Mail Today, New Delhi, Sunday, February 28, 2010 Mail Today, New Delhi, Sunday, February 28, 2010
ReviewPage 22 Page 23
Boys become angryyoung men Page 24
The Maharani andher Munshi Page 26
WHAT’S common to RohitBal, Arun Jaitely, NirmalPandey, R. Ravimohanand Ranjan Das? Yourimmediate response willbe that they are success-
ful men who have many professionalachievements to lay claim to. Bal is ahigh-profile fashion designer. Jaitley isone of BJP’s most eloquent leaders.Pandey was an intelligent actor. Ravi-mohan was the face of CRISIL, thecountry’s premier credit rating agency,before he was inducted into the RILboard. Das was the CEO of SAP India.
That is not why they figure in this story. Theyare all pointers of a disturbing trend — heartattacks striking younger men at the peak of theirprofessional life. Bal, 42, suffered a heart attackthis week and is now recuperating in a city hos-pital. Das, who was 42, however, was not thatlucky. So was Pandey, 46, who passed away lastfortnight. Jaitley underwent a heart surgery in2005 at the age of 52.
Heart disease in India is taking on dangerousproportions. More and more Indiansare suffering from it and they aredoing so at least 10 to 15 years earlierthan their peers in the developedcountries. Over 70 per cent of theheart attacks occur after 70 in devel-oped countries; two-thirds of theheart attacks in India take placeamong people below 60. For heartattacks in India, 40 is the new 60.
Not only is heart disease occurringamong Indians at a young age, it alsocomes with a very high death rate.The rising graph of heart attacks hasgiven a new life to the myth that Indi-ans are genetically predisposed toheart disease. The basis of this mythis the theory of ‘thrifty genes’ —which Indians seem to haveacquired, over centuries, to copewith long spells of drought andfamines. These lead to slow metabo-lism and conservation of fat in theblood — both risk factors for heartdisease. This hypothesis — and newgenetic connections identified inrecent years — cannot explain thespurt in heart disease in last quarterof the 20th century, when Indianshave had the same genetic pool forcenturies. Surely, something else isacting, along with faulty genes.
“Family history is importantbecause you are growing up in a cer-tain environment. And now we knowthat this environment is likely tocause certain epigenetic changesthat could cause heart disease whenyou grow up,” explains Dr K. SrinathReddy, cardiologist and chairman,Public Health Foundation of India.
“Epigenetics changes the waygenes are expressed without alteringthe underlying DNA,” he says. “For
instance, if a father smokes in thepresence of children it does moreharm than just what is normallycaused by passive smoking. It canchange the wrapping of certain genesand make them express themselves ina different way.”
Recent studies have also shown thathuman genes interact with the envi-ronment to heighten disease risk. “Weknow that genes and environmentalfactors influence the occurrence ofheart disease, diabetes and cancer,but most research has focused onunraveling genetic components of dis-ease risk and ignoring the effect ofenvironmental stimuli. We have shownhow the molecular interactionbetween the two leads to heart dis-ease,” points out Jake Lusis of theUniversity of California, who pub-lished his paper last week in AmericanJournal of Human Genetics.
IF IT’S NOT genetic predisposi-tion, then what’s causing thistsunami of heart disease inIndia? What’s happening isthat traditional risk factors —
smoking, unhealthy diet, lack ofphysical activity and so on (seegraphic) — are working againstyoung people. As much as 80 percent of heart attacks among thosebelow or around 40 can be explainedby smoking alone.
“Smoking is the number one reasonfor heart attacks under 50,” says DrDorairaj Prabhakaran, director, Cen-tre for Chronic Disease Control, New
Delhi. “If you are under 40 and smoke20 cigarettes a day, you are seventimes more likely to get a heart attackthan a non-smoker.” Typically, smok-ers also are victims of sudden heartattacks, as they may not have exten-sive coronary disease but developarterial plaques that lead to suddenclot formation.
The second most important rea-son is unhealthy diet. Abdominalobesity and lack of physical activ-ity are key risk factors among themiddle and rich classes, Prab-hakaran points out.
And although women have naturalprotection against heart disease intheir pre-menopause years, thecover goes if they’re diabetic orsmokers. Physical inactivity isanother major risk factor. A study ofphysical activity among 350 personswho suffered an acute heart attackand 700 healthy individuals in Delhiand Bangalore has revealed a directrelationship between physical inac-tivity and heart disease. Those downwith heart disease had spent moretime on activities such as watchingTV, listening to music, reading andwriting, with bulk of the sedentarytime spent — an average of 3.6 hoursa day — on watching television!
The writing is on the wall for all tosee. The time has come when wetake population-wide steps throughpublic policies that encourage peo-ple to quit tobacco, eat healthy andstep up the level of physical activity.Otherwise, India’s growth story willhave a tragic ending.
By Gaurav Vashisht
WHEN YOU are young, you believeyou’re invincible. You live life king size:You work hard and party hard becauseyou believe your body is in peak formand nothing can happen to you. I wasno different from many other 37-year-olds with a senior marketing positionin a media group. I was travelling fivetimes a week trying to meet sales tar-gets with no time for exercise andproper meals.
