EMERGING SCENARIO OF CORONARY ARTERY DISEASE IN YOUNG INDIANS
THE MISSING LINK


Dr. Arun Goyal
MS, M.Ch, FIACS
Senior Consultant Cardiac Surgeon
Escorts Goyal Heart Centre
JODHPUR.

The heart is a pump and coronary arteries are its fuel supply pipelines. The fuel is oxygen which is carried in the blood. Coronary artery may narrow due to thickening in its walls and this reduces blood flow to the heart muscle. The process is called arteriosclerosis. When the narrowing gets worse, the lack of oxygen may cause pain called Angina. If the narrowing gets critical, it can cause a complete blockage and lead to Heart Attack.

At the threshold of the new millennium, coronary artery disease is looming large as the new epidemic afflicting Indians at a relatively younger age in severe and diffuse form of lesions. The prevalence of CAD progressively increased in the India during the later half of the last century. The conventional factors namely Hypertension, Diabetes Mellitus, Hypertriglyceridemia, lower level of HDLS, Central obesity, Lipoprotein A, LDL – C, Lower level of antioxidants (Vitamin A, E & Beta Carotene) rising affluence, rapid modernization associated with sedentary life style.

The risk of CAD in Indians is 3-4 times higher than white Americans, 6 times higher than Chinese and 20 times higher than Japanese. India will be the world capital of Coronary artery disease by the year 2020. There are as estimated 45 millions patients of coronary artery disease in India. Premature coronary artery disease is defined as cardiac event occurring before the age of 55 in men and 65 in woman. In its severe form it is defined as CAD occurring before the age of 40 years. Indians affected 5-10 years earlier than other communities. There are at least 20 million diabetics in India, which is the highest ever reported number from anywhere in the world.

Risk Factors

Tobacco Consumption in any form specially smoking is the most important of all the risk factors. It increases risk of CAD by 3-5 times. Contrary to popular belief, smoking small amounts is nearly as heavy as heavy smoking so that cutting down does not help very much. Smoking cigar and pipes is also bad as the harmful ingredients of smoke are also absorbed through the mouth. It is never too late to QUIT smoking.

Hypertension remains a standard risk factor associated with CAD. Contrary to the popular opinion, blood pressure may be raised without any symptoms at all. Therefore it is important to get it measured regularly.

Diabetes is another Condition that may exits without one’s knowledge and can be detected by testing the urine for sugar. Careful Diabetes control should reduce the extent of Coronary Artery Disease.

Hypercholestremia and other fatty substances in the blood also increase the risk. In contrast to decreasing mean cholesterol level in the USA, the mean cholesterol levels in urban Indians are rising. In Delhi the mean cholesterol level has risen from 160mg/dl in 1982 to 199mg/dl in 1994. In Indians even with low levels of serum cholesterol have higher risk of Coronary Artery Disease.

Central Obesity depicted by waist to hip ratio is an independent risk factor for CAD. Even modest increased in body fat with central distribution increases the risk further.

New Risk Factors
Lipoprotein – a (LP-a) is an independent risk factor for Coronary Artery Disease. It is genetic risk factor not affected by any life style modifications. It is 10 times more atherogenik than LDL-c.

Indians with Coronary Artery Disease have high triglyceride levels than high cholesterol levels. Indian demonstrates a triad of High Triglycerides, High LDL-C and Low HDL levels. This triad combined with high LP-a constitute the Deadly Lipid Quartet.

Insulin resistance syndrome, serum fibrinogen, hyperhomocysteinaemia and various viral and bacterial infections especially Chlamydia pneumonia is considered as an important risk factor for Coronary Artery Disease.

PREVENTION

How you live your life can greatly affect the health of your heart. Taking the following steps can help you prevent Coronary Artery Disease as well as a Heart Attack and Heart Failure.

Don’t smoke. Smoking and second hand smoke are major risk factors of Coronary Artery Disease. Nicotine constricts blood vessels and forces your heart to work harder. Carbon monoxide reduces oxygen in blood and damages the lining of blood vessels.

Control your blood pressure: Have your blood pressure checked every two years. Your doctor may recommended more frequent measurement if you have blood pressure higher than 115/75 mmHg or a history of heart disease. Your risk of coronary artery disease doubles with every 20/10mmHg increase over 115/75mmHg.

Check your Cholesterol: Have your blood cholesterol levels checked regularly. If your blood cholesterol level is undesirably high, your doctor can prescribe changes in your diet and medications to help lower your cholesterol and protect your cardiovascular health. Having an LDL level above 160 or HDL below 40, places you at a higher risk of heart disease.
Exercise regularly: Exercise helps prevent coronary artery disease by helping you to achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure, Try to exercise at least 30 minutes on most days. If it’s been a while since you exercised, check with your doctor before starting any exercise Programme and start exercising in 10 minute intervals and then gradually increased the amount of time you spend exercising.

Maintain a healthy weight: Being overweight increases your risk of coronary artery disease, but by losing weight, you can reduce that risk.

Eat a healthy diet: Too much saturated fat and cholesterol in your diet can narrow the arteries leading to your heart. A diet high in salt can raise your blood pressure. Follow your doctor’s and dietician’s advice on eating a heart healthy diet. Fish is a part of a heart healthy diet because it contains omega – 3 fatty acids, which help improve blood cholesterol levels and prevent blood clots. Eating plenty of fruits and vegetables also is encouraged. Fruits and vegetables contain antioxidants – vitamins and minerals that help prevent everyday wear and tear on your coronary arteries.

Get regular medical check ups: Some of the main risk factors for coronary artery disease – high blood cholesterol, high diabetes – have no symptoms in their early stages. Coronary artery disease itself may produce no symptoms. But your doctor can perform tests to check that you are free of these conditions. If a problem is found, you and your doctor can manage it early to prevent complications.

Manage stress: To reduce your risk of cardiovascular disease, reduce stress in your daily activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events as well as anger in your life.

CORONARY ARTERIES ARE OUR LIFE LINES REQUIRE FRESH AIR, FIBERS & FRUITS AND NOT FRIED, FATTY & FAST FOOD.

Beware of White Poison - Salt, Sugar & Dairy Products
(Use judicially after the age of 40 years)

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