India’s Cardiac Burden has a New Face
By Dr Pravin Kahale, Consultant, Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
India’s cardiac crisis is evolving—but public health messaging hasn’t kept up. Younger, fitter individuals are collapsing due to risks no one is talking about: extreme workouts, supplement misuse, poor sleep, and even lingering effects of COVID-19. What needs to change? Policies must focus on early prevention, targeted education, and routine cardiovascular evaluations for young adults—before it’s too late, says Pravin Kahale, Consultant, Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
The increase in heart attacks among younger individuals is driven by multiple factors, including sedentary lifestyles, poor diets, high stress levels, and environmental contributors such as pollution. Rising obesity rates, excessive consumption of processed foods, and lack of regular exercise are accelerating the build-up of plaque in the arteries, leading to blockages. Chronic stress, often linked to demanding jobs and social pressures, raises cortisol levels, which can contribute to high blood pressure and inflammation in the arteries. Additionally, smoking, excessive alcohol consumption, and even genetic predisposition play a role. Recent research also suggests that air pollution and lack of proper sleep may further increase the risk of heart disease in younger adults. A 2023 study published in the Journal of the American College of Cardiology found that air pollution exposure is linked to a 30% increase in cardiovascular disease risk among individuals under 50.
Underlying Risks Often Go Unnoticed in the Young and Active
While lifestyle changes and chronic stress are major contributors, other overlooked factors could include genetic predisposition, undiagnosed conditions such as hypertension or diabetes, and the lingering effects of viral infections, including COVID-19. Some people who appear physically fit may still have high levels of visceral fat, which increases cardiovascular risk. For example, individuals with visible muscle tone but high visceral fat, or those who engage in excessive exercise without adequate recovery, may still be at risk. Additionally, the use of performance-enhancing drugs or supplements, excessive caffeine consumption, and extreme workout regimens can sometimes put excessive strain on the heart. Sleep deprivation and exposure to environmental toxins are also emerging concerns.
Fitness, but at a Cost? When Appearances Conceal Vulnerability
The term “seemingly fit” are individuals who may have an outwardly healthy appearance, such as a lean physique or visible muscle definition, but may still have underlying health risks. These could include hidden metabolic issues like high cholesterol, hypertension, insulin resistance, or excessive visceral fat, that is fat stored around internal organs, which is strongly linked to cardiovascular disease. Even those who exercise regularly but follow poor dietary habits or experience chronic stress may unknowingly be at risk.
Preventive Health Must Begin Early and Be Sustained
The most effective preventive measures include maintaining a heart-healthy diet, engaging in regular physical activity, and managing stress effectively. Avoiding processed foods, excessive sugar, and trans fats while incorporating whole grains, lean proteins, and healthy fats can help keep cholesterol levels in check. To be more specific, individuals should aim for at least 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking or cycling, combined with two strength-training sessions to improve cardiovascular health. Managing stress through mindfulness, meditation, and adequate sleep is also essential. Young adults should also undergo regular health screenings to check cholesterol, blood pressure, and blood sugar levels. Avoiding smoking, limiting alcohol consumption, and recognising early warning signs of heart issues—such as chest discomfort, breathlessness, or palpitations—can significantly reduce risk.
Demystifying Angioplasty: A Lifesaving Intervention
Angioplasty is a medical procedure used to open up narrowed or blocked arteries, typically in the heart, to restore proper blood flow. It involves inserting a thin tube (catheter) into a blood vessel, usually through the groin or wrist, and guiding it to the blocked artery. A small balloon at the tip of the catheter is inflated to push the blockage against the artery walls, widening the passage. Think of the stent like scaffolding that holds the artery open after the balloon has cleared the way, ensuring long-term stability. In many cases, a stent (a small mesh tube) is then placed to keep the artery open and prevent it from narrowing again.
Angiogram and Angioplasty: Knowing the Distinction
A stent is not always necessary during angioplasty. In some cases, if the blockage is minimal and can be treated effectively by simply inflating the balloon, the procedure may not require a stent. However, in most cases, particularly when there is a high risk of the artery narrowing again (restenosis), a stent is placed to provide long-term stability. Without a stent, there is a higher chance of re-narrowing, which could necessitate another procedure. Research suggests that in cases where a stent is not used, there is a 40% higher likelihood of restenosis within a year. Drug-eluting stents, which release medication to prevent re-narrowing, are often preferred over bare-metal stents for better outcomes.