I was mostly eating junk food at oddhours and supplementing it with beeror whisky and my weight had gone upto 100 kilos. In fact, on some days I wasdrinking much more than eating, eventhough I knew I was prone to high BPand heart disease — the condition runsin my family. At this time I was undersevere stress as I was still recoveringfrom a stint in Oman that did not gowell for me.
On September 22, 2008, I was drivingto my office at Lajpat Nagar when Iexperienced a severe pain in my chest.I was also sweating profusely. At thattime, I was reminded of all those for-warded emails about things to do incase of a heart attack. The only tip thatI remembered was to drink lots ofwater. I parked my car on the road sideand drank a litre of water. After aroundfive minutes, I felt better and drove tooffice. Once there, I dumped myself onthe sofa but was still feeling uncom-fortable. I then asked a colleague todrop me at Moolchand Medcity.
In retrospect, it’s difficult to believethat I walked by myself to the emer-gency ward and told them I was havinga heart attack. They gave me pills anddid the angiography which showed 40per cent blockage but thankfully it wasnot in any main artery. The doctorsimplanted a stent and since then I haveturned my life around.
I quit my job to take up one thatmade fewer demands and didn’trequire me to travel much. I eat ontime, that too only home-cooked low-fat vegetarian food. I walk 7-8km daily
and I have lost 25 kilos after going onthis fitness regimen. I do get hassledeven now when deadlines are not met,but liquor is no longer my stress-buster. I occasionally drink rum whichmy doctor says is better than beer andwhisky.
The good thing is I get more time tospend with my family and I also feelyounger. I am full of energy and myblood pressure has also stabilised.Somehow, all that health advice youread in newspapers has started makingsense. Wish I could respect my bodyearlier.
—— AAss ttoolldd ttoo MMaannuu MMoouuddggiill
THE YOUNGARE NOTINVINCIBLE
THOSE WHO SUCCUMBED...
THOSE WHO SURVIVED...
MYTH NO. 1IT IS A DISEASE OF THEELDERLYHeart disease is striking theyoung in India, even thosebelow 40. It is now estab-lished that the diseaseoccurs among Indians atleast 10 to 15 years earlierthan it strikes their counter-parts in developed coun-tries. Diabetes and hyper-tension — two major riskfactors for heart disease —are occurring among Indi-ans in their 30s.
MYTH NO. 2WOMEN ARE PROTECTEDTILL MENOPAUSEThough women enjoy a nat-ural protection againstheart disease in their pre-menopause years, the coverdisappears if they are dia-betic or smokers. The use oforal contraceptives too hasbeen linked to heart diseaseamong women. In India, thedisease is occurring amongyoung women as well.
MYTH NO. 3IT STRIKES ONLY THE RICHHeart disease has ceased tobe the disease of the rich.Risk factors such as tobaccoconsumption and unhealthydiet are prevalent amongthe poor as well. Diabetesand hypertension have beenreported from slumdwellers as well as in ruralpockets.
MYTH NO. 4WE ARE GENETICALLYPRE-DISPOSEDTraditional risk factors —smoking, unhealthy dietsand physical inactivity —alone are responsible forheart disease epidemic inIndia. Some genetic factorshave been implicated forheart disease, but scientistssay these alone cannotexplain the huge diseaseburden. Recent studies haveshown that a healthy dietand physical activity canhelp people trump theimpact of genetic adversity.
HEART ATTACK MYTHSTHAT MUST BE BUSTED
Fat chance of growing up to be healthy adults
IN INDIA, body fat has tradi-tionally been considered a signof good health. In some parts ofthe north, particularly in Pun-jab, ‘healthy’ is synonymouswith ‘fat’. It is normal todescribe extra fat on the body asa ‘sign of prosperity’. It is thismentality that is making Indiansignore a major epidemic oflifestyle diseases that is buildingup. Children being raised on adeadly combination of junkfood, television time andreduced physical activity — areall set to become victims ofheart disease as they grow up.
A survey conducted by the All-India Institute of Medical Sci-ences (AIIMS) among 16,000school-going children in theage group of 5 to 18 in Delhihas shown that over 22 percent of them who belong tohigh-income families fell inthe category of what’s med-ically defined as overweightand obese. The level ofengagement with leisure-timephysical activity such as jog-ging and outdoor games ofthese children was higherthan that of their peers, yetthey had a higher Body MassIndex and weight.
This is because their energyintake is higher and so is the useof energy-saving devices. Scien-tists say the situation is alarmingas 70 per cent of obese childrengrow up to become obese adults,making them prone to heart dis-
ease. Another recent study inDelhi and NCR has found thateating out can be the singlemost important factor for chil-dren becoming obese. If theyhave three to four meals outsidehome every week, the risk ofthem becoming overweight is 12times higher than that of chil-dren who eat out much less.
