Cardiovascular ailments top the list of diseases that kill. Symptoms are many and only the right treatment at the right time can save lives. World Heart Federation celebrates 29th September as 'World Heart Day' - a day to increase awareness on preventive measures to avert heart diseases. But then, not many are willing to take these measures. Only when they realise that an unexpected heart attack can drag them to death, do they start thinking of ways to prevent them. By then it could be too late.
Why is the number of heart patients increasing alarmingly?
Results of a study, jointly conducted by the Public Health Foundation of India and the Harvard School of Public Health that included eight lakh people from 27 Indian states, have been published in the journal called Plus Medicine. People between the ages of 34 and 70 were examined for a period of three years. The subject of the study was the increasing number of heart patients in India and the reasons for the surge. Kerala is leading in terms of the severity of heart disease. 19.90 per cent of people in Kerala have a dangerously increased risk of heart disease. In 1993, the incidence of heart disease in Kerala was 1.4 per cent, but in two and a half decades, it has jumped to 19.90 per cent. Men (32%) are more prone to the disease than women (15pc). While smoking is considered the leading cause of heart disease in the lower economic middle class, high blood pressure, elevated cholesterol, diabetes, and obesity are the main risk factors among those in the upper strata.
Another study conducted in 2016 put the number of people with cardiovascular diseases in India at 54.5 million. Cardiovascular diseases claim one in four lives. The Registrar General of India has been publishing statistics at regular intervals. Death from heart disease has more than doubled in the last 30 years - from 15pc in 1980 to 32pc in 2013.
According to a survey in 2018-19, the death rate from heart disease among people aged between 40 and 69 in Kerala was 37.8pc. Among those over the age of 70, the number rises to 45.7pc. At least 63,000 people die due to heart attacks in Kerala every year. In India, an average of 29pc die of heart disease, while in Kerala it is more than 40pc. It is estimated that by 2030, 35pc of the Indian population will die of a heart attack. It's alarming.
The condition of people below 30 years is pitiable.
In September 2020, Srichithira Thirunal Institute, Thiruvananthapuram, published the results of a study conducted between 1978-2017, based on the risk of heart attack and subsequent death in people under 30 years of age. Most of the studies to date have been conducted on people aged between 30 and 74. When people below 30 were admitted to the Srichithira Thirunal Institute for heart attack and treated for the next 10 years, it was observed that 30 percent of them succumbed to death; 48 percent died after 20 years. This death rate surprised everyone. It was found that the condition of people under 30 is more pitiable than that of older adults who suffer heart attacks. The results of 40 years of extensive research and observations were published in the September 2020 issue of the Indian Journal of Medical Research.
Delay in receiving treatment is the main cause of death among the young: 38 percent reach the hospital after the desired time limit.
Primary treatments (primary angioplasty, thrombolytic therapy to dissolve blood clots) are only beneficial if received within a specific time frame. The 'golden period' is an hour and a half. If a patient is able to undergo primary angioplasty within this time frame, the narrowed coronary artery can be resected (or expanded) by placing a stent. In this way, it is possible to pump blood to heart cells that are close to expiry but not yet dead. Heart cells that are suffocating due to blood deficiency will receive vital air and nutrients and return to their original state and heart function will be balanced. On the other hand, hours or days after a heart attack, heart cells die or become weak. The heart's contractility declines and such patients die quickly.
When risk factors become the main villain
A high prevalence of traditional risk factors was seen in 95 percent of people admitted with heart attacks. Cholesterol was found to be excessively elevated in 88.5pc. Various risk factors like smoking (63.5 percent), alcohol consumption (20.8 percent), high blood pressure (8.8 percent), and diabetes (4.4 percent) were associated with heart disease. No obvious risk factors could be found in 4.4 percent. Alarmingly, even after being discharged from the hospital after a heart attack, a good percentage of people failed to follow the doctor's instructions and persisted with their bad habits. According to the study, 34 percent continued to smoke, 16.8 percent drank alcohol, 50 percent refused to exercise, 41 percent stopped taking prescribed medications, and 79 percent did not follow the diet. So these are the reasons for the increased death rate among youngsters.
What is the Kerala paradox?
In terms of literacy, Kerala ranks first (96.2 percent) among other states in India. It also leads the country in terms of life expectancy.
