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Why the young die of heart attacks

September 24, 2006

You may have a smooth unwrinkled skin but do you have that spring in your step that carries you easily up a flight of stairs? You may have six by six eye-sight and a slim figure but do you have the agility and flexibility to jump up and answer the door when you are spread out on the couch? If you don’t, then you may be young in years, but not in your heart. Those with strong, young hearts can do all the above things, and much more. That is why they have a young heart in the first place. ‘The process of blockage of arteries starts at birth, but the speed at which happens depends a great deal on our energy expenditure, besides the genes and diet,’ says Dr. Shantesh Kaushik, cardiothoracic and vascular surgeon. So you may be just thirty years old, but your heart may be much older…

What determines the age of your heart?
Two major aspects determine the age of the heart: the health of your arteries and the health of your heart muscle. If you don’t move, your heart muscles become flabby. And arteries start getting blocked. You could be just 30, in the prime of your life, but your heart could have aged. Such a heart won’t pump sufficient blood and through it, life-giving oxygen. Everything will be fine until one day your heart can’t take the load anymore. Dr. Sudhansu Bhattacharya, cardiac surgeon, compares it to the working of a car. ‘Think of defective blood vessels as a narrow fuel pipe. As long as you are in 1st or 2nd gear it’s alright, but the minute to go into 4th or 5th the car will stall.’ A heart which does not get an adequate supply of blood from the artery stalls too.

The terrifying reality is that as long as we don’t go into fifth gear, we may never know that there is a problem with our heart, not unless we go in for diagnostic tests, as arteries get blocked gradually. Dr. A.V. Ganesh Kumar, Chief Interventional Cardiologist at Hiranandani Hospital says, ‘The heart has to pump more blood during exertion or some emotional upset, and this can cause a heart attack.’ There may be no warning signs before this, not as long as we are cruising along in second gear. ‘If the patient has breathlessness and fatigue, these are signs that it’s already late, that the blockage has progressed to an advanced stage,’ says Dr. Kaushik.

A partically blocked artery can cause trouble
Even more chilling – an artery need not be completely blocked for the heart to give way. ‘It’s a mistake to think that an artery has to be blocked eighty to hundred per cent before a heart attack takes place,’ warns Dr. Kaushik. In fact, younger people who have heart attacks often have partically blocked arteries. Why does a partically blocked artery cause a heart attack?
Dr. Kaushik explains, giving an example of a smoker, though something similar can happen to a non-smoker. A sudden clot formation which causes the artery to give way. ‘A certain percentage of smokers who have heart attacks have only 40% blockage in their arteries,’ he says. The nicotine can cause a clot to form and the artery to rupture.
‘There can be a sudden clot formation and within minutes the blood flow via that artery can stop,’ says Dr. Ganesh Kumar. ‘When this happens, when the artery is only partially blocked to start with, but because of underlying conditions and/or external factors, there is stoppage of blood due to say sudden clot formation, the heart often starts to beat chaotically in reaction, often at 300 beats per minute. You can die in a few minutes,’ he says.
This kind of heart attack is more dangerous than if the blockage happens gradually. Older people usually suffer from a gradual blockage. ‘In that case the heart has time to form natural bypasses,’ explains Dr. Kaushik. Also, older people are more likely to have heart check-ups, stress tests, all of which can warn him of what could happen.

Youngsters can be caught by surprise
So how can youngsters be forewarned? How can they find out if they are at risk from a heart attack? ‘Just assume that your heart is ageing, and body fat is a good indicator,’ advises Dr. Kaushik. A waist of over 32 inches for women, and 36 inches for men is the danger sign. ‘Fat goes on the abdomen only when the arteries and internal organs have had more or less enough,’ he adds. There are other risk factors like family history, diabetes and urban lifestyle factors like smoking, lack of exercise, a fatty diet and a stressful life.

Indians at greater risk
We Indians come a poor second to the world in most of the above factors. In fact they are genetically predisposed to heart disease. ‘Studies show that Indians living abroad suffer from a greater incidence of heart disease than the local population,’ says Dr. Ganesh Kumar. He feels that lack of exercise could be a factor, but our diets too could be a cause. Indians tend to eat a lot of fried food…and in fact consume a fair amount of Trans Fats. Call them Trans Fats or Killer Oils, they are found in products like margarine and vanaspati and are commonly used for frying. They are very dangerous to heart health. And commercial food invariably contains transfats. In India we tend to eat a lot of fried food and this means a higher consumption of trans fats. In fact sweets, chocolates, biscuits and cakes all contain trans fats.

