If you are good, you are like Pavan Malhotra. He leads a retired life in New Delhi, having bucked a familial trend for 20 years to stay alive. Malhotra, 68, had seen all his immediate family members succumbing to heart diseases, one after the other. He was also handed down a weak heart, which his doctor discovered when he had a mild cardiac attack nearly 20 years ago. “You don’t have the luxury of adding yet another risk factor. So keep yourself in shape and watch your blood sugar and blood pressure and you will be fine,” he was told. “He followed the advice. Today he is as fit as a fiddle,” says Krishan Aggarwal, cardiologist and president of the non-governmental Heart Care Foundation of India.

But if you are unlucky, you are like Arindam Roy. His father had died of a heart attack at a young age, and Roy did all he could to stay fit. He played a regular and vigorous game of squash, cycled to work and back and hated nicotine. Then, when he was 43, he suddenly had a severe heart attack. Roy didn’t know what hit him. After all, he had always gone by the doctor’s book on how to keep heart problems at bay.

So can you beat your genes — or will your DNA have the last laugh? A section of medical scientists and practising cardiologists believes that if you have a family history of heart disease, it is going to stalk you. But a recent study urges you not to condemn your genes: instead, blame smoking, bad diet, diabetes, physical inactivity and blood lipids. It says that almost all cases of heart attacks among south Asians are linked to such risk factors.

The jury is still out on this — as the recent case of Saif Ali Khan demonstrates. The Hindi film actor, just 36, fell prey to what can be called an unwanted inheritance. Saif knew there was a problem in the family: his father, Mansoor Ali Khan Pataudi, former Indian cricket team captain, has a heart problem. His grandfather, Iftikhar Ali Khan Pataudi, who played Test cricket for England and for India, succumbed to a cardiac arrest at the age of 42 in 1952. He died while playing golf.

So Saif did his best to keep fit. He hit the gym thrice a week and watched his diet. But despite all that, the chhote Nawab — an actor much in demand — suffered a mild heart attack earlier this week.

“Saif will be going slow now for a while,” says his sister, actress Soha. “He was always very careful. He took proper care of his health. He would do his exercises on time. He would work out, eat proper food. He wasn’t into overeating or any sort of indulgence. We don’t know how it took a toll on him.”

Doctors say they know how — or why. “Saif is a heavy smoker —— don’t forget that,” says Ravi Kishore, a cardiologist at Narayana Hrudayalaya in Bangalore. And then, of course, there is the family curse.

Family history has for years been recognised as a risk factor that decides whether or not your heart is going to plague you. Doctors always advise people with a history of heart problems to take care. “In such cases, you need to follow a stricter lifestyle,” observes Aggarwal. According to him, all close relatives — siblings or offspring — of men who suffered an attack before the age of 55 and women before 65 should get themselves examined for heart related problems.

Agrees B.C. Kalmath, a cardiologist at Bombay Hospital and Medical Research Centre, “Studies have shown that if your parents have suffered a heart attack, you are four times more prone to it.”

What is worrying is the high incidence of heart attacks in India. Some three million people died of cardiovascular diseases (CVD) in 2000. CVD accounted for 24.2 per cent of deaths in 1990. In 2020, it will be the cause of nearly 42 per cent of deaths from diseases.

So is this high incidence because of a genetic problem in the region? The question troubled heart specialists after they discovered a disturbing trend about two decades ago — heart attacks tend to strike Indians five or 10 years earlier than Europeans or North Americans. “The average age of my patients in the UK is 65 years, whereas that in India is 46,” says Devi Prasad Shetty of Narayana Hrudayalaya.

So a team of international scientists, including a few from India, designed a study to specifically look into the question. The results are just out. The study — which appeared in the January issue of the Journal of American Medical Association — failed to find any genetic reasons for the high incidence of heart attacks in India.

The researchers, who used more than 27,000 samples — from India, Pakistan, Sri Lanka, Bangladesh and Nepal, as well as from other countries — concluded that early heart attacks in the Indian subcontinent may have very little to do with genes or unknown factors.

“What we found was that nine out of 10 early heart attack cases could be easily explained by the traditional risk factors which are commonly found across the world,” says Prashant Joshi, one of the authors of the paper. However, the risk factors — current and former smoking, hypertension, diabetes, obesity, bad diets and so on — were found to be at much higher levels in South Asian patients than in their western counterparts, observes Joshi, who now works at Government Medical College in Akola in Maharashtra.

“Genes may or may not influence one’s vulnerability to heart attacks. But till date the scientific understanding of this is very limited,” says the president of the New Delhi-based Public Health Foundation, Srinath Reddy, who also participated in the study.

Reddy points out that the Indian gene pool hasn’t changed much in recent years. Yet there are a lot more heart attacks today than there were 70 years ago. And the difference between then and now is the change in lifestyle. And since lifestyle behaviour can be checked, heart attacks can be prevented.

Stress, for one, has to be tackled. Saif, for instance, was under serious stress, moving as he was from one shoot to another, or from show to show. There have been more and more cases of the rich and the famous — or the very, very busy — succumbing to stress related to modern-day diseases. Actor Manoj Bajpai speaks of a close friend who was a fitness freak. He died of a heart attack the night before he was to shoot for his debut film. Apparently, he could not take the stress and pressure of working the next day.

“It often gets very strenuous for people like me because we have a lot of action scenes,” says actor Suneil Shetty. “Umpteen takes and retakes make life more difficult for us,” he says.

Suresh Vijan, cardiologist at Lilavati Hospital in Mumbai, narrates the case of a jet-setting executive in his late 30s who had suffered a heart attack. His life was so busy that he travelled to three continents in as many days.

According to Kishore, while stress is not primarily responsible for heart attacks, it can be a precipitating factor, if one is already carrying any other risk factor. Aggarwal believes that other factors need immediate attention. He calls them the “ABC” of preventing heart attacks. A is for abdominal circumference, which should be less than 36 inches for men and 32 for women. B is for controlled blood sugar and blood pressure, and C is no to Cigarettes.

If you are careful on these counts, half the battle is won. And even a genetic problem, adds Kishore, is not the end of the road for anyone. “Many of my patients have records of early heart attacks in their family, but they continue to lead a normal life by keeping other risk factors in check.”

So what’s the moral of the story? It’s all about taking care — and more so when the genes are troublesome. If you are careful, you will live like Pavan Malhotra. But if you are an Arindam Roy, take that extra bit of care. A heart attack, after all, is just a signal urging you to slow down.

(Some names have been changed to protect the identity of patients.)

The stars foretell

I avoid junk food. I don’t even like to eat out, and I avoid eating when I party. I live on fruits and juices when I go for outdoor shoots.

Akshay Kumar, actor

 

You have to be very careful. You need to simply close your eyes to food even though it may look sumptuous.

Neetu Chandra, actress

Working out helps us keep in shape, though health problems can happen to anyone. My morning workouts keep me going.

Suneil Shetty, actor