The study shows that life expectancy of Indians has increased by more than 10 years in the last three decades. But life expectancy varies in different states due to various reasons.
Kerala ranks the highest for life expectancy. In 1990, the average life expectancy in India was 59.6 years. In 2019 it was 70.8 years. Currently, the life expectancy in Kerala is 77.3 years. However, this cannot be considered a healthy life expectancy as several people live with diseases and physical challenges as they age.
The phenomenon seen in India and other countries is that infectious diseases are decreasing (currently the spread of Covid-19 is a standout) and lifestyle diseases are increasing. Thirty years ago, maternal mortality, malnutrition and infectious diseases reduced the life expectancy of South Indians. In 1990, infectious diseases were only 29 percent. But today it has risen to 58 percent. Heart disease, diabetes, high blood pressure, stroke, bone diseases, lung diseases, etc have deteriorated the health of Indians in the past 30 years.
In Kerala, which stands out in terms of literacy and life expectancy, it should be assumed that heart diseases and other lifestyle ailments such as blood pressure, diabetes, obesity, etc. are low. But the truth is the opposite. That is Kerala paradox. Heart diseases are on the rise. Related lifestyle diseases are also far ahead of the Indian average. 60% of men and 40% of women in Kerala die before the age of 65 after cardiovascular disease, a consequence of early-onset arterial conditions. Here the first heart attack occurs 10 years earlier than in other states. It should be remembered that 60-80% of a family's income could be wiped out if an economically backward person suffers a heart attack.
When heart disease leads to death
It appears that Keralites are not afraid of diseases, especially lifestyle ailments. If at all, they have some fear of infectious diseases like COVID-19. The Covid pandemic has claimed 6.5 million lives globally until September. A good percentage of these people must have had heart diseases.
17.9 million people worldwide die from heart disease every year. That means heart disease is still the leading cause of death in the world.
Heart disease can be prevented, but Malayali hardly care
Can heart disease be prevented? Of course, but what if the Malayali doesn't want it? Even if you tell a Malayali after assessing his quality of life and the risk factors, that he might be prone to heart attack or death, he is not hassled. Even if they are told that by regularizing their lifestyle and preventing the risk factors, at least 90 percent of heart diseases can be avoided, they are not willing to listen or obey. This is the current situation. Finally, the same Malayali will burst into tears when he is admitted to the intensive care unit with a heart attack. Then you can witness a rush to regain health and life. He would sell everything and get an angioplasty or bypass done. Therefore, hospitals are now competing to set up Cath labs in Kerala. It is estimated that there are more than 140 Cath labs in Kerala. It should be remembered that these facilities are comparable to any civilized country in the world. The reason is that there is no place to treat heart patients when they multiply.
According to a massive inter-heart study conducted on 27000 people from 52 countries by Canada-based Malayali Prof Salim Yusuf, it was found that the prevalence of nine risk factors (smoking, high blood pressure, high cholesterol, diabetes, obesity, lack of exercise, poor diet, alcohol consumption, and stress) accounted for 90 percent of heart disease. It has been shown that 90 percent of heart diseases can be prevented by identifying and controlling these risk factors. Hereditary and genetic factors, which account for 10 percent, are not controllable. Don't you want to know the severity of the risk factors seen in Malayalis which are much more than the Indian average? Statistics show that 65,600 people die every year in Kerala due to the effects of high blood pressure, increased cholesterol accounts for 52.3 percent, high blood pressure at 38.6 percent, diabetes at 15.2 percent, and smoking at 28.1 percent.
Today, 40 percent of people who come for examination in the outpatient department in Kerala have high blood pressure. A survey conducted in 2016 found that 66.1 percent with high blood pressure were not receiving treatment. About 40 percent of people are not aware that they have high blood pressure. Similarly, more than half of the food-obsessed Malayalis have elevated cholesterol.
Remember that prevention is the key. Treatment and screening for heart diseases are expensive. It is better to prevent the disease than go bankrupt due to rising treatment costs. It is only a misconception that you don’t need to worry if you have access to a good doctor and a big hospital.
(Dr. George Thayil is Senior Consultant Cardiologist, Lourdes Hospital, Ernakulam)