Heart attacks among the young people have grown by an alarming 200 per cent over the last 20 years with India contributing to nearly 50% of deaths from heart attacks worldwide, said Dr Ashok Seth, Chairman of Fortis Escorts Heart Institute, New Delhi, during an exclusive conversation with HT Digital.
On the occasion of World Heart Day, the renowned cardiologist and Padma Bhushan awardee talked about stress being an important factor for heart disease. “Acute stress can lead to heart attack and chronic stress causes changes in the inner lining of the heart arteries, causing inflammation which could make the blood clot as well as lead to heart attack,” he said. Suggesting solutions to the people on managing stress, he also recommended combination of yoga and aerobix exercise for good heart health. Terming walking to be the best exercise for heart health, he also said that instead of a chai-samosa break, one could take an exercise break while working.
Urging people to take care of their heart and underlining the importance of exercising, Dr Seth said people should stop taking their hearts for granted as there is no going back if it is damaged.
Excerpts from the interview:
Cases of sudden cardiac arrest in Covid-19 times seem to be on rise. People aged 40-50 are dying due to heart troubles. Recently celebrities like Sidharth Shukla and Raj Kaushal passed away due to heart attack. These are the people who seemed to be fit and in perfect health. What could be the possible reasons for this?
The unfortunate events with some young celebrities has brought attention on heart disease in the young. The commonest cause of sudden death is silent heart attack or a presentation of heart attack. About heart attack on the increase especially in young people, we have multiple reasons for that. Heart attack in the young has grown by 200 per cent over the last 20 years. Nearly 50% of the deaths from heart attacks worldwide occur from India. It is important to understand this has happened because of change in lifestyle in multiple ways. Among the obvious changes in lifestyle are increase in smoking, less of activity and obesity. At the same time we must not forget the other important changes in our lifestyle which is that the world has become very competitive for the young now. Late nights, stress of competition, deadlines, no time for relaxation, fast food eaten out, have all become a norm. And that goes along with the fact that there is less time for exercise and less time for your own stuff. In addition to that let’s not forget that pollution plays a big part especially in bigger cities. Pollution is known to create inflammation of arteries and risk for heart attacks.
As a genetic predisposition, every Indian is a loaded gun to have a heart attack, three times more than the Europeans, six times more than Chinese, twenty times more than Japanese, despite similar risk factors of diabetes and hypertension existing in population. For example – Indians living for three generations in West Indies who ever never have been to India, despite living with the lifestyle of West Indies have still higher chances of having a heart disease than the local people.
Coming to the heart health now, people who are exercising in the gym, bodybuilding, working on their muscles, appearance, that is not equated with heart health. For example, a brisk walk of 45 minutes a day for five times a week can decrease the chances of heart attack by 20%. If you increase that to running or jogging for 10km-20km, it is not adding to your heart benefit. It can be detrimental to heart in multiple ways, detrimental to the body and it is only increasing stamina and weight loss, but not necessarily improving heart health. I also want to add here that because 25% of heart diseases do not have any symptoms and heart attacks can occur even on blockages which are 30-40%. That is the reason you don’t know what’s happening in the arteries without a checkup and young individuals who may have risk factors in their family and haven’t had checkups can have a sudden heart attack, can have a cardiac arrest and can unfortunately pass away as well.
Are stress and sedentary lifestyle to be partly blamed for the heart troubles people are experiencing? What can people do in a situation where they have to put certain hours at work or adopt a certain lifestyle? What can be done keeping in view our current situation where most of us are leading a sedentary lifestyle?
We cannot quantify stress because it is not measurable. Stress is an important factor for heart disease and causing heart attack. Acute stress can lead to a heart attack and chronic stress causes changes in the inner lining of the heart arteries causing inflammation which may cause the blood to clot as well as heart attack. Most people have stressful lives nowadays. Some have stress of finishing work and meeting deadlines, a doctor may have stress of treating a very difficult patient and trying to save lives. Everybody has some stress or the other. Some lady may stress about their children’s performance in school, spouses and that goes for men also. They have got family life stress and professional stress. How we manage stress and how we actually respond to it is the most important aspect. How our body absorbs stress and how we interact with it and react to it makes the difference.
Relaxation, taking time away from those stressful situations, getting time away from work or those circumstances, finding hobbies, finding things that we enjoy, finding things that could aid relaxation like it could be music, a hobby, it could be gardening, travelling or spending time with family. These are all ways to manage stress. We can take up a number of activities which could relieve our stress by diverting our attention away from those stressful situations. Spirituality also helps in releasing stress.
Many people are also incorporating Yoga in their schedule. Is it helpful in relieving stress?