An angiogram is a diagnostic test used to identify blockages or narrowing in the arteries. It involves injecting a contrast dye into the bloodstream and taking X-ray images to see where blood flow is restricted. Angioplasty, on the other hand, is a treatment procedure that follows an angiogram if a blockage is detected. While an angiogram helps doctors diagnose the issue, angioplasty is the intervention used to correct it by opening up the blocked artery.
Pulmonary Oedema Post-Angioplasty: Recognising and Managing the Risk
Water retention in the lungs, known as pulmonary oedema, can sometimes occur after angioplasty, particularly in patients with pre-existing heart conditions. This happens when the heart struggles to pump blood efficiently, causing fluid to accumulate in the lungs. It can be triggered by sudden changes in blood flow, complications during the procedure, or underlying conditions such as heart failure. While it can be serious if left untreated, prompt medical management with diuretics and oxygen therapy can help resolve the issue.
Time is absolutely critical during a heart attack, and immediate medical attention can be the difference between life and death. When a heart attack occurs, blood flow to a portion of the heart muscle is blocked, leading to tissue damage. The longer the delay, the more damage the heart sustains, potentially leading to irreversible heart failure. The first 60–90 minutes, known as the “golden hour”, are crucial—restoring blood flow during this period significantly reduces the risk of complications.
The Golden Hour: Timely Response Saves Lives
A real-world study found that every 30-minute delay in treatment increases mortality by 7%. This means that for every half-hour that passes without medical intervention during a heart attack, the chances of survival decrease significantly. When blood flow to the heart is blocked, heart muscle cells begin to die due to oxygen deprivation. The longer this blockage remains untreated, the greater the damage, which can lead to severe complications such as heart failure, arrhythmias, or even sudden cardiac arrest. For example, if a patient has a delay of 90 minutes in receiving treatment, their mortality risk could increase by more than 20%. This highlights the critical need for early recognition of symptoms and immediate medical intervention, reinforcing why individuals should seek emergency care at the first signs of a heart attack rather than waiting or self-medicating. A delay can also increase the likelihood of arrhythmias (irregular heartbeats), which can be fatal.
Not All Blockages Are Equal: Severity Lies in the Details
The danger posed by a blockage depends on several factors, not just the number of blockages. A single, critical blockage in a major artery, such as the left main coronary artery, can be more life-threatening than multiple smaller blockages in less critical locations. The degree of narrowing, the location of the blockage, and the patient’s overall heart function all play a role in determining severity. Additionally, some people develop collateral circulation (alternative blood flow pathways), which can lessen the impact of a blockage.
Aspirin and Sorbitrate: Aiding Response, Not Replacing Treatment
Social media is full of viral videos with doctors advising carrying medicines like aspirin or sorbitrate tablets in your pocket in case of chest pain. This is not a misconception—medications like aspirin and sorbitrate can help buy critical time during a heart attack. Aspirin acts as a blood thinner and can prevent further clot formation, while sorbitrate (nitroglycerin) helps relax blood vessels, improving blood flow. They may reduce damage in the first 20–30 minutes, buying time until emergency care arrives. However, these medicines are not a substitute for emergency care. Anyone experiencing chest pain should take aspirin (if not allergic), use sorbitrate under medical guidance, and seek immediate medical attention. Delaying proper treatment by relying solely on these medications can be dangerous.
Post-COVID Cardiac Risks Warrant Vigilance
Research suggests a strong link between COVID-19 and increased heart attack risks, particularly among younger individuals. The virus has been shown to cause inflammation in blood vessels, increase clot formation, and accelerate the progression of underlying heart disease. Even after recovering from COVID-19, many individuals experience lingering cardiovascular effects, including myocarditis (inflammation of the heart muscle) and arrhythmias. One study found that post-COVID patients under 40 were twice as likely to experience heart inflammation within six months compared to those who never had the virus. Even after recovering from COVID-19, many individuals experience lingering cardiovascular effects, including myocarditis (inflammation of the heart muscle) and arrhythmias.
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