Speculative theories about heart health have never appealed to senior Nagpur physician Dr Prashant Joshi. Mutation, genetic alteration, environmental factors—he thinks little of their role in the heart disease epidemic that has swept India over the last 15 years.
So, when the analysis of the data he collected over four years on Indians with coronary diseases came in from the Population Health Research Institute in Canada, it merely proved what he had believed all along. That bad lifestyle habits were responsible for the 10-year drop in the age of cardiac disease in India.
“Indians below 40 do not suffer from cardiac diseases because they have genetic disadvantages like thin arteries or bad lipoproteins. Ninety per cent of heart patients eat, drink and live badly,” says Dr Joshi, whose work with a team of 10 doctors on heart disease among South Asians was published in the Journal of American Medical Association (JAMA) last month.
At the root of the problem lies one single factor: altered lifestyle. Fifteen years ago, 30-year-old Pune techie Abhishek Tripathi would have had no reason to seek out a cardiologist. He doesn’t smoke, doesn’t drink and is a staunch vegetarian. But last year was particularly tough for the programme analyst who works in one of India’s leading software companies. In January, he joined a huge project with a three-month deadline that turned his life upside down.
“Very often, I would come in to work at 9am and return home early next morning. A 14-hour workday was normal. I barely slept those days. It got so bad that once in three days, I would end up forgetting dinner. Or manage with standard canteen fare like vada pav and samosa,” he says.
In April, Tripathi started suffering severe back and chest pains. He endured the pain till July last year, when his doctor asked him to take a treadmill test. The results were disturbing enough for the doctor to seek an angiography. It showed up a 95 per cent block in an artery, severe enough to warrant a bypass surgery.
“It was a huge shock to me and I couldn’t swallow the idea that I needed a bypass at 30. It took me a couple of weeks to agree to it. But I managed to recover within three weeks of the surgery,” he says.
Tripathi would make for a typical patient under the JAMA scanner. Of the 470 Indians in the survey, 11% were below 40. The mix of factors behind their heart problems was classic.
In the group, every patient below 30 smoked. Some 25% of the risk of a heart attack, says the study, comes from eating less than a fruit a day. It has now been proved that 400gms of fruit a day (that’s about three small apples) goes a long way in keeping the heart healthy. Even those who did include the prescribed 400gms of vegetables in their diet usually overcooked them in curry, killing all protective folate content. Around 36% of those afflicted did not exercise. And high levels of stress worked alone as well as with this cocktail of factors to worsen the crisis.
Three decades ago when Dr Ramakant Panda started practising, patients in their 40s were rare. And he cannot recall treating any patients in their 30s. Now the director of the Asian Heart Institute Research Centre (AHIRC) in Mumbai sees at least one young patient being wheeled into his clinic every three days.
Today, his biggest concern is the number of patients aged between 28 and 32, with blockages severe enough to warrant a quick bypass surgery. “My doctors are now getting used to seeing patients in their early 20s. It is a serious epidemic and we don’t seem to realize its social and economic costs. You can’t just retire at 30,” says Panda.
The World Health Organization predicts that by 2020, five million Indians will have cardiovascular diseases. This means a 111% rise in numbers since last year and a huge leap from the 15% projected for developed countries like the US and the UK.
At the Heartcare Foundation in Delhi, Dr K.K. Agarwal has a radical theory about why the epidemic is spreading in young Indians. “I believe that the Indian heart is genetically programmed to the Indian way of life. If we thoughtlessly start aping Western food habits and ways of life, it cannot cope. The only way out is to return to basic Indian food habits,” he says.
Typical Indian notions of vegetarianism, however, don’t seem to guarantee a healthy heart. Twenty-eight year old entrepreneur Amit Vira, who belongs to a strictly vegetarian Kutchi Jain family, says the community newspaper often reports heart-related deaths among its younger members. The last victim he read about was all of 23. The family itself is prone to cardiac problems—the grandfather was 84 when he suffered a heart attack. Vira lost his father at 54 to a malfunctioning heart valve.
The problem lies in the kind of vegetarian food that makes for the daily Indian diet. The Vira family, for instance, loved a rich vegetarian spread on the dining table. They also loved bingeing on pizza, sandwiches, sev puri, pao bhaji and samosas.
But the heart attack Vira suffered last March jolted the family into bringing in some sweeping changes in its eating habits. Wife Sonal has now replaced the ghee and the groundnut oil in the kitchen with olive and sunflower oil. Vira and his grandfather split a cup of a highly spiced Ayurvedic brew in the mornings. It consists of arjun chaal (Arjuna myrobalan), believed to be a cholesterol reducer, stirred into milk with sugar. Cinnamon powder, dried ginger and mango ginger are other home remedies that the family is using increasingly in its cooking. An aunt has devised for him a digestive using flax seeds now recommended as a wonder cure for coronary problems (see box).
The other big change in his life is at the workplace. Vira, whose firm, ITISL System and Network Solution, sells customized software, has scaled down his sales target so that he can lead an easier life. “I used to be very ambitious and aggressive, but no longer. I have lowered my expectations. It is telling on my sales figures, but I would rather live,” he says. Vira’s weekend mornings are now reserved for cricket and he works out at the gym every single day.
Stress has now been proved to be an independent factor in heart disease. It releases a stress lipid, catecholomes, which is damaging to the heart. It also sends out of kilter the kind of food and exercise routines the heart needs to stay fit. Even health-conscious high achievers, who realize that there is a problem with their lifestyle, find it hard to steer their life in a different direction.
Twenty-nine year old sales executive Namit Panpalia, for instance, had to opt out of two jobs with job portals because they required hectic working hours. Panpalia, who suffered a severe heart attack last April, followed by a botched-up angioplasty at a Hyderabad hospital, says he now wants to find a stress-free assignment. “I want to be in a situation where my workday will allow me a healthy lifestyle, not always possible in a sales job,” he says.
Workplaces headed by highly health-conscious bosses sometimes do manage to make a positive change. For instance, Vijayan Krishnamurthy, CEO, JP Morgan, has been trying hard to whip up enthusiasm among his staff for a cardiac health programme. During his earlier stint at JM Financial Ltd, Krishnamurthy had led a vigorous cardiac health campaign at work and managed to get half the staff to join with dramatic results.
Krishnamurthy is a fitness freak himself. He has stuck to a gym workout schedule for 30 years now and is very particular about healthy eating. His fitness formula for JM was pegged on his observation that people use every excuse to not exercise. “So, if you bring exercise, good food and health tests to their doorsteps, they cannot resist the offer beyond a point. But we still had employees refusing blood tests at home,” says Krishnamurthy.
At JM, staff were refunded their gym expenses if their work-out attendance exceeded 50%. And the better the attendance, the higher the reimbursement. Those who chose to work out at home were given exercise schedules that did not require machines. If employees chose not to exercise, they were given pedometers to ensure they did the 10,000 steps a day essential for heart health.
At the end of two years, the experiment showed very clear results. “The cardiovascular fitness profiles of all the participants showed huge jumps,” says Dr Ashish Contractor, who heads the rehabilitation and preventive cardiology section of AHIRC. The lipid profiles of those who had bad numbers to start with, changed dramatically. And those who were more compliant did much better.
The JAMA study proves what traditional cardiologists have always stressed. It takes four basic lifestyle inputs to keep coronary disease at bay—240 minutes of exercise a week, 400gms of fruits and vegetables cooked only partially or eaten raw, and small doses of leisure. “But these habits have to start young, by the early teens. The West has managed to push the age of heart disease by more than a decade since the 1950s with sheer effort. There is no reason why we cannot reverse the epidemic here,” says Dr Panda.