Chandrakant Lahariya | Cut stress, modify lifestyle, diet to check heart attacks

Recently, the news of the death of a 41-year-old cardiac surgeon due to a sudden cardiac arrest made the headlines all over the country. This has not been isolated news. In the past three years, we have regularly heard of several incidents of celebrities as well as people around us -- many of them otherwise seemingly healthy -- to untimely deaths from sudden cardiac attacks. These incidents have also been -- without sufficient scientific evidence -- been linked to Covid-19 infections, but there is no scientific evidence that this is happening because of Covid. One thing is for sure that due to the increase in social media sharing and prime-time telecast on TV channels, such incidences are getting more attention.

There is an epidemiological transition in the health conditions of many people. With a reduction of infectious diseases, heart, kidney and liver diseases are now becoming the leading causes of death in India and around the world. Then, as life expectancy increases, the likelihood of serious illness and death due to chronic conditions increase. Specifically, for India, the average age of heart attacks in India’s population is 10 years earlier than in most Western countries. Indians are genetically predisposed for such cardiac events. Since the population in India is relatively young, heart attacks are more common among young people in our country. This used to happen even before Covid-19 as well. The changing lifestyles, rising burden of obesity, diabetes and high blood pressure rates are making this situation worse. The findings from India’s largest study on diabetes and hypertension published recently in a prestigious journal Lancet Diabetes and Endocrinology has indicated around 10.1 crore Indians are diabetic; and 13.6 crores are pre-diabetic. Essentially, one in every four Indian adult is either fully diabetic or in an early stage of diabetes. Every one in three Indians is hypertensive. One in every four have deranged cholesterol levels.

About 60 to 70 per cent of heart attacks are either preventable or can be delayed. However, due to familial and genetic factors, a small proportion of heart diseases in otherwise healthy and young people are difficult to detect and prevent. For young people, a rising risk factor is high competitiveness and stress. The cause of death for the 41-year-old doctor and many others who have had sudden cardiac arrest was stressed or that they were physically inactive and got involved in vigorous physical activities. Many such otherwise healthy-looking individuals are genetically predisposed for such conditions. Sudden cardiac arrest can happen in any age group, and occurs either when a coronary artery in a person’s heart ruptures from a plaque build-up or an even rarer condition called cardiac arrhythmia. Such cases can hardly be prevented but we can reduce their risk by minimising the other risk factors.

First of all, everyone above the age of 35 should pay attention to the preventable causes of heart diseases. The risk of cardiovascular diseases is determined by assessment of age, sex, diabetes, smoking, lipid profile and family history. Every person who is above 35 years should do his risk assessment in consultation with any doctor. There are also several free online platforms (like the ACC ASCVD risk calculator at https://tools.acc.org/ldl/ascvd_risk_estimator/) that can help to roughly measure one’s risk for future cardiovascular events -- the 10-year risk and lifetime risk. Once such an assessment of risk has been made, a well-crafted dietary advice, regular exercise and, in some cases, medicines such as statins can reduce the risk. Some small lifestyle changes can help prevent heart and other diseases.

The 41-year-old cardiac surgeon who died reportedly performed 16,000 surgical procedures over 10 years, on an average of 1,600 per year, or about five to six surgeries per day. Also, may have been involved in other daily outpatient duties and care for admitted patients. This is clearly a heavy workload and would cause a lot of stress for anyone and could lead to serious illnesses. This affects the heart the most. Young people need to do a lot more to reduce work-related or any form of stress.

If we can learn anything from such incidents in the last three years, it is that we can prevent all this to a great extent by making some small changes in our lifestyle. First, everyone should do 60-90 minutes of moderate-intensity physical activity at least five days a week. Second, eat a healthy and balanced diet with less fat and less refined sugars. Include as much fruits and vegetables as possible. Third, try and avoid sugary drinks and ultra-processed food. Reduce salt in food as much as possible and stop smoking completely. Fourth, get at least seven to eight hours of sleep daily and sleep on time. Reducing one’s working hours to eight to nine hours a day will reduce stress. Any kind of stress on the body results in the release of those chemicals/hormones which results in heart attack. Therefore, anything done to reduce stress -- whether it is a walk in the park or meditation and yoga -- will reduce the risk of sudden cardiac events. All adults above the age of 40 years should get their heart disease risk assessment done every one to three years, depending upon the risk.

There is a need for more intensive policy interventions. The interventions done to reduce diabetes and hypertension will reduce the burden of heart diseases. The lifestyle interventions should be started from the school age. It is the school age when the behaviours are formed and unhealthy lifestyles are adopted. Therefore, early interventions through school health programmes will prevent future risk of cardiac events. The taxation on tobacco and high fat products should be increased. The front of the package labelling on all food items should be implemented and people need to be made aware about how to read and interpret food packet nutritional information. At 10 gm per person per day salt intake, Indians consume double what the WHO recommends: less than 5 gm salt per day. It is at the root of the 31.5 crores, or one in every three adults, being hypertensive in this country. There is a need for running a salt consumption reduction programme. Salt must be removed from the dining table in every single Indian household.

Many cardiac deaths, if not all, in young adults are preventable and it requires interventions from individuals, society and the government. It is doable and is urgently needed.

Dr Chandrakant Lahariya is a senior consultant physician based in New Delhi. Email: c.lahariya@gmail.com.