Many unexpected sudden deaths are taking place these days. We have to really go deep and study the possibilities. By definition, premature coronary artery disease (CAD) occurs at a young age below 55 years in men and 65 years in women. Many studies have found that Indians are prone to CAD at younger age, this should worry us.

A recent American study found that sudden cardiac arrest among persons mid-30s to mid-40s increased by 13%. The prevalence of heart disease among the young is increasing. According to the Indian Heart Association, heart disease in the young occurs much earlier than other age groups. Heart disease in Indians occurs at least a decade before their counterparts in the West; hence, they mostly occur in the age group 30-69 years. Factors such as a sedentary lifestyle, diabetes, smoking, hypertension, increasing alcohol intake, stress increase the risk of sudden cardiac arrest among the young. However, many do not have any known risk factors. Hence, the young should be urged to get regular checkups to create greater awareness about sudden cardiac arrest.

Nearly 30% of heart attacks occur suddenly and unexpectedly among individuals who are otherwise healthy or appear healthy. The rising incidence of heart disease, its early onset and the high case fatality rate are reasons enough to worry about the epidemic of heart diseases in India.

The shift from communicable to non-communicable diseases in India happened rather quickly. From 1990 to 2010, premature deaths increased by nearly 60% from 2.32 crore to 3.7 crore. Heart diseases are a major cause of death in India, not just in urban areas, but also rural areas and poorer states. Lifestyle changes are the major culprit.

Many young Indians have recently lost their lives due to sudden cardiac death. On 29^th October, 2021, Puneet Rajkumar, renowned Kannada actor, collapsed after a morning workout and died within an hour. Just a month back, Siddharth Shukla, a 40-year-old television actor died suddenly after he complained of chest pain at night. In the same year, Raj Kaushal, a 49-year-old film director and producer, died of a heart attack.

There have been cases of sudden cardiac arrest in sportspersons too, who everybody expects to be physically fit. Radhakrishnan Dhanarajan, a football player, collapsed during a match in Kerala and could not be revived. He was 39 years old. 

India is a young country; these untimely deaths therefore necessitate reassessment of CAD in the young population.

The first nationwide study, which examined cardiovascular mortality in India over a period of 15 years found that the odds of death due to ischemic heart disease have increased in the 30 to 69 age group. The mortality rate rose from 10.4% to 13.1% in men and from 4.8% to 6.6% in women between 2000 and 2015. Up to 26% of myocardial infarctions occur in Indians below 45 years of age vis a vis 5-7% in the western population. The largest increase has been seen in women around 35 years of age. The maximum increase in mortality due to ischemic heart disease among men aged 50-54 years was 2.4% whereas it was 2.8% among women aged 35-39 years.

Sudden cardiac arrest brings the heart to a stop without a fair warning. Irregular heartbeats due to problems in the electrical system of the heart prevent it from performing the vital function of pumping blood to the body. It does not give enough time to revive a person unless it is done within approximately the first 10 minutes. Persons with sudden tachycardia or those with genetically at risk of heart disease are more likely to develop a fatal arrhythmia.

Cardiopulmonary resuscitation (CPR), if performed within the first 10 minutes of a sudden cardiac arrest, provides the best odds of survival as it restarts the heart immediately.

Therefore, it is of utmost importance to adopt healthy lifestyle behaviors. These include a well-balanced diet rich in fruits and vegetables, regular exercise, avoiding smoking and drugs, consumption of alcohol in moderate amounts, regular sleep and stress management. Persons with a positive family history should especially take care. A cardiac consultation with frequent check-ups is imperative to diagnose any underlying heart disease. Early diagnosis allows timely intervention.

Increasing the tax on tobacco, reduction of salt in processed foods and treatment of hypertension are some cost-effective policies to reduce the burden of heart diseases. The government is taking necessary steps to mitigate this increasing burden. In the 2023 Union Budget, the government has increased the taxes on cigarettes by 16%.

About the Author: Prof (Dr) M Wali, MD FACC  (USA), MBA, FRCP (GLASGOW). Senior Consultant Physician Sir Ganga Ram Hospital. Former Consultant Physician to the President of India.

Presidents Estate Clinic, North Avenue, New Delhi-110004. Leading Health Professionals of the world - 2017. Founder President National Trust for Hypertension and Stroke. Former Physician CGHS, RML Hospital.