Smoking rates among school-going children in Delhi andother metros are reachingalarming proportions. TheGlobal Youth Tobacco Surveypoints out that the prevalenceof tobacco use — in any form —among school-going children inthe 13-15 age group is 17.5 percent. Even those in the sixth toeight grades have been found tobe regular smokers.
The prevalence of smokelesstobacco use, mainly gutka, inthe same age group is esti-mated to be 14.6 per cent.Nearly 37 per cent of these chil-dren initiate smoking beforethey turn 10 and daily, 5,500children begin tobacco use. It isto discourage tobacco useamong such vulnerable groupsthat the sale of tobacco is pro-hibited within 100 yards of aneducational institution. Insteadof seeking strict implementa-tion of this rule, some MPs havereportedly asked for waiving ofthis rule to protect the interestsof retailers. Clearly, they’ve lit-tle time to understand the dan-ger looming ahead.
HALE AND HEARTY: Life started at37 for this marketing professional
Are young and successful Indians genetically predisposed to heart disease? It’s more likely that your lifestyle is a killer trap.
If a father smokes when hischildren are around it doesmore harm than what iscaused by passive smoking.
It alters the wrapping of certain genes.’
If you’re under 40 andsmoke 20 cigarettes aday, you’re seven timesmore likely to suffer aheart attack than thosewho don’t smoke.
‘
’— D. Prabhakaran, director, Centre for Chronic Disease Control
HEART ATTACKWARNING40 IS THENEW 60
‘
NIRMAL PANDEYAge: 46
R. RAVIMOHANAge: 52
ARUN JAITLEYAge: 57
ROHIT BALAge: 42
RANJAN DASAge: 42
Graphic: MUKESH SHARMA
KICK THE TOBACCO HABITNicotine raises the heart rate, BP and blood fats. Itcauses arteries to constrict, reducing blood supplyto the heart. Tobacco use is responsible for almost20 per cent of India’s cardiovascular deaths andis a major cause for premature heart attacks.
QUIT THE COUCHA study of 350 persons suffering from heart disease and700 healthy individuals in Delhi and Bangalore revealsthat those admitted to hospitals had spent 3.6 hours onan average being couch potatoes. Spend at least halfan hour daily engaging in some physical activity.
REDUCE YOUR WAISTLINEThe National Family Health Survey estimates
13 per cent of women and 9 per cent of men in the country areoverweight or obese. Your risk of metabolic diseases increases with yourwaistline. Remember, fat cells aren’t just passive stores of energy in the body.
GET YOUR DIET RIGHTAvoid excess of food items that are sugary, salty and fatty. A so-calledtypical Western diet — fried foods, salty snacks and lots of meat —accounts for about 30 per cent of the heart attack risk across the world.Trans fats present in bakery products and snacks fried in vanaspati boostbad cholesterol and lower good cholesterol in blood.
YOU NEED TO KEEP A TAB ON YOUR BPHypertension can slowly hasten the progress of any oneor more of the several potentially fatal complicationssuch as heart attack and stroke. You can control your BPby bringing down your salt intake, quitting tobacco andworking on reducing your waistline.
YOU CAN’T AFFORD TO HAVE DIABETESEvery sixth diabetic in the world is an Indian. Diabeticsmay have fatty plaques in blood vessels but they maynot be large enough to obstruct blood flow. Theseplaques can rupture as fatty plaques in diabetics have thin caps. This suddenrupturing of plaques can completely obstruct blood flow all of a sudden andcause a heart attack.
YOU NEED TO CAP YOUR CHOLESTEROL LEVELToo much of cholesterol in your blood can lead to a build-up in the walls of arteriesand harden them over time. They become narrow and slow down blood flow tothe heart. If enough blood and oxygen cannot reach your heart and if the bloodsupply to a portion of the heart is cut off by a blockage, the result is a heart attack.
STRONG FAMILY HISTORYThis means if your father or a brother developed heart disease orhad a stroke before turning 55, or your mother or a sistersuffered similarly before they were 65, you run the risk ofdeveloping heart disease.
GENETIC PREDISPOSITIONRecent studies show that many Indians have a genetic mutation — adeletion of 25 letters of the genetic code from the heart protein geneMYBPC3 — that predisposes them to heart disease. Future researchmay make it possible to detect this gene and offer possible treatment.
THE ETHNIC DISADVANTAGEIndians settled abroad, or those living in Europe or America withgenetic roots in India, Pakistan, Bangladesh or Sri Lanka, have anincreased risk of heart disease compared to local populations.
What you can do now…
Why a visit to your doctor may be due…
Risk factors you can do little about…
HERE’S A CHECKLIST OF THE RISK FACTORS FOR EARLY HEART ATTACKS.MAKE SURE YOU ARE NOT ONE OF THE POTENTIAL VICTIMS.
HAS YOUR HEART BECOMEA TICKING TIME BOMB?
By Dinesh C. Sharma
Binging on junk food predisposes kids to early heart disease
— K. Srinath Reddy, chairman, PHFI