Other causes?
‘There are also indications that our arteries are narrower,’ suggests Dr. Ganesh Kumar, although he acknowledges that research is still being done in this area. The result is plain to see however. There is something in the genetic make-up of Indians that make them prone to heart disease! Dr. Kaushik has a plausible theory. He believes that ‘a shortage of food in the past has genetically programmed Indians to store fat more efficiently than other races.’
Indians also tend to suffer from more incidences of ‘diffused’ heart disease. ‘This means that instead of an artery getting blocked in just one place, it gets blocked in various places, sometimes the whole,’ explains Dr. Ganesh Kumar. This hinders treatment.
The patient who survives an heart attack in time to reach the hospital and gets quick intervention is lucky, because effective treatment needs to be given within 3-6 hours. ‘Otherwise the heart tissue can be damaged permanently,’ says Dr. Ganesh Kumar. Damaged heart tissue means quality of life suffers and a rapid acceleration into old age.
So worry less about that line on your forehead that tells you that 30 is just round the corner, and worry a lot if your body suggests that your heart has touched 40. You might be able to fix that wrinkle, but fixing a heart means procedures like angioplasty, by-pass surgery or even an organ transplant. If you’re lucky.

(An abridged version of this appeared in the Times of India in 2006)

Dr A B Mehta, head of cardiology department, Jaslok has these tips to offer:-

If a person collapses at a public place, like an airport, the first hour is critical if he is suffering from cardiac problems. The maximum damage and number of deaths occur during this time. Help should immediately be given so that the movement of the heart muscles and the flow of blood are brought under control. Blood flow should not be left at minimal or zero levels
The patient should be given immediate first-aid. For cardiac arrest, the first-aid would include administering a defribillator shock along and intubating the patient so that a breathing pathway is created.
Hospital and healthcare phone numbers should be readily available. It is advisable to call up a hospital and find out if it has enough beds instead of simply landing up there and surprising the doctors. That way precious time is saved by contacting a hospital with a vacant bed and driving to it immediately.
Ensure that a cardiac resuscitation trolley is handy. It must contain an intra-venous set, emergency drugs, intubation apparatus and a defribillator.
It is preferable to have either an ICU or ICCU (cardiac care) ambulance available, as continous treatment can then be administered to the patient on the way to the hospital.

A study commissioned by President Kalam in 2006:
A low-fat, high fibre vegetarian diet, an hour of yoga and a long walk reduce heart disease by 12 %.
Yoga reduces angian, chest pain and improves pumping of pure blood into the aorta by 30%
Walking reduces bad cholesterol, production of stress hormones including Epinephrine by 31 %

Other Statistics from the same study:
The prevalence of cornonary artery disease in India has increased from 1% in 1960 to 11% in 2001. It afflicts about 15% of the adult population today.
CAD is 10 times more prevalent amongst Indians in the younger age group (30-40 years) compared with the rest of the world.
Indians have low levels of good cholesterol (HDL)

Heart Risk – Race and Ethnicity:
Caucasians – 22%
Japanese – 30%
Africans – 44%
South Asians – 60%

These statistics show that India is in the middle of a heart disease epidemic.

(A revised version of what was published in the Times of India)

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23 Comments leave one →
  1. Aswani Ram permalink
    November 14, 2006 3:43 pm

    Hello Ms.Nita Jatar Kulkarni,
    I came across your article”Why young people die of heart attacks”while I was searching for Dr.Ganesh Kumar.
    I found it really interesting & informative.I will def check other articles by you.
    I am a musician waiting for that big break which can make me famous! Some articles about me have appeared in Mulund Plus/Planet Powai & other smaller mags.But that big break is evading me.

  2. anand permalink
    November 24, 2006 8:08 am

    Dear Ms.Kulkarni,
    you have quotes there of 60% for south Asians. is this what you are referring to.
    are these figures for India.
    if so every hospital should be full of cardiac patients. we have a billion people & 60% of them are cardiac patients. sounds very rubbery indeed.
    if you are referring to migrants in USA that may be true, but i cannot comment on that

  3. November 24, 2006 9:13 am

    I have said very clearly that the figure of 60 per cent pertains to Heart Risk. People with heart risk are those who are obese, have high blood pressure, have a certain life-style, smoke, eat a certain kind of diet, have diabetes, etc. Frankly I do not know exactly whether one or more factors are taken into account for calculating heart risk. I do know that the figure of 60 per cent is given for whole of South Asia and talks of race and ethnicity risks for South Asians. South Asians are more prone than other races because they have the heart risk factors. They may not develop the disease but are at risk only.
    At present I do not have the statistics for heart risk for Indians specifically. However Indians who actually suffer from CAD are estimated to be around 15 per cent of the adult population today, in 2006. This has been clearly mentioned in President Kalam’s survey.
    Hope this clarifies the issue.

