Five billion people globally remain unprotected from harmful trans fats, with only 43 countries, home to 2.8 billion people, having implemented best practice policies, said a recent status report by the World Health Organisation (WHO). In addition to preventing deaths due to cardiovascular diseases, the intra-government agency said, “Policies to eliminate industrially produced TFA are relatively simple to implement and can save lives and economies.”
Although implementation of these best practice policies began in India in 2022, Dr RR Kasliwal, Chairman of Clinical and Preventive Cardiology at Medanta Hospital, Gurugram, says that it may be years before their impact is felt. At present, he increasingly sees heart attacks in the young because of wrong lifestyle choices and eating patterns.
What happens when we consume trans fats?
Trans fats are not naturally-occurring substances and have been linked with endothelial dysfunction (damage to the inner lining of blood vessels). This is because they lead to deposition of low density lipoprotein (LDL) or bad cholesterol in the blood vessels, narrowing them down than they already are and causing heart attacks and strokes.
The condition of those already with say 30 to 40 per cent blockage deteriorates faster if they consume excess trans fats. Coronary artery diseases are actually childhood diseases with a long latency period. This is because atherosclerosis or the deposition of cholesterol in the arteries starts at a young age and then causes heart attacks later in life.
How has the consumption of processed foods, many of which have trans fats, changed the heart disease pattern over the last decade or so?
The change in disease pattern is for all to see. Heart attack rates have shot up to a level that is hard to believe. Heart attacks are now happening in younger and younger people. One of the doctors in my team very non-chalantly said that a 32-year-old patient had been admitted after a heart attack; it’s that common now, not a rarity or exception.
It may not all be because of trans fats but our diet has definitely had an effect – people eat out more frequently now, they eat more fried stuff, sweets and namkeens, and other things high in fats, sugar and salt. This is especially true of children who don’t like home-cooked meals and want to eat these foods.
Then there are risks of a sedentary lifestyle like obesity, high blood pressure and diabetes at younger ages, and smoking – all of these increase the risk of heart diseases. Add to that people working from home, not following any schedule, munching through the day. This has been the drill for around two years during the pandemic. The high levels of pollution are not helping matters either; they act as a trigger for heart attacks.
In people who have all these risk factors, the winters are a compounded risk factor. We see a high number of heart attacks during the winters because the arteries constrict due to the cold in addition to the blockages caused by plaques. This year, in fact, has been worse because of the extreme cold days. Besides, many with a history of COVID-19 are facing problems.
So, is there a way to ensure a better diet even while eating out sometimes?
See, the first thing to ensure is a healthy diet at home, especially for children, so that they learn to like the food.
Having said that, it doesn’t mean that people should never eat out at restaurants. But there is a need to change what is ordered. Order healthier things like salads and beans. Have leaner meats. You can order sabji and roti without ghee or butter, I suppose. You can even eat pizzas if you ask the restaurant to make them thin crust, with no extra cheese and top it up with a lot of vegetables. And, avoid anything with a high level of salt.
More important is to eat food on time, exercise daily and quit smoking.
How can these episodes of heart attack in the young be prevented?
If you have a history of heart diseases, check in with your doctor, especially during the winters. Now, it is so easy to do so online.
Men over the age of 25 years and women over the age of 30 years, with a strong family history of heart diseases, should go through a thorough screening. And, not just a treadmill test, they should get a CT angiography done along with calcium scoring to understand whether they have atherosclerosis and by how much. Then, if the lipid levels are high, they should be treated with statins.
Why Dr Kasliwal? He is the chairman of Clinical and Preventive Cardiology at Medanta Hospital, Gurugram. He has over three decades of experience in the field and has previously worked at centres such as Escorts Heart Institute, National Heart Institute and the All India Institute of Medical Sciences. He has over 200 publications to his name and several awards, including the highest honour for physicians, Dr BC Roy Award.