Why are young Indians increasingly dying of heart diseases?

Most cardiologists say that over the past decade there has been a rapid rise in heart attacks in people aged 25-55 in India and the issue has been exacerbated after COVID-19

The shocking death of singer Krishnakumar Kunnath, better known by his stage name KK, due to a heart attack has brought the focus back on the alarming rise in the instances of the fatal condition among Indians under 60 years of age.

KK, 53, had just performed at a concert in Kolkata on the evening of May 31 and collapsed after complaining of chest pain and uneasiness in his hotel room. He was declared dead on arrival at the hospital where he was taken for treatment.

Cardiologists say his death may be yet another example of how cardiac arrests are becoming commonplace among Indians less than 60, in line with some other developing countries.

The reasons attributed to the spike in heart ailments include sedentary lifestyle, lack of exercise, stress, smoking and consumption of alcohol, lack of proper sleep, and poor nutritional choices. Underlying diseases such as hypertension and diabetes—sometimes undiagnosed—increase the risks manifold.

A paper published in India this year said the incidence of those suffering heart attacks has almost doubled in the last 20 years and 25 percent of these people were below 40 years of age.

The most recent Global Burden of Disease study, brought out by the Institute for Health Metrics, University of Washington, Seattle, said that the death rate in India due to cardiovascular diseases—heart conditions that include diseased vessels, structural problems and blood clots—is 272 per 1 lakh people, compared with the global average of 235.

Government data shows that every year, cardiovascular diseases cause 24.8 percent of total deaths in the 25-69 age group in the country, far higher than any other disease or condition.

Heart attack and cardiac arrest

Dr Haresh G Mehta, a consultant interventional cardiologist with S L Raheja Hospital in Mumbai, explained that a heart attack, called myocardial infarction medically, occurs when blood supply to the heart is blocked, usually due to a clot.

Cardiac arrest is not the same as a heart attack—the former happens when the heart stops beating for a while or completely. A person having a heart attack is still talking and breathing (and in many cases not even aware of the event) but such a medical episode increases the risk for going into cardiac arrest.

Dr Mehta also said that shortness of breath, chest pain that often extends to the hand and neck, and uneasiness usually precede a heart attack.

“Unfortunately in many cases there are no signs at all,” said Mehta.

Nurturing a healthy heart

Dr G Ramesh, senior consultant interventional cardiologist with Yashoda Hospital in Secunderabad, said that although there is no definitive age to experience a heart attack, the kind of lifestyle choices you make, your diet plans, your workout routines and how you manage your stress levels can influence your probability of undergoing such an emergency.

The most important cause of heart attack in the young is smoking. Other reasons are sedentary lifestyle, eating junk food, early onset of lifestyle diseases like diabetes and hypertension, in addition to stress,” he said.

Also, according to Dr Ramesh, many young people start on an exercise regime at their gym without a pre-cardiac check-up and even go for exercises such as weight training, which increases the thickness of the heart wall.

A thickened heart muscle and changes in the structure of heart cells can cause changes in the heart’s electrical system, resulting in fast or irregular heartbeats. Atrial fibrillation can also raise the risk of developing blood clots, which can travel to the brain and cause a stroke.

Some even take supplements that are not good and cause damage to the heart, leading to arrhythmia (irregular or abnormal beating of the heart).

Dr Ankur Phatarpekar, director cath lab and interventional cardiologist, Symboisis Hospital, Mumbai stressed that a healthy heart is essential for general wellbeing.

At any age, adopting a healthy lifestyle can help you avoid heart diseases and reduce your risk of a heart attack or stroke,” he said, adding that even if one has previously had a heart attack, changing their habits to support good health can make a difference.

COVID-19 and heart diseases

Dr Ramesh pointed out that while increasing heart diseases have been an observable trend over the last decade, the rise in cases last year is more concerning. There is empirical evidence supporting that statement.

A massive study carried out in the US on over 1.5 lakh volunteers, whose findings were published in February this year, showed that even a mild case of COVID-19 can increase a person’s risk of cardiovascular problems for at least a year after being infected by the virus.

Researchers found that rates of many conditions such as heart failure and stroke were substantially higher in people who had recovered from COVID-19 than in people in a similar cohort who hadn’t had the disease.

The most alarming finding was that the risk was elevated even for those who were under 65 years of age and lacked risk factors.

These results highlight the indirect burdens of COVID-19 that people worldwide may have to bear for a long time to come.

Immediate assistance needed for those in dire need

Dr Mehta pointed out that many patients may often be revived with cardiopulmonary resuscitation (CPR), an emergency procedure that can help save a person’s life if their breathing or heart stops.

During cardiac arrest, the heart cannot pump blood to the rest of the body, including the brain and lungs. Death can happen in minutes without treatment and most estimates show that about 9 in 10 people who have cardiac arrest outside a hospital die.

CPR, which is a set of chest compressions accompanied by blowing into the airway of the patient, can help revive patients or at least keep them alive until expert medical help is available

There has to be general awareness and basic training on CPR given to a large number of volunteers and automated external defibrillators installed in public places,” Dr Mehta said, pointing out that in some developed countries such as the US, there are defibrillators installed at places such as auditoriums, airports and malls

Some other experts however said that while defibrillators may also be visible in many public areas in India as well, but they are few and far between and knowledge of how to keep those undergoing heart emergencies alive is woefully lacking.