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Indians at home & abroad run highest risk of heart disease

Mumbai, Dec. 10: India is the world leader in heart disease.

According to the World Health Day 2002 report by WHO, India is home to an estimated 45 million heart disease patients — and they are getting younger by the day. Its closest competitor is China.

Current projections suggest that by 2020, India will have the largest cardiovascular disease burden in the world, the report adds. By 2020, one-third of all deaths are slated to be from coronary heart disease.

There are more modest estimates of the epidemic. Says Dr K.S. Reddy of AIIMS, quoting The Global Burden of Disease, by C.J.L. Murray and A.D. Lopez, 1996, that while 28.4 per cent of 35+ Indians were suffering from heart disease in 1981, in 2021, the figure is supposed to shoot up to 42.4 per cent.

But everyone agrees that coronary heart disease is the biggest killer in 21st century India. It is not because of population strength.

“Indians are at the highest risk of developing coronary heart disease (CHD) among all ethnic population in the world,” says Dr Ramakanta Panda, cardiac surgeon and CEO, Asian Heart Institute and Research Center, a sprawling heart clinic that came up recently in the city. “CHD tops the list for death and disability for the new millennium in India, whereas such deaths have come down significantly in the West,” he adds.

A special warning to the young. Heart disease in developed countries is getting older, with the vulnerable population being 50+. But in India, it’s the reverse trend; heart disease is increasingly becoming common in persons in their 30s and 40s, especially in urban areas, because of the three S’s — increased smoking, stress and sedentary lifestyle.

Working women are especially at risk, too, because of being one of the most stressed segments.

“There are no absolute figures regarding the disease,” says Dr Jamshed Dalal, cardiac consultant with Leelavati, Breach Candy, Hinduja and Holy Family hospitals in the city, because there are so many cases that are not reported or misreported, especially from rural India. “But there are many reasons why the disease affects Indians most,” he says.

The conventional risk factors are well known: smoking, high blood pressure, cholesterol, obesity, diabetes (India is home to 35-40 million diabetics, too, and heart disease and diabetes are often coincidental) and family history. The new risk factors include high triglycerides, insulin resistance, the so-called metabolic syndrome and fibrinogen factors.

It has a lot to do with the Indian diet, feel doctors, which is heavy in fat, and the low health awareness level.

But more and more doctors are saying that it is something in the Indian constitution.

The Barker hypothesis, outlined by David Barker and his colleagues, says that death risk from coronary heart disease is highest among those who were thin at birth and at one year, but whose weight gain accelerated in childhood, so that they have an above-average body mass later. This scenario is not difficult to envisage in India.

“Indians generally have weaker arteries, too, compared to other ethnic groups,” adds Dr Dalal.

Their special vulnerability is reflected in the many recent studies done on migrant Indians. If their cousins in the native land are suffering, NRIs are not faring any better.

Indians around the globe have the highest rate of heart disease despite the fact that nearly half of them are lifelong vegetarians.

According to the website, www.cadiresearch.com, a site for data on “coronary artery disease among Indians”, the death rates among overseas Indians have been 50 to 300 per cent higher than Americans, Europeans, Chinese and Japanese, irrespective of gender, religion, or social class, a figure corroborated by doctors.

Among those under 30, the mortality among Indians is three-fold higher than Whites in the UK and 10-fold higher than the Chinese in Singapore, the term Indian referring to all with origin in India, Pakistan, Bangladesh and Sri Lanka.

About 50 per cent of all heart attacks among Indian men occur under the age of 55 and 25 per cent under the age of 40, unheard of in any other population.

Given the scenario, it is a happening scene for the healers. No wonder so many heart clinics are coming up in the city — Asian Heart Institute is to be followed by Nitu Mandke institute, another plush clinic.

There are specialised services mushrooming, too: Dr Lal Pathlabs, a state-of-the-art pathological laboratory which set up shop in the city recently, offers a lipid profile which is meant to identify specific problems that are missed out in a routine test.

There are world-class doctors coming to the city, performing heart surgeries. Last week, the city played host to Dr Shigeru Saito from Japan, who performed two quick transradial angioplasty operations, one taking 15 minutes and the other 25 minutes.

But no doctor fails to remind the patient that heart disease is predictable and curable: with a healthy low fat diet and physical exercise. And prevention is better than cure.

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