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Journalism of Courage
Written by Dr Prabhakaran Dorairaj
Many families in India will have a story to narrate about how they lost a young relative in the prime of their life. Anecdotally, many cardiologists will recount the young person who was admitted with acute myocardial infarction and died despite their best efforts. Several experts would argue that there were no known risk factors and attribute this to “genetic risk.” Is this true, or a numerator fallacy, or an anchoring bias?
Cardiovascular disease (CVD) or heart disease in India is one of India’s most urgent public health challenges (with a fifth of the world’s 20.5 million CVD deaths), not only by its scale but also by its early onset. This results in huge losses of lives during the productive years, resulting in adverse macro- (losses to the nation’s GDP) and micro-economic (affecting families) consequences.
This premature epidemic of heart disease stems from a convergence of factors, and many argue that the foundation is genetic. While this may be partly true, many factors influence the early onset of heart attacks or other heart diseases. There are differences among Indians in terms of their higher propensity to diabetes, altered lipids compared to their Western counterparts, such as higher triglycerides, low HDL-cholesterol (good cholesterol) and relatively low LDL-cholesterol (bad cholesterol). In addition, these risk factors appear to act at lower thresholds as compared to
other populations.
So, is this risk genetic or lifestyle-related?
For example, Indian diets are often heavy in refined carbohydrates, sugar and trans fats while fruits, vegetables and nuts remain under-consumed. Processed foods account for a growing share of daily calories in cities and salt intake averages more than double the recommended limits. These dietary patterns have fuelled rising obesity and diabetes, even among younger people.
Meanwhile, air pollution in Indian cities is more than three times the global average, compounding the risks of hypertension and vascular disease. Physical inactivity is common even among rural residents, and urban residents find it insecure to walk on the roads without sidewalks or footpaths. Long working hours, stress and sleep deprivation further accelerate the problem, particularly among the urban workforces. Therefore, our genes may load the gun but lifestyle pulls the trigger for heart disease. An old Tamil proverb says that a smart mind can overcome fate and destiny.
Bearing this in mind, the first thing is to know our numbers, and as we approach our thirties, it is essential for us to get our blood pressure (BP) and blood sugar measured. In terms of lifestyle, paying attention to our diet (particularly reducing the portion size and keeping our carbohydrate intake under check), and reducing consumption of refined sugar to a minimum should be our mantra. In addition, physical activity such as brisk walking for at least 30 minutes could go a long way in reducing the risk of heart diseases. Early identification of our risk factors and managing them adequately can prolong healthy life and prevent complications.
Are COVID and COVID-19 vaccines responsible for the rise in sudden deaths?
Many viral infections, including COVID, increase the risk of heart attacks or strokes by three to six-fold, particularly in the immediate aftermath of an infectious episode. However, vaccines against them are protective, particularly in the vulnerable, such as those with diabetes, cancer, previous heart disease or among the older individuals (above 65 years). It is a myth that vaccines increase sudden death.
Other reasons for sudden death in the young include rare undetected heart diseases such as hypertrophic cardiomyopathy (where the heart muscle is large), and certain genetically determined arrhythmias (irregular and fast or slow heart rates).
In India, out-of-hospital cardiac arrests are estimated at about 40 per 100,000 people each year. That is nearly 600,000 cases every year — the size of Istanbul, Turkey. When cardiac emergencies do occur, the outcome is poor. Only a fraction of victims receive cardiopulmonary resuscitation (CPR), and almost the entire population of India remains untrained in basic resuscitation techniques. Automated external defibrillators (AEDs) are rarely available in public places, and implantable defibrillators are used at a fraction of the rate seen in high-income countries. Some recent efforts, notably CPR training drives led by hospitals and a state-level initiative in Karnataka to install AEDs, are encouraging, but they remain far too limited to make a national impact.
What should be policy interventions?
Further research in India on heart diseases is limited. Without India-specific research and clinical guidance, prevention and treatment will remain misaligned with the true risk profile and Indians will continue fighting CVD with tools designed for someone else’s population.
Reversing this trend will demand action on several fronts. Policymakers must fully enforce measures such as eliminating industrial trans fats and strengthening tobacco and alcohol control. National campaigns are needed to embed healthier diets, physical activity and stress management into daily life.
Screening for high-risk groups, particularly those with family histories, diabetes, or elevated lipoprotein (a) or sticky cholesterol should become routine. Emergency preparedness must also be prioritised: universal CPR training in schools, workplaces and communities, and AEDs as standard equipment in gyms, offices and malls. Corporates, too, can play a pivotal role through workplace wellness programmes that promote regular health checks and healthier environments. All these interventions must be underpinned by investment in indigenous research to ensure guidelines reflect India’s reality.
None of these changes will be easy, but the rise in premature CVD deaths is not inevitable. By acting decisively now, India can save millions of lives and protect its developmental future. The urgency of this mission is being echoed on the global stage: at the United Nations General Assembly this year. Among other essential actions, the World Heart Federation urges countries to scale up hypertension awareness and treatment, which is one of the biggest risk factors for heart attacks and strokes, and tackling it is central to curbing cardiovascular disease.
India’s choice is clear: Invest in bold preventive measures today or face a future where heart disease continues to rob its citizens of decades of life and potential.
Dr Dorairaj is president-elect of the World Heart Federation (WHF) and executive director of the Centre Chronic Disease Control in India (CCDC)
