The Indian cardiology faculty has noticed a worrying increase in incidence of young patients presenting with heart attack. An additional concern is rising trend among young women. On an average 10-20% of acute heart attacks involve patients younger than 45 years of age universally, a proportion which is rising rapidly in developing countries.
How are younger people differently prone to heart disease than the rest of the age group? So here is some valuable information that the youth should know to maintain a healthy heart.
THE BASICS
What defines a heart attack?
Let us distinguish heart attack from sudden cardiac deaths (SCD). Heart attack is responsible for 40-50% of SCD but rest are due to anomalies of birth, thickening of heart muscles or electrical disturbance. The heart attack happens due to sudden interruption of blood flow to the muscles of the heart leading to infarction/necrosis.
What causes the heart attack?
The eventual manifestation is the result of interplay of two conditions viz atherosclerosis (thickening and blockages in arteries) and atherothrombosis (the thrombus /clot formation). The development of blockages are well understood scientifically and we are aware of risk factors like
1. Diabetes mellitus/hypertension
2. Altered lipid profile
3. Smoking
4. High stress
5. Sedentary lifestyle
6. Genetic predisposition
What is not yet fully understood is Atherothrombosis, the entity which leads to clot formation. We are aware that it is due to rupture of the surface of blocks (irrespective of its severity). Which means that the clot can form even on blockages which are at a nascent stage and may not be visible even on angiography. These aspects make heart attacks an unpredictable event. Unfortunately atherosclerosis effects the middle age and atherothrombosis hits the young people. Though what causes the blocks to rupture and form clot is uncertain, it may be a cumulative effect of high stress, inflammation in body, altered lipid /cholesterol quality and genetic predisposition.
A FEW MYTHBUSTERS
1. The common myth is that chests should pain during heart attack. In fact heart attack hardly pains, instead the common awareness is of discomfort, heaviness, choking, distress, gas , breathlessness or ill feeling. This is the basic reason some of the attacks do not get the attention of either the patient or the doctor.
2. Young at age does not guarantee a healthy artery. Most blockages (fatty streaks) start developing in the arteries in the second decade of life. Whether they progress to blockages late in life depends on the life style, environmental and genetic factors. The lifestyle modifications should start in the teens rather than wait for the later years.
3. The perception that metabolic syndrome /diabetes / heart disease were due to high fat intake is changing. There is more and more evidence that it is the high sugar and carbohydrate which is the culprit not only fat!
4. Most patients who present with heart attack have normal cholesterol. Most of the times it is quality of cholesterol which matters not a particular quantity.
5. A normal ECG and a normal 2-D Echo does not rule out an underlying heart disease
6. Heart attacks are unpredictable and can’t be foretold by most investigations available clinically.
7. People who are thin should not assume that they are protected from heart attacks. The evidence is that outside visible fat is not responsible but it is the internal hidden fat stored in liver and other organs which are inflammatory.
8. Coughing will not prevent an attack. It is an internet hoax. it helps only in some arrhythmias but not in an attack
9. Taking an aspirin will not prevent an acute attack. it just helps to limit the damage
10. Women may be protected against development of heart disease due to oestrogens but that protection is only to development of blocks not clots. They must follow the same preventive guidelines as men have to
11. Vegetarianism is not an absolute protection from heart attacks.
Ultimately it depends upon overall caloric consumption and intake of processed food that matters
SO WHAT DOES THIS MEAN FOR THE YOUTH?
In midst of the alarming trend it is also heartening to see the general awareness on the rise. The treatment guidelines and protocols have also refined with time and we see an early intervention and discharge with a restored heart function. A young survivor can expect a normal quality and quantum of life ahead.
WHAT CAN YOU DO?
I hope the heart disease will assume a social responsibility. Otherwise we may turn in to a nation like NAURU Island where half the farming population turned into diabetic within 30-40 years of industrialization. We must have a multi-pronged strategy effective at multiple levels.
1. Home: A child learns the eating habits at home. a basic awareness among parents and encouraging exercise regimen is a must.
2. Schools: Educating young minds regarding proper eating regimen, imparting education about diet and exercise. The schools must take a lead and ban processed food and drinks in the canteens.
3. Food industry: A self-regulation must be practised regarding additives, supplements, ban trans-fat, curtail sugar , proper labelling. A shift from low fat / high carb diet has resulted in an epidemic of obesity and metabolic syndrome in young people.
4. Government: The government must increase awareness by media campaign, increase budgetary support, curtail food processing and nicotine abuse and must create a better healthcare infrastructure to support early diagnosis and treatment of heart attacks.
Dr.Sudhir Pillai in http://www.dnaindia.com
Dr Sudhir Pillai, is a Consultant Cardiologist, P.D. Hinduja Hospital & Medical Research Centre
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