  4. February 24, 2007 7:10 pm

    India population’s propensity towards heart disease is alerming. If we don’t make the necessary changes to our lifestyle and reduce the pollution in the cities which is a major contributor to the inflammation and allergies, our economic miracle may develop a clot. I can’t imagine the MNCs will be willing foot high costs of medical insurance for employees in their lat 30s and 40s.

  5. March 4, 2007 1:32 am

    “We Indians come a poor second to the world in most of the above factors. In fact they are genetically predisposed to heart disease. ‘Studies show that Indians living abroad suffer from a greater incidence of heart disease than the local population,’ says Dr. Ganesh Kumar. He feels that lack of exercise could be a factor, but our diets too could be a cause. Indians tend to eat a lot of fried food…and in fact consume a fair amount of Trans Fats. Call them Trans Fats or Killer Oils, they are found in products like margarine and vanaspati and are commonly used for frying”
    In my personal opinion, this is largely misleading. Indians are not genetically predisposed to heart disease. If it were so, then the Indian civilisation would never have been able to survive so long in the first place. The very fact that we are here today means that our ancestoral chain had been healthy enough to reproduce and live long in days when medical technology didn’t exist. Its sad that we quote western studies about Indians living abroad and take their word for it like it were the word of God. Another thing is that Indians living abroad suffer from heart disease not just because of a lot of fried food. Its more due to eating the wrong “kinds” of fats and due to eating excessive sugars and starches. Margarine and vanaspati may be used for commercial frying, but I seriously don’t know of anyone who uses these at home. Indians use “refined” vegetable oils at home to fry their food (which are of course toxic). And when they eat out, they are least bothered about the ingredients they are putting in their bodies.
    In my opinion and a little experience, Indians have started suffering from these western diseases only recently. The most important cause is that we have forgotten and discarded our traditional wisdom about health in favour of allopathy and we prefer being slaves of the western world. We have lost our capacity to think and reason.
    I have a lot more to say but I’m tired of typing.. lol

  6. eleni permalink
    April 16, 2007 4:53 am

    I found your article very interesting. My partner died very suddenly in February when we were travelling in India (we are British) and the post mortem carried out in India simply said that he had suffered a heart attack and that his arteries were narrowed. It did not say they were blocked but perhaps he had a clot as you suggest? Everything happened so quickly, he developed breathing problems and soon collapsed. It is all such a terrible shock as he was a slim 33 year old who seemed fit. He did however smoke so this may have triggered it? Could you tell me where you found your information as I would really like to learn more? Thankyou

  7. April 16, 2007 6:59 am

    Eleni, you could talk to a very high level heart specialist. I talked to one who explained it to me and its very complicated. Dr. Shantesh Kaushik, cardiothoracic and vascular surgeon was the one who explained this to me. All of it was really too technical for me to write down here.

  8. Divya permalink
    January 23, 2009 7:20 pm

    sir,i am a software engineer and recently i heard about one of my friends cousin’s death.he died because of heart attack and what shocked me is “he is just 23 years old” ,he did not have any heart disease,he was an healthy person.suddenly he hold his hand near his heart and just in 10 minutes he died as he coul’nt breath.my question is”does young people do get heart attacks and what percent of people among youngsters die becoz of heart attacks? does tension that we younsters take for every small problem is the reason for that or the stress for our works?or working for long hours with stress is the reason?
    sir please do reply me.i am desperately waiting for your answer.

    A very small percentage of young people die of heart attacks Divya. Most people die of accidents and disease. But yes young people can certainly get heart attacks and tension is not the main thing. It is your diet, genes and the amount of exercise you do that are the main factors and ofcourse stress is often the catalyst. – Nita.

    • August 27, 2012 12:13 am

      Dear Divya, If you are following a “whole plant based diet” you will never have a heart attack. Even people who have had a heart attack can reverse their condition and open up the arteries by simply following the “whole plant based diet.” Read articles by Dr. Caldwell B. Esselstyn.

  9. Afrin permalink
    February 20, 2009 5:13 pm

    So..after reading so much about TFA one of the leading cause of herat disease & diabetes in Indian y cant we carry out a study to determine the average intake of TFA in a individual, who has his so called healthy home food…

  10. Afrin permalink
    February 20, 2009 5:28 pm

    After knowing so..much about TFA as one of the leading factor for diabetes & heart disese in India, y cant a small study to estimate the TFA content in an so called healthy indian home foods, n if such study

  11. ash permalink
    October 8, 2009 6:03 am

    PLEASE BE CAREFUL AND TAKE CARE OF URSELFS, YOUNG OR OLDER, MY 26 YR OLD FRIEND DIED TODAY OF A MASSIVE HEART ATTACK, HEALTHY, NOT OVER WEIGHT..COMPLAINED OF HEART BURN FOR 2 DAYS, IT WASNT!!

