surges, including the COVID-19 Omicron phase, overall reversing a heart-healthier pre-pandemic trend.

Prior to the COVID-19 pandemic, heart attacks were the leading cause of death worldwide but were steadily on the decline. However, the new study—recently published in the peer-reviewed Journal of Medical Virology—shows that heart attack death rates took a sharp turn and increased for all age groups during the pandemic.

The rise in such cases has been seen across surges including the presumed less virulent omicron phase. Another disturbing finding reported is a significant increase in the 25-44 years age group who otherwise are often considered to have a lower risk.

Several plausible explanations have been proposed. The COVID-19 virus may accelerate pre-existing coronary artery disease even in young adults, it may lead to inflammation which may trigger the rupture of vulnerable plaques, mental stress like job loss fears, staying indoors with resultant lack of exercise and delay in seeking medical attention (for fear of exposure) may all play a role in triggering acute events.

Q. It has been recommended that one keep Aspirin 300 handy. Is that advice useful? Is it wise to disseminate this information?

A. A common misconception is that if a medicine is available without a prescription and can be purchased over the counter, it must be completely safe.

Aspirin is a vital medication in our armamentarium for treating heart attacks, but when used improperly, it increases the risk of internal bleeding.

It is important to only use the medicine when under a doctor’s supervision. If one thinks one may be having a heart attack, it is best to get medical help right away.

If one is remotely placed then perhaps chewing a 325 mg aspirin tablet may be considered a reasonable option while sincere attempts are made to reach the nearest medical facility.

Q. Many people are resorting to herbal medicines after surviving a heart attack. Are they reliable?

Modern allopathic medications have a positive impact on post-heart attack care, according to large-scale randomised clinical trials.

The treatment plan for people who have undergone a heart attack includes the following medications broadly.

– Antiplatelet agents, which thin the blood.

– Statins, which lower cholesterol in the blood,

– Beta-blockers, which reduce blood pressure and,

– Angiotensin-converting enzyme inhibitors, which help relax the veins and arteries to lower blood pressure

As far as herbal medicines are concerned, they have not been tested in any major clinical trials, so their role in managing such patients is dubious and in some cases may be detrimental.

Q. What can be done to keep a young heart healthy?

The key to a healthy heart is to have a healthy lifestyle which includes a balanced diet, regular exercise, low-stress levels, giving up smoking, managing risk factors, and getting regular checkups. No signs or symptoms should be overlooked, and getting quick medical assistance may help keep us safe.

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