Yoga gives peace to mind. It actually relaxes mind, body and soul. Yoga is not about a ten-minute routine, but a yogic way of life. It transforms the life gradually into a way which relaxes you physically, mentally and spiritually.
Do you practice Yoga and recommend it to your patients for heart health?
I am not an expert at yogasanas and their benefits but I do believe that they do have their benefits. I do practice yoga. Many people ask me whether they should go for exercise or yoga. Yoga has exercises that are beneficial and improve flexibility but I also believe that aerobic exercises are important along with yoga as well. You have to combine both for best benefit for your heart health.
Are their any early warning signs that one may notice before having heart attack?
Coronary artery disease or blockages in the arteries of the heart is the biggest killer in both men and women of this country. The warning signs of coronary artery disease is discomfort in the chest on brisk walking, which disappears on slowing down or stopping. This will of course only be picked up by people who are exercising and walking a lot. But once you get at an advanced stage, then it starts affecting people on gentle walking or small distance walking also. But that’s in advanced stage. Many people who do not exercise pick it up only when it’s advanced because they don’t have habit of walking of even 100-200 yards in a day. Important point to understand is that the top sign is when people experience symptoms of discomfort going down the left arm. In diabetics, the symptom may just be restless leg syndrome.
25% of people may not have any symptom even when they have developed severe blockage and they could be still walking 4 km without experiencing symptoms. When we hear about seemingly healthy individuals suffering a heart attack and passing away, they probably did have heart problem except it could not be diagnosed. Either it was in its early phases or they didn’t have any symptoms. Severe exertion or smoking can cause this. Patients who are 30-year-old and who are heavy smokers get admitted for severe heart attack in a very serious condition and they have blockages with 40% on which suddenly a clot forms and block the artery completely leading to a heart attack.
Those people who have risk factors of having a heart attack, like strong family history where one or the other parent, mother or father have had a heart attack at an early age of less than 60 or have had sudden death in their families, they are at a very high risk of developing heart problem even if the person has done nothing wrong. The same person with diabetes has six times the risk of heart attack. People who are at risk with family history, diabetes, hypertension, smoking should certainly get their regular checkups done. At the age of 20, one should start getting their blood tests done, by the age of 25, they should start getting exercise test, by the age of 30, they should start getting checkups every year and the blood cholesterol levels. By age of 35, they should have all had CT scans done to be able to pick up blockages at a very early stage. Good risk factor modification, lifestyle modification, medicines to reduce cholesterol can be instituted which prevents heart attacks in later years. I would recommend checkups, checkups, and checkups especially for those with risk factors.
Are their any heart healthy habits we can incorporate in our daily schedule?
We have a lot of excuses in our life that we don’t get time. I always say this engine which is heart should be well taken care of. We have a car and we keep sending it for regular checkups, but we take our hearts for granted. It is the single most effective and efficient machinery which beats and functions for years and years beating at 70-80 beats per minute for hours, days, months, years and so. We take it for granted and when it stops, our life stops. We keep cleaning our cars and putting lubricants to out engines, but for our own heart we do nothing. You can’t take it for granted. The first thing that everybody says is that I don’t have time for this. When the blockages in the heart are created, they can’t be undone, the heart is damaged, we will have weakened hearts and our lives will be cut short. We won’t be able to survive for long. If you have time to read newspaper, have food, watch TV, time to take a bath, then you must have time for exercise. It is more important than reading newspapers and watching TV, more important than anything else.
There are the habits you can follow for healthy heart:
* Firstly, walking is the best form of exercise. 45 minutes of brisk walking, 5-minute warm up and 5-minute cool down 5 days a week can reduce the risk of a heart attack by 20%.
*If you can’t find 45 minutes, you can take out 25 minutes in the morning and 25 minutes in the evening.
*Another way we can accommodate physical exercise is parking our transport 1 km away from your destination and walk that distance. Get down at metro station and walk the rest of the distance.
*Instead of lift, take stairs as it is the best way to keep your heart healthy. Apart from problem with knees, nothing should stop anybody from walking upstairs and downstairs.
*Our biggest pastime at our workplace is tea breaks where we have a cup of tea with samosa or some snacks. 75% of what we eat in our snacks is the worst of trans fats. Why can’t we transform this tea break into an exercise break where we get up from our table and use it from going down the stairs and coming up or walk for these 15 minutes? It shouldn’t be an excuse that we don’t have time for our heart. Every office should become heart healthy in the sense they have a room with a treadmill there so that anybody who wants to take a break, instead of having tea and gossip, can hop on to the treadmill and exercise.