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February 2010
The Golden Hour
Prof Adrian Kennedy
 
While the rest of the world enters the heart attack zone at 55, we Indians do so at the age of 35

Did you know that 60 to 80 percent deaths in the world due to ailments are from heart attacks – much more than any other disease? Since heart attack is the major killer in the world, and since both the Apollo Hospitals Group and Pepsico Quaker Oats are committed to healthy living, they, along with the Times of India, launched a nation wide Heart Risk Assessment Campaign. This was to ascertain the heart health status of India and promote heart health, by educating the participants. The campaign was nationally advertised by the Times of India, and comprised of an online cardiac risk factors assessment. The software for this scan was created by Apollo Hospitals – whose doctors also undertook the online corrective cardiac counselling. Pepsico Quaker Oats had conceived and sponsored this scheme.

Urban Youth Statistics
Till date, over 1, 30,000 persons from all over India have undergone the scan. But more men have undergone the online scan than women - 78 percent males were able to make use of this, as opposed to 22 percent females – possibly also an indication of internet users in the country. Since the average age of the respondents is 34 years, this study can best be described as the cardiac status of India's urban youth.

Although a heart attack is a sudden and often fatal incident, it is of the consequence of decades of inappropriate lifestyle. Research worldwide has identified factors that cumulatively contribute to a heart attack. In relation to India's urban youth, the Apollo – Pepsico Cardiac Risk Scan identified the following data.

Cardiac Risk Factor Population (%)
Genetic and family history
Existing cardiac ailment
High blood pressure
Diabetes
Elevated cholesterol levels
Abnormal ECG /TMT
Accelerated resting heart rate
High fat diet
Non vegetarian
Overweight
Sedentary lifestyle
Lack of exercise
Stress at home
Occupational stress
Insufficient rest and relaxation
Stressful personality
Crisis and problems
Smoking
Passive smokers
41
5
14
5
9
9
29
46
63
53
71
57
32
35
31
50
20
21
19

Genetics and Family History
This is an extremely disturbing finding. 41 percent of the respondents would probably suffer a heart ailment within their lifetime, unless they did not alter their lifestyles, by being more physically active, having a healthier diet, avoiding stress, and smoking etc. In fact, five percent of the young respondents had already had a cardiac event, with nine percent reporting abnormal ECG readings.

HBP, Diabetes and Cholesterol
Looking at these figures (High Blood Pressure at 14 percent, diabetes at 5 percent and cholesterol at 9 percent) give us some hope, since the numbers are low. Compare this to the National Urban Study, where the average age of the respondents was 45 years. HBP was 32 percent, diabetes 17 percent and elevated cholesterol, 51 percent! What this means is that we could keep these figures low if our youth adheres to a heart friendly lifestyle of a low fat diet, exercise activity, low levels of stress and no smoking.

Nutrition and Obesity
An earlier research that compared nutritional habits of Indian children with those of their parents had indicated two things. One, that adults were more overweight than children (61 percent, as compared to 39 percent children). Two, that children however had worse nutritional habits than their parents (high fat intake of 46 percent as compared to 26 percent adults; high sugar intake of 37 percent as compared to 23 percent adults).

The Apollo Pepsico Heart Scan findings indicate that at age 34 the respondents will be added to the existing overweight (53 percent) and high fat diet consuming (46 percent) group. This group not only needs to reduce the high fat intake, but also to lose weight in order to avoid obesity, and consequent cardiac related complications of HBP, diabetes and elevated cholesterol and triglyceride levels.

The Attack
Myocardial infarction, as the 'attack' is medically called, is a result of the stoppage of blood flow in the coronary arteries that supplies blood to the heart muscle. This situation is known as arteriosclerosis, and is a consequence of the accumulation of fat deposit (plaque) in the lining of the arteries. The narrowing of the arteries impedes the blood flow. When the blood flow is insufficient for heart function, we get a sharp pain in the chest, which doctors call angina. This is often the first symptom of a heart attack.

Exercise and Fitness
The statistics here are appalling. 71 percent of our youthful respondents have a sedentary occupation and in spite of that, 57 percent do not exercise! Compare this to our school children where only 29 percent do not exercise, or to older adults where 66 percent are sedentary. If at all we wish to divert the cardiac juggernaut, all corporate institutions will need to emphasise daily exercise as part of their work culture. Remember, those who exercise almost always survive heart attacks. It is usually the sedentary smoker who falls victim.

Stress and Tension
Stress and tension levels of young urban Indian are the highest amongst any age group. Most significantly, more than 50 percent of them are Type A, high-pressured, stressed out, cardiac risk prone personalities!

This personality type drops to 37 percent as we Indians get older. 35 percent of the respondents had stressful occupations, and 32 percent carried stress and tension to their homes. Only 31 percent had insufficient rest and relaxation. As a consequence, 21 percent of our urban youth are in a burnout crisis state. Things will get better as the young Indian grows older with manageable levels of stress - if he does not have a cardiac breakdown before that! Keeping in mind that India is the most heart attack prone nation (while the rest of the world enters the heart attack zone at 55, we do so at 35 years), we need to seriously look at the stress our youth is staggering under.

Smoking
The final and perhaps the most pernicious of all risk factors is smoking. Earlier associated with mainly cancer, smoking is now equally relevant to heart attack in several ways. Smoking causes the blood to coagulate and thicken. It speeds up arteriosclerosis, reduces blood oxygen, and most significantly, smokers rarely survive a heart attack. 21 percent of our youth smoke (as compared to 11 percent older adults) – and 19 percent are passive smokers, meaning that they become susceptible by inhaling side stream smoke from others. The first step to be taken here is for the passive smoker to protect their airspace, the next step is for the smoker to quit.

Conclusions
The Apollo Pepsico Heart Scan has thrown up significant findings. 41 percent of the respondents have a family history of cardiac ailments, 53 percent are overweight, 71 percent are sedentary, 50 percent have stressful personalities and 39 percent are either active or passive smokers. The reason why we Indians get heart attacks at 35 years instead of 55 is identified
Prof Adrian Kennedy is Managing Director, Wellness Rx, International guru on health, wellness and lifestyle medicine and guest faculty for Harvard Medical School, USA

    
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