  12. sarah permalink
    December 5, 2009 6:03 pm

    my twin brother died of a heart attack at 35, it is truly devastating, he looked fit and healthy. I will never understand it.

  13. Mohit permalink
    January 3, 2010 2:14 am

    i m 29 yrs and suffered a massive heart attack 6 months back.. i was lucky that i got treatment on time… i went through an angiography and my blockage was 40%. i hv changed my life style completely… i use to smoke packet of ciggrates a day which i hve completely stopped..
    i m on the medication till one year.. anything i should know.. kindly advise…

  14. January 19, 2010 5:07 am

    Hiya there my name is stephanie i live in gateshead… my sister died at the age of 22 she was a mother to four chidren she died of a heart attack. then four years later my 16 year old cousin died they could not find a reason for her death. then last year my great cousin she was 35 died ov a heart attack so since 2002 i have lost three family members… i have had a heart scan and they say im fine but i have breathing problems really bad i feel like i cant catch my breath all the time my doctor says it anxioty but i dont feel it is as im not stressed… please reply to my e-mail.

    I have not received any email from you Stephanie but for the life of me I don’t know why you want to write to me. I am a journalist, not a doctor. Please talk to a doctor about your problem. – Nita

  15. January 20, 2010 4:12 am

    well i do apoligse nita i thought u were a doctor SORRY STEPHANIE

  16. Alkesh Parmar permalink
    July 25, 2010 11:35 am

    If a 35 year old person get 1st heart attack then how long he can survive without medication?
    What are the other things we can do to save him during the way to the hospital?

  17. sunny permalink
    July 16, 2011 9:57 am

    well Nita, I was surfing the net and trying to find something about young people getting heart attacks and came across your blog, its been knowledgeable to a certain extent but I would like to know if you know any big cardiologist somewhere in and around bangalore.

    As of my case , I am a 26 year old person who suffered a heart attack just 12 days ago but was lucky enough to reach hospital in time (within 6 hrs that is) and now i am in recovery period. I amdoing good now but just want to have an alternate opinion about my case.

    Hullo Sunny, Unfortunately I do not know any reputed cardiologists. However you can always find them attached to big hospitals. Best is to take a recommendation from someone who has had personal experience though. As I have never been to a cardiologist in my life, I will not be able to advise you here! All the best! – Nita.

    • August 27, 2012 12:14 am

      you can reverse your condition using whole plant based diet . Kindly read articles and books by Dr. Caldwell B. Esselstyn.

  18. Sunny permalink
    July 19, 2011 6:09 pm

    Hello Nita,
    thanks a lot for your feedback. will keep you updated.

  19. October 7, 2011 6:52 pm

    I would be skeptic about random studies whether done in India or the western world. Looks like some of the results were ‘forced’ to keep fit what I call pop-science.
     
    Take President Kalam’s sponsored study for example. There are so many problems with a low fat high fibre vegetarian diet. First, too much fibre can make it difficult for the stomach to absorb nutrients and if people eat vegetarian diets low in fat, they’d end up consuming more carbs to feel satiated, which of course leads to insulin crashes. Keep that up long enough and diabetes would be just around the corner. Just look at the diets of people from the North Eastern states and then look up their prevalence of diabetes and heart attacks – it is close to zero and they eat just the opposite of what Kalam’s study advised.
     
    No, we are not genetically prone to diabetes, we have gone urban and still follow a diet that was designed for farmers, not businessmen, software engineers or doctors.

  20. Sirah jarret permalink
    March 9, 2012 2:23 pm

    Hi i was searchin the web an ur blog caught my attention im only 22years old an weigh 397 i have high blood pressure an border line diabetic no doctor will give me a stress test because they safe if 5 pounds over there weight limit is there a way now that they can take ur blood to see if u could have artery disease

  21. August 27, 2012 12:10 am

    Dear Sir, I am a businessman living in india. I do have a very simple solution for the heart related problems. If your total cholestrol level is below 150 mg/dl then you will not have heart attack. And yes even genetic problems will not affect this. You can stop your heart attack by following “whole plant based ” diet. Looks very simple but still very effective. My mother got cured of sarcoidosis because of leaving animal products. My own cholestrol level is 139 mg/dl. Doctors or cardiologist themselves dont know how to reduce cholestrol apart from medication and surgeries, otherwise why even cardiologist suffer from heart problems? Kindly read book by Dr. Caldwell B. Esselstyn. Hope it will save so many lives in this world.

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