Cardiovascular diseases (CVDs) remain the primary cause of mortality worldwide, resulting in a substantial number of fatalities and disabilities. The alarming statistics from 2021 reveal that CVDs claimed 20.5 million lives, accounting for approximately one-third of all global deaths.
Young Indians are increasingly vulnerable to heart disease due to alarming environmental and lifestyle factors. Rising air pollution, coupled with a surge in diabetes cases, poses significant concerns. Mental health also plays a critical role, as chronic anxiety and depression can indirectly contribute to cardiovascular issues.
As a result of these risk factors, individuals may exhibit intermediate risk factors, including raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These intermediate risk factors can be identified through measurements taken at primary care facilities and serve as critical indicators of an increased risk of heart attack, stroke, heart failure and other complications.
Early detection and management of these risk factors are vital in preventing cardiovascular diseases and mitigating their devastating consequences.
We spoke with Dr. Purshotam Lal who is a renowned interventional cardiologist and recipient of Padma Vibhushan, Padma Bhushan and the Dr. B. C. Roy Award by the President of India for his significant contributions to the development of interventional cardiology in India. He currently serves as the Chairman of Metro Group of Hospitals.
Prevalence and risk factors of heart disease
Dr. Purshotam Lal: Major risk factors include unhealthy diets rich in trans fats and sugars, physical inactivity, smoking, excessive alcohol consumption, and conditions like hypertension and diabetes. Stress, often overlooked, is a significant contributor especially in high-pressure environments like urban centers. In India, factors such as rising pollution levels, genetic predisposition, and lack of early detection mechanisms make heart diseases more prevalent. One of the most important factors that people often ignore is a strong family history of premature coronary disease.
Common cardiovascular conditions and symptoms
Dr. Purshotam Lal: The three most common cardiovascular diseases are coronary artery disease (CAD), heart failure, and arrhythmias.
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Coronary Artery Disease (CAD):
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CAD is the leading cause of death globally, accounting for approximately 9 million deaths per year, which represents 32% of all global deaths according to the World Health Organization (WHO).
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In India, CAD contributes to over 1.7 million deaths annually, making it the most prevalent cardiovascular disease in the country.
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Common CAD symptoms include chest pain (angina), shortness of breath, and fatigue. It is often diagnosed via stress tests, angiograms, or blood tests.
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Its treatment includes lifestyle changes, medications, or surgical interventions like stents or bypass surgery.
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Heart Failure:
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Heart failure affects around 64 million people For India, the numbers are estimated at 8-10 million cases, with heart failure contributing to 35% of cardiovascular-related hospitalizations.
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Its symptoms include persistent coughing, swelling in the legs, and breathlessness. Diagnosis typically involves echocardiograms or MRI.
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Treatment for heart failure focuses on lifestyle changes, medications to manage blood pressure, and sometimes the implantation of devices like pacemakers.
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Arrhythmias:
- Arrhythmias cause palpitations, dizziness, or fainting spells. Generally, it is diagnosed through ECG or Holter monitoring and can be treated with medications, electrical cardioversion, or ablation.
Heart Disease in younger populations
Dr. Purshotam Lal: In recent years, heart disease has surged among younger adults due to a mix of lifestyle and environmental factors. Unhealthy diets, sedentary lifestyles, and high levels of stress, often driven by work pressure, have become common. Smoking, including the use of e-cigarettes, and excessive alcohol consumption have added to this trend.
For younger populations in India, increasing air pollution, a higher prevalence of diabetes, and a lack of awareness about preventive healthcare are major concerns. Mental health issues, such as chronic anxiety and depression, are also indirectly linked to the rising incidence of heart disease.
Genetics and heart disease: Preventive measures for those at risk
Dr. Purshotam Lal: Genetics significantly influence an individual’s risk of heart disease. People with a family history of cardiovascular conditions, particularly those related to high cholesterol, hypertension, or early-onset heart disease, are at a higher risk. However, genetics don’t seal your fate; lifestyle choices play a crucial role in determining outcomes.
For those with a family history, it’s essential to start preventive measures early. Regular health check-ups, monitoring blood pressure and cholesterol, maintaining a healthy diet, exercising regularly, and avoiding smoking can mitigate genetic risks. Genetic screening may also be beneficial in identifying specific markers that indicate higher susceptibility.
Impact of technology on heart health management
Dr. Purshotam Lal: Modern technology has revolutionised heart disease management and prevention in the past few years. Wearable devices, like smartwatches, can monitor heart rate, detect irregularities like atrial fibrillation, and track physical activity. This constant monitoring helps in early detection, even in asymptomatic individuals.
Telemedicine has also emerged as a game-changer, providing real-time consultations without geographical barriers. This has been particularly impactful in rural areas in India, where access to specialized cardiologists is limited. Remote monitoring and virtual check-ups ensure that patients with chronic heart conditions remain connected to their healthcare providers, improving compliance with treatments and lifestyle recommendations.
Heart disease in women: Unique risks and underdiagnosis
Dr. Purshotam Lal: Women often experience more subtle symptoms of heart disease, such as fatigue, nausea, shortness of breath, and pain in the neck, jaw, or back, rather than the more obvious chest pain typical in men. Hormonal differences, especially after menopause, further increase the risk of heart disease.
Heart disease is underdiagnosed in women for a few reasons. Historically, medical research has been more focused on men, and women’s symptoms are often attributed to less critical conditions like anxiety or indigestion. Hence, increasing awareness among both healthcare providers and women themselves about these differences is crucial for early diagnosis and better outcomes.
Congenital heart conditions in children
Dr. Purshotam Lal: Congenital heart defects (CHD) are the most common birth defects worldwide. Common types include atrial septal defects (ASD), ventricular septal defects (VSD), and tetralogy of Fallot. Early detection can be achieved through prenatal screening using fetal echocardiography, which can identify most heart defects during pregnancy. Post-birth, symptoms such as rapid breathing, poor feeding, or bluish skin color can be warning signs.
Early detection is crucial as many congenital heart defects, when caught early, can be corrected or managed with medical or surgical interventions, improving the child’s quality of life.
The COVID-19 pandemic’s impact on heart health
Dr. Purshotam Lal: COVID-19 has had a profound impact on heart health, particularly among those with pre-existing conditions. The virus has been linked to complications such as myocarditis (inflammation of the heart muscle), blood clots, and arrhythmias. Even in individuals without prior heart conditions, post-COVID syndrome, or “long COVID,” can lead to persistent cardiovascular issues such as chest pain, fatigue, and palpitations.
Those who were impacted by COVID-19, especially those with heart conditions, should continue monitoring their heart health closely. Regular check-ups, echocardiograms, and maintaining a healthy lifestyle can help mitigate long-term effects.
Artificial intelligence in cardiovascular care
Dr. Purshotam Lal: Artificial intelligence (AI) and machine learning are transforming cardiovascular care by enhancing diagnostics, predicting patient outcomes, and personalizing treatment plans. AI algorithms can rapidly analyze large datasets from imaging techniques like echocardiograms or MRIs, helping detect heart issues earlier and with greater accuracy.
In India, AI-powered tools are increasingly being used for early screening of conditions like heart failure in underserved populations. Machine learning models can also predict the likelihood of heart attacks based on patterns in patient history, allowing for proactive, rather than reactive, healthcare. For example, Tricog Health, an Indian startup, uses AI-based solutions for diagnosing heart attacks remotely. By combining AI with human expertise, it delivers ECG interpretations in real-time. This has proven to be crucial for early diagnosis in rural India, where access to specialists is limited. Tricog has been credited with reducing the diagnosis time for heart attacks to under 10 minutes in many cases.