Heart to heart By Manash Pratim Gohain The Pioneer Monday, September 29, 2003 At this rate, India will emerge to be a hereditary heartless! As was observed this September 28 - on World Heart Day. There are more than two million patients suffering from rheumatic heart diseases in India. Nearly 1.5 lakh Indian children suffer from congenital heart diseases but only two per cent get treated. The rest die of complications or suffer throughout their life. Of the total 50,000 children suffering from congenital heart diseases and requiring surgery, less than 1,000 are in a position to afford it in the country. Projections by WHO and ICMR indicate that India will emerge as the heart attack capital by 2020. As for the West, it was as early as 1960s that Finland and the US topped in coronary artery disease. These countries have brought down the rate to 60 per cent through lifestyle management. We asked Dr Prabhu D Nigam, former HOD cardiology at Ram Manohar Lohia Hospital and serving presently as senior consultant with the Apollo group as to how true are these reports. The doctor said research world over has established that coronary heart disease, heart attack and angina are increasing in Asian-Indians, specially in our region. "We are seeing maximum number of heart attacks and angina cases in India and nearby countries than other parts of the world. Earlier, it was highest in Europe and Finland. And now it is South-East Asia with a prominence in India," he added. Q: What are the common heart diseases among Indians? A: The most common heart related problems are heart attacks, coronary artery diseases, high BP and rheumatic heart disease in which the heart valves are involved. Q: Why are we witnessing this trend? A: Reasons are many: Genetic, food habits, sedentary lifestyle involving less physical activities and factors like smoking. Patients may suffer heart diseases, attacks and angina even if these factors are not present. But presence of these factors makes them all the more susceptible. Therefore, we must lay emphasis on prevention rather than cure. Q: What preventive measures can you suggest? A: We must modify our lifestyle and keep ourselves physically fit through exercises, keep our weight in check, avoid smoking and company of smokers. If we get regular medical check-ups annually in the form of physical examination, blood examination - blood sugar level, lipid profile and blood pressure etc done then we can ourselves monitor our condition. But tests do not provide a 100 per cent precautionary measure. Q: Why are even the young so susceptible to heart diseases nowadays? A: A decade ago, heart disease happened in 50-60 age group. While in the West, the high probability is still between 40-60 years, in India it has dipped to the early 30s. The younger generation is suffering mainly due to junk food. Other reasons include habits like smoking. Plus there is diabetes, high blood pressure and high cholesterol. Mainly, this disease occurs due to deposition of cholesterol in the blood vessels which supply the heart muscles. This starts as early as at 10 years of age and takes seven years to grow. In Indians, there has been an acceleration in this process as compared to other countries. This is related to the genes. Q: How are the genes responsible for this increase in heart diseases among Indians? A: If you go into molecular biology, there are certain types of bad lypoproteins and other bio-chemical abnormalities which are more found in Indians or Asian- Indians anywhere in the world than in other ethnic groups. These are probably related to genes and are under study. If we are able to localise the genes for their abnormal presentation in human body, we will be able to tackle the problem and prevent it. The future for any disease including heart is gene therapy. In a couple of years, we may be able to prevent them by gene therapy rather than using pharmaco therapy and surgery. Q: What is the relation between heart disease and diabetes as they are following a parallel pattern in their increasing trend? A: About 60 per cent of diabetics develop heart disease and about the same per cent of heart patients (I mean coronary artery disease which results in the form of angina and heart attacks) are diabetics. Diabetes is also an expanding disease not only in our country but all over the world. Heart disease has attained an epidemic proportion in our country. Again in diabetes, there is a molecular level abnormality. Cholesterol gets deposited in the blood vessels. Bad cholesterol damage the functioning of the cell lining of the blood vessel that supply the heart and other organs like kidney, eyes and brain. Another trend is young women now being prone to heart disorders. There was a time when females were considered more or less protected from coronary heart diseases till they were menstruating. But diabetes reverses this and nullifies the protective effect in menstruating women, again more prevalent in Indians and Asians. It must also be at the molecular level... some genes may be responsible. Q: What is the most recent technology in cardiology? A: When the heart muscle is damaged, it has no power to recover. Other muscles in our body can recover and regenerate, stem cells are the cells taken from the bone marrow. Stem cells have the property of developing the cell type wherever they are inoculated. If they are inoculated in the heart, they will develop into heart cells. There is a hope that this is the future therapy by which you can develop the muscles, blood vessels of the diseased heart. Q: Despite best doctors and facilities, why is India's health sector still ranked among the lowest rung? A: Medical treatment is very expensive. No government in the world can offer free treatment. This should be understood by everybody. Which is why in America only the elderly and the very poor are supported by the government. We should make health insurance mandatory. Government hospitals alone cannot take up this burden. The government spends huge amount in hospitals but there is a lack of will in the workers there. Everyone has got the power of not to work! 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