World Heart Day: How to keep your beat safe?

The theme for World Heart Day (WHD), which falls on September 29 (Monday), is 'Don’t miss a beat.' This year marks the 25th Anniversary of this heart awareness day, when the World Heart Federation attempts to unite its global networks to advance cardiovascular disease (CVD) prevention. This theme is very relevant to Kerala.  Most recently, the public attention to this rampant lifestyle disease was ignited by the unfortunate death of a 46-year-old gentleman while dancing during the Onam celebrations in the Kerala Assembly.  About 20 million deaths occur in the world every year due to cardiovascular disease. One in 5 people dies prematurely, below the age of 65 years, and 80 per cent of these deaths are preventable.  

Behavioural risk factors
Four major behavioural risk factors:
1)Unhealthy diet
2) Physical inactivity
3) Tobacco use
4) Unhealthy indulgence in the consumption of alcohol... Leads us to the four major non-communicable diseases: 1) 1)Cardiovascular diseases
2) Cancer
3) Chronic respiratory disease
4) Diabetes
Adopting a healthy lifestyle, including a prudent diet, regular physical activity, adequate sleep, and avoiding tobacco and alcohol, forms the fundamental pillars of preventing these diseases.

Adults over the age of 30 should supplement it with regular health check-ups to monitor elevated blood sugar, cholesterol, and blood pressure levels. A yearly workup could be ideal if any family member is already affected. High blood pressure is asymptomatic in the majority, and 4 out of 5 people who have high blood pressure are not getting the appropriate medications needed to control their blood pressure.  

Why are cardiac diseases high in Kerala
Kerala is now the epicentre for the tsunami of heart diseases due to various cardiovascular issues, with high prevalence of diabetes,  hypertension,  and elevated blood cholesterol levels, putting them at maximal risk for cardiovascular disease, compared to the rest of India. Approximately every 7 minutes, somebody dies in Kerala due to a cardiovascular disorder.  The wide prevalence of heart disease and diabetes is reflected in the proliferation of cardiac catheterisation laboratories (cath-labs) and dialysis centres in Kerala.

Kerala now has around 200 cath labs, approximately one cath lab for every 2 lakh adults, which will be a record when compared to the usual recommendation of one lab for a population of 5 lakh. The health transition for Keralites from diseases due to malnutrition and infections, which were prevalent in the 1970s, to significant morbidity due to non-communicable diseases, which happened over a period of 30 years. 

Kerala-based study 
Community studies by Dr CR Soman at the beginning of the millennium threw light on this ticking time bomb. In 2007, systematic studies conducted at Varkala demonstrated its association with detonation, showing that the age-adjusted cardiovascular mortality in Kerala is almost twice that of the United States and three times that of Japan (published in 2013). 

The study also showed that deaths due to stroke and heart attack in women are also substantially high compared to the two countries taken for comparison. The flames of this time bomb detonation are now very evident in the health status of Kerala. Kerala was given the title of the Diabetes Capital of India at the beginning of the millennium, and the prevalence of non-communicable disease risk factors in Kerala now exceeds the prior predictions made, except for the decline in the prevalence of tobacco smokers.  This translates into destructive health spending by the people of  Kerala, who have a very meagre support system in the form of health insurance. The health system in Kerala, therefore, requires a policy change to address the younger age escalation of non-communicable disease risk factors and diseases.   

Why is Kerala's cardiac health poor?
In the 2004 article, Dr CR Soman had critically called attention to the declining physical activity in Kerala, which is now reflected in the increasing obesity rates documented by the NFHS surveys 4 and 5, conducted five years apart between 2015 and 2021. Obviously, the increasing environmental temperature is a significant deterrent to engaging in work, transport, or leisure-related physical activity. The type of clothes which Keralites wear could also be a deterrent.

The gadgets with screens providing unlimited entertainment take away the time spent on physical activity and sleep. It also provides opportunities for indulging in an unhealthy diet, facilitated by advertisements and the immediate availability of online provisions.  Screen-induced physical inactivity now begins with children and is perpetuated by academic pressure. 

COVID needs to be blamed for making the screens unavoidable for children.  In many cities in Kerala, children spend more time commuting to schools and tuition centres than engaging in physical activity. In this context, the government's expenditure on school uniforms, amounting to Rs 80 crores per year, if diverted to facilitate physical activity in children, could be a worthwhile long-term health investment.  Competitive academics need to give way to cooperative talent development.  

Unhealthy mothers
The other major driver of this younger age escalation of risk factors is the increasing prevalence of non-communicable disease risk factors among 'to-be mothers.' One-third of the pregnant mothers in Kerala now suffer from obesity,  diabetes,  or high blood pressure.  The first nine months of the developing baby in the mother’s womb program them for the early onset of these risk factors and diseases, as shown by the follow-up studies from Mysore and Pune. 

At present, Kerala has a strong medical system, which does the last hour firefighting by identifying and treating these disorders in pregnant mothers. What we need to do is to facilitate the development of healthy lifestyle habits in adolescent children, so that they become healthy parents when they become mothers.  About a third of the teenage girls already have markers of early onset of these risk factors, like obesity, PCOS and acanthosis nigricans.

The major challenge ahead for healthcare workers and the healthcare system in Kerala is to identify what works with these Gen Z children to help them adopt a healthier lifestyle, ensuring healthy parenting. What happens in Kerala is essentially a harbinger of what is to come in the rest of India and the developing world. Hence, these health challenges offer a golden opportunity for us to seize and work towards maintaining our health system as a role model.   
(The writer is an Adjunct Professor of Cardiology 
Manipal Academy of Higher Education, Manipal, Karnataka)
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