Today, more and more younger people are suffering heart attacks.

A study presented last year at the 67th annual conference of the Cardiological Society of India (CSI) found that the average age of patients with acute coronary syndrome (ACS) during a two-year period at the casualty of the Institute of Medical Sciences, Varanasi, was 30. More than 80% of the patients were smokers, 18% were obese, 59% had low levels of protective HDL cholesterol, and 29% had elevated lipoprotein(a) (LPA), which is known to increase the risk of heart disease and stroke. Around 69% of these ACS patients went on to suffer a heart attack.

“These troubling statistics are the result of the usual suspects—unhealthy lifestyle, poor dietary habits like consumption of excessive junk food, lack of regular exercise, low awareness of risk factors. But lots of new heart messes—excessive alcohol consumption, smoking, sleep deprivation—have been added to the mix, upping the heart attack epidemic," says Nilesh Gautam, senior interventional cardiologist at the Asian Heart Institute in Mumbai.

Among the top risk factors is excessive intake of alcohol. According to a study published in January in the Journal Of The American College Of Cardiology, heavy drinking doubles the chance of an irregular heartbeat, raises the risk of a heart attack by 40%, and more than doubles the risk of heart failure. Dr Gautam says that even if one has no underlying risk factors or a family history of heart disease, alcohol abuse increases the risk.

“Smoking directly reduces the amount of oxygen in the blood and affects the blood vessels adversely, and is thus one of the common causes for heart attacks in young people, especially those who begin smoking young (in their early 20s)," says Rajpal Singh, consultant interventional cardiologist at Fortis Hospital, Bengaluru.

Steroids are a big risk factor too. These fight inflammation and are often prescribed for conditions such as asthma, inflammatory bowel disease, and inflammatory arthritis, “but overuse can increase the risk of developing high blood pressure, diabetes and obesity, which are major risk factors for heart disease", warns Dr Gautam. Also, anabolic steroids, prescription-only medicines that are increasingly being taken without medical advice by the young to increase muscle mass and improve athletic performance, are harmful for the heart. “These are associated with high blood pressure and an increased risk of left ventricular hypertrophy," adds Subrat Akhoury, associate director, Cath Lab & interventional cardiologist, Asian Institute of Medical Sciences, Faridabad.

Sleep deprivation is an important yet often overlooked factor, according to Rajneesh Kapoor, senior director, interventional cardiology, at Medanta—The Medicity in Gurugram, adjacent to Delhi. “We conducted a study spread over two-and-a-half years at our hospital on 104 patients who were below 40 years old and were physically fit. We found that 68 of them were sleeping less than 6 hours in a day," he shares.

“Sleep deprivation upsets the balance of the key hormones leptin and ghrelin, which regulate the appetite. Sleeping for a minimum of 7 hours can reduce the risk of fatal heart attacks immensely, and combined with other healthy habits such as exercise, the risk of heart attack can be reduced by as much as 83%," he adds.

A study published in May in the Journal Of The American Heart Association found that not getting enough sleep can double the chance of dying from heart disease or stroke in people with metabolic syndrome and risk factors like diabetes, obesity, high blood pressure and cholesterol.

Stress too is dangerous. “Unfortunately, the level of stress cannot be measured (unlike blood pressure ) but it plays a crucial role in aggravating different disorders, particularly heart disease," says Dr Gautam.

Many seemingly perfectly healthy people “suddenly" get heart attacks because their arteries are not perfectly healthy and they don’t know it. “Contrary to popular understanding, most heart attacks don’t strike in severely blocked arteries. Instead, inflammation of the arterial walls is critical as it can destabilize plaque, causing it to rupture and tear the blood vessel lining, creating a clot," explains Dr Kapoor, who advises disciplined lifestyle and food choices to keep inflammation low in the body.

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