A nation under cardiac pressure: What is really putting India’s hearts at risk? |
A heart attack is often imagined as an old-age emergency. But increasingly, the risk factors that set the stage for heart disease are building much earlier: long hours in a chair, poor sleep, chronic stress, expanding waistlines, diabetes and high blood pressure can quietly become part of everyday life long before a person thinks of themselves as a “heart patient.”The scale of the problem is difficult to ignore. Cardiovascular diseases accounted for 28.9% of all recorded deaths in India in 2017–2019, making them the country’s leading cause of death in the latest National Health Profile data based on the Registrar General of India’s Causes of Death Statistics. The Union Health Ministry also says non-communicable diseases, including cardiovascular disease, cancer, diabetes and chronic respiratory diseases, account for an estimated 63% of deaths in India.And the warning signs are often hiding in numbers people may not routinely check. India’s National Programme for Prevention and Control of Non-Communicable Diseases had recorded 9.36 crore people under treatment for hypertension and diabetes on its portal. Government hypertension guidelines have also described cardiovascular disease as the leading cause of death in India and hypertension as its leading risk factor.So what is changing about the way Indians are developing heart risk? Is it simply cholesterol and blood pressure, or is the modern Indian workday itself becoming part of the problem?In this interview, Dr. Deepak Krishnamurthy, Director & Lead Consultant – Cardiology, KIMS Hospitals, Mahadevapura, Bengaluru, explains why heart risk can begin accumulating silently in the 20s and 30s, how stress, sleep, sedentary work and screen time interact, why two people with identical cholesterol levels can have very different cardiovascular risks, and the three changes he would ask young Indians to make today.India is seeing heart disease at younger ages. What are the biggest factors driving this shift, and how different are they from the traditional risk factors we usually talk about?Dr. Deepak Krishnamurthy: Increased prevalence rates of heart disease among young Indians have resulted from the confluence of sedentary lifestyles, bad eating habits, improper sleep routines, chronic stressors, obesity, and metabolic conditions including diabetes and insulin resistance. Overall, it is worth remembering that classic risk factors such as elevated blood pressure and cholesterol levels, diabetes, and smoking still play their roles, albeit at younger ages.Genetically inclined and being more prone to developing metabolic problems at lower levels of obesity, young Indians may have yet more reasons to worry about cardiovascular health. Pollution, abuse of alcohol, and long hours spent sitting in front of screens can also enhance risks. Importantly, conditions leading to heart problems develop slowly and unconsciously.Stress, poor sleep, sedentary work and long screen hours are increasingly common. Which of these has the strongest evidence linking it to cardiovascular risk, and how do they interact with each other?Dr. Deepak Krishnamurthy: Among these factors, poor sleep and chronic psychological stress have strong evidence linking them to cardiovascular risk, while prolonged sedentary behaviour is also associated with higher risks of hypertension, diabetes and heart disease. Long screen hours often contribute indirectly by increasing sitting time, disrupting sleep and reducing physical activity.These factors are often interrelated with chronic stress leading to sleep disruption. Yet at the same time, lack of sleep boosts the levels of stress hormones, appetite and blood pressure. Sedentary jobs and excessive screen time reduce physical activity and may result in weight gain. Hence, they are all linked to inflammation, insulin resistance and increased blood pressure. Therefore, they should be addressed together.Why can two people with similar cholesterol levels have very different heart risks?Dr. Deepak Krishnamurthy: People with identical cholesterol levels can possess an entirely different level of cardiovascular risk due to a number of other factors affecting risk estimation. Such factors are: blood pressure, blood sugar and diabetes level, smoking, abdominal obesity, physical activity rate, relationship or age. In addition to customary lipid profile, the Indian population is said to pay special attention to non-HDL cholesterol, ApoB and lipoprotein (a) in people with family history of early heart disease. Blood pressure and blood glucose should be regularly monitored as well. We should not forget that it is very important to measure the total risk of developing cardiovascular ailments instead of stressing a single figure.If you could ask every Indian in their 20s and 30s to make just three changes today, what would they be?Dr. Deepak Krishnamurthy: If I had to give only three recommendations, they would be: steer clear of tobacco, make regular exercise a part of your routine and eat heart-friendly foods while also keeping a watch on your waistline. Young adults should also be aware of their basic health indicators, such as blood pressure, blood sugar and cholesterol, and not wait for the symptoms of the disease.
