Diseases reacquaint us with mortality, making us experience an altered state of health and well-being. They hold up a mirror to us, how we treat ourselves and each other. Epidemics hold up the same mirror to the human race. They question us about how we wish to evolve. For many decades now, heart disease has been asking us the same question.
A silent epidemic afflicting a fourth of India’s population and responsible for a third of all deaths, heart disease is increasingly claiming the young. We are regularly shaken by the news of young and seemingly healthy Indians succumbing to heart diseases and cardiac arrests. We mourn the early loss of life, but largely return to following the same unhealthy lifestyle that increases the incidence of heart disease. We wonder what is driving this sudden upward trend of cardiac illness — and one part of the answer is Covid-19.
Covid-19 is known to cause myocarditis (inflammation of the heart muscle) weakening the heart muscle, causing arrhythmia (irregularity of the heart rhythm) and sudden cardiac arrest (SCA). There are longstanding ramifications of Long Covid, during which time inflammation in the heart, besides the body, lingers on for weeks to months. Many people start exercising in this vulnerable period and end up with cardiac arrest — indicating that while outward symptoms may subside, the effects of myocarditis, and how it affects the body, need to be monitored even when (and after) a person tests negative for the infection.
This was particularly acute in the Delta wave that swept through India last year, with at least 15-20% Covid patients showing signs that the virus affected their heart function — this included people in their 30s, an age group that usually doesn’t develop heart ailments (and were relatively unaffected during the first wave of Covid-19). Patients with a history of heart-related illness, bypass surgeries or with stents in their hearts sought medical help for severe symptoms after they tested positive but, in some cases, patients with no pre-existing history of cardiac ailment were also affected. Therefore, anybody contracting the infection would do well to undergo a series of specifically tailored tests to check the condition of their heart even after the symptoms disappear and they test negative — especially if they aim to undergo strenuous physical exercise.
But Covid-19 alone cannot be blamed for the surge in cardiac deaths among younger people. We must remember that even though there is a lot of evidence on Long Covid Syndrome’s effect on cardiovascular health, the scientific findings are still in the early stages. Such deaths have been happening for a few decades and the pandemic has only exacerbated this trend, indicating that the way our lifestyle is evolving is dangerous.
The major cardiac risk factors — diabetes, hypertension, and hypercholesterolemia (very high levels of bad cholesterol) — are not just caused by obesity but also stress, lack of sleep, irregular eating patterns, use of body-building drugs, alcohol and tobacco use. Each of these increases a person’s risk of developing atherosclerosis, coronary artery disease, sudden cardiac arrest, and arrhythmias (irregular heartbeat). Add to this list our genetic make-up.
The Thrifty Gene hypothesis says that certain populations survived famines by storing fat, giving them an evolutionary advantage. I believe that it could also predispose us to heart problems at least 10 years before our western counterparts. Our sedentary lifestyle and diet advance our at-risk age by another decade. So, if the average age of developing a heart disease for Americans is 70, an Indian is likely to develop it by 50. This figure, however, still does not explain how an increasing number of men and women in their 30s and 40s are developing heart disease. For this, we must observe our teenagers. A review of scientific data and clinical observations shows a sustained rise in the number of children who are obese and hypertensive, pointing to the role of calorie-rich diets and sedentary-stressful lives. The pandemic is also likely to have contributed as it restrained children indoors, disrupted school, sporting activities, and increased screen time.
Guided by scientific observations, clinical findings, and my experience, I believe that a deeper study of genetic understanding has the potential to turn the Indian population’s genetic disadvantage into a strategy against heart disease. We should look at our family tree to trace vulnerabilities and use the learnings to find the best possible prevention and treatment plan. There is a 25% chance of a person developing heart disease if one of their parents has it too. If no parent has a cardiac history, but multiple second line of relatives do, then also the risk is high, especially when coupled with environmental and lifestyle factors. In such cases, even the young must approach a cardiologist, and be evaluated against a matrix of heart health parameters to assess their 10-year risk, besides being prescribed a prevention plan. While there is little that can be done about non-modifiable risk factors, studies and our clinical experience show that consistent lifestyle modifications can stop and reverse heart disease, thus improving the quality of life and long-term health outcomes.
The foremost recommendation is not to chew or smoke tobacco or vape. The young must remember to stay active. The human body was designed to move. It starts ageing very rapidly when we don’t put it to use. Add to it our habit of consuming tasty or processed food over healthy food to beat stress, and obesity and diabetes become inevitable. They hit the heart by damaging the nerves and blood vessels that are further squeezed by hypertension.
Build habits slowly and be consistent. Exercise at least thrice a week for 30 minutes, do yoga. But if you do get lazy, call it a day with pranayama and meditation. If you are stressed and overworked, remember to breathe deeply, even if it is for five minutes. Whatever you do, do it every day.
Dr Naresh Trehan is managing director, and chairman, Medanta
The views expressed are personal