What's wrong with young Indians' hearts?

Exactly 10 days ago, power star Puneeth Rajkumar, one of the most bankable actors in Kannada cinema, collapsed after a morning workout and died within hours.

The untimely death of the 46-year-old actor, a fitness buff and the face of a heart care campaign, sent shock waves across the country, with everyone wondering — how could this happen? The aftermath of the tragedy saw Bengaluru hospitals flooded by young people worried about their health.

Medical researchers tracking India’s cardiovascular disease (CVD) burden, however, were not surprised. They are seeing such cases more frequently in the recent past. Documenting the changing landscape of CVDs over the past two decades, they have come up with similar conclusions — heart diseases cause the maximum deaths in India and the number is on a steady rise.

Since CVD strikes Indians nearly a decade earlier than other populations, a large number of heart attacks happen to people between 30 and 69 years old.

“Nearly 30 per cent of heart attacks come suddenly,” said Dorairaj Prabhakaran, who heads the Centre for Chronic Disease Control at Gurugram.

Experts list the rapid expansion of the disease in the population, early age of disease onset and high case fatality rate as a particular cause of concern in the Indian CVD epidemic.

India’s epidemiological transition from infectious to non-communicable diseases took place rather fast. Between 1990 and 2010, premature mortality in terms of years of life lost rose by 59 per cent, from 2.32 crore to 3.7 crore. Despite wide variations in the prevalence of risk factors, CVD has emerged as the leading cause of death in all parts of India, including poorer states and rural areas, mainly due to lifestyle changes.

"Between 1990 and 2015, the prevalence of the CVD rose by more than 50 per cent in India and in a population of more than a billion people, 1

0 per cent people without any risk factors, may suddenly experience a heart attack,” Prabhakaran said.

There are several such incidents in recent memory. A month before Puneeth Rajkumar’s tragic death, Siddharth Shukla, a 40-year-old television actor and one of the winners of the Bigg Boss reality show died suddenly, following a complaint of chest pain at night.

In June, film director and producer Raj Kaushal, 49, died of a heart attack.

Even sportspersons, whose physical fitness is a professional requirement, have not escaped the disease. A couple of years back, in 2019, Radhakrishnan Dhanarajan, a former East Bengal and Mohan Bagan defender collapsed during a match in Kerala and could not be revived. He was 39 years old.

Sports lovers in Bengaluru may also recall the tragic death of Cristiano Junior. The 25-year-old Brazilian footballer collapsed at the Sree Kanteerava Stadium while playing in a Federation Cup match and died.

Rise in mortality

Between 2000 and 2015, India’s mortality due to heart attacks among males rose from 48 per 100,000 to 61 per 100,000 for people between 35 to 39 years of age. The increase was equally stark in the 40 to 44 years category (from 85 per 100K to 106 per 100K); 45 to 49 years (from 134 to 170); 50 to 54 years (from 226 to 282) and 55-59 years (from 357 to 408).

Over the years, medical researchers have gathered enough evidence to show that death due to cardiovascular disease is on the rise in India. CVDs caused more than a quarter of all deaths in the country in 2015 and are now affecting rural populations and young adults the most.

The first nationally representative study to track cardiovascular mortality in India over 15 years showed that the chances of dying from ischaemic heart disease (IHD) — cardiac issues caused by a narrowing of the heart’s arteries — in populations aged 30 to 69 have increased.

Between 2000 and 2015, the mortality rate rose from 10.4 per cent to 13.1 per cent in men and 4.8 per cent to 6.6 per cent in women.

Led by Prabhat Jha, the Director of the Centre for Global Health Research of St Michael's Hospital in Toronto, Canada and a professor at the University of Toronto, the 2018 study found that heart attack mortality rates rose rapidly in rural India and surpassed those in urban areas between 2000 and 2015. Other contributors to the study include Prabhakaran and Denis Xavier from St John’s Medical College and Research Institute, Bengaluru.

"Myocardial Infarctions (heart attack) among Indians less than 45 years old is a huge problem. Two recent studies from Tamil Nadu and Gujarat show that 24 - 26 per cent of such cases occur in young Indians. The corresponding number in the western population is 5 to 7 per cent,” said Thomas Alexander, an interventional cardiologist from Kovai Medical Centre and Hospital at Coimbatore.

While mortality due to heart attacks is increasing in the age 30 to 45 year age group, the largest increase was actually seen among women around the age of 35 years.

“The maximum increase for ischaemic heart disease mortality for men was 2.4 per cent annually in those aged 50–54 years and for women was 2.8 per cent in those aged 35 to 39 years,” Calvin Ke, a professor at the University of Toronto told DH.

Causes

High blood pressure is associated with about 6 to 8 times the odds of dying from ischemic heart disease. But it is an even stronger risk factor for heart attack mortality among younger adults. In the age group of 30 to 39 years, elevated blood pressure increases the odds of dying from a heart attack by 12 times.

Studies have also shown that high blood pressure is driving the increase in IHD deaths, especially in rural areas, as such risk factors are no longer restricted to urbanised populations. “Also among younger males, smoking plays an outsize role,” added Jha.

While the change in lifestyle in an aspiring India contributes tremendously to developing IHD, poor access to treatment increases mortality.

Treatment

Over the last two years, the National Health Mission of the Union Health ministry was sitting on a heart attack management proposal in Karnataka using a hub-and-spoke model of hospitals, said Alexander, director of STEMI-India, a non-governmental organisation that came out with such a proposal.

If implemented, this would significantly reduce the delay in finding a designated hospital and reduce mortality. In neighbouring Tamil Nadu, implementation of the STEMI scheme led to a 4 per cent drop in heart attack mortality in one year.

But in the absence of such a system, the primary emphasis, according to Prabhakaran, should be on prevention and implementing population-level policies like stopping tobacco use and encouraging people to consume more fruits and vegetables.

“The universal health coverage proposed by the central government needs to include care for CVD and related non-communicable diseases. Tobacco taxation, salt reduction in processed foods, and hypertension treatment are all cost-effective policies that reduce CVD,” said Prabhakaran.

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