World Heart Day: Why are a rising number of young Indians dying due to heart attacks?

India is witnessing a surge in deaths attributable to heart attacks. The passing of a Class 9 student in Lucknow due to heart failure, serves as a stark reminder of the decreasing age group that has begun to qualify for the incidence of heart attacks.

"We are witnessing a sudden spurt of more than 25 per cent deaths in the age group of 25 - 44 years due to cardiac failures," informs Dr Anita Suryanarayan, MD (Pathology), Vice President and Head Quality Assurance (Region 1), Metropolis Healthcare Limited. She adds that this trend is not limited to India only and is being witnessed worldwide. A recent study conducted by the Indian Heart Association reveals that the number of heart attack cases among individuals under the age of 40 has doubled in the past decade.

In another instance, a 19-year-old college student from Jamnagar succumbed to a heart attack during a Garba dance session. This unprecedented death spike among younger individuals underscores the need for better preventive measures, increased awareness and improved access to healthcare services.

Why are young Indians succumbing to heart attacks?

Medical experts have conducted extensive research to discover a connection between Covid-19 and an elevated risk of cardiovascular diseases. The pandemic led to an increase in stress among people who either suffered from the disease or lost a close family member to it, shares Dr Sushant Srivastava, a heart transplant specialist from Artemis Hospitals, Gurugram.

Additionally, trigger factors like stress and anxiety got integrated into people's behavioural responses which increased the risk of heart attack, informs Dr Nihar Mehta - a cardiology expert from Jaslok Hospital and Research Centre, Mumbai. Due to the lockdown, patients could not follow up with their doctors or get access to health care easily during the pandemic, which contributed to increased cardiac problems even amongst those unaffected by the coronavirus.

Then there comes inflammation of arteries triggered by Covid-19 infection which can accelerate pre-existing coronary artery disease. Even in younger adults, it can foster atherosclerosis (the buildup of fatty plaque within arteries) and the formation of blood clots, thereby heightening the risk of heart attacks, added Mehta.

Additionally, the psychological and social challenges associated with the pandemic, such as job loss, financial pressures and the shift to work from home, may have led to acute or chronic stress, increasing the risk of heart attacks, remarks Mehta.

"It's truly alarming to witness an increase in heart attacks among children as young as 15. Apart from rare genetic and anatomic conditions, the other potential factors contributing to this increase are the growing prevalence of sedentary lifestyles, poor dietary choices and childhood obesity," said Dr Ashish Mishra, Consultant Interventional Cardiologist, Wockhardt Hospitals, Mira Road.

Mehta opines that people want to be on the fast track to fame and riches. This has led to mounting stressors that young ones are facing from school performance to social media, and pressures to perform at work. These combined factors only contribute to significant stress and anxiety which is already a major risk for cardiac disease and heart attacks.

Researchers suggest that sleep apnea, causing abnormal heart rhythms, might also play a role. Sleep apnea is a sleep disorder characterised by brief and repeated interruptions in breathing during sleep, often causing loud snoring, poor sleep quality, and daytime fatigue. It lowers oxygen levels, triggers the fight-or-flight response, and stresses the heart mechanically, informs Suryanarayan.

The alarming increase in heart attacks among young people is multifactorial, shares Mehta. Popular celebrities and comedians like Sidhartha Shukla, Satish Kaushik, Reema Lagoo, Krishnakumar Kunnath, Farooq Sheikh and many more succumbed to cardiac failures in the last two years - urging medical experts to dissect the risk factors for heart attack.

What are some of the common risk factors for heart attacks?
Over the years, there have been significant changes in the risk factors associated with heart attacks. Traditionally, factors such as high blood pressure, diabetes and high cholesterol, smoking and obesity were considered major contributors to heart disease.
Studies have shown a clear link between chronic stress and an increased risk of heart attack, remarks Mishra. Lack of physical activity not only increases the likelihood of obesity but also weakens cardiovascular health over time, making individuals more susceptible to experiencing a heart attack.

High Blood Pressure
This is a leading risk factor for heart attacks. When blood pressure is consistently elevated, it causes the heart to work harder to pump blood, which can lead to the thickening and narrowing of arteries. This, in turn, increases the risk of atherosclerosis, where fatty deposits (plaque) build up on the artery walls. These plaques can rupture, leading to blood clot formation that can block blood flow to the heart, resulting in a heart attack.

Sedentary lifestyle
Prolonged periods of inactivity can result in weight gain and obesity, which are associated with an increased risk of high blood pressure and insulin resistance. Additionally, physical inactivity weakens the heart and cardiovascular system, making them less efficient at pumping blood and oxygen throughout the body, said Srivastava.

This reduced efficiency places extra strain on the heart and elevates the risk of atherosclerosis, the buildup of plaque in arteries. As a result, sedentary individuals are more prone to the formation of blood clots, which can block blood flow to the heart, leading to a heart attack.

Smoking
Smoking is a major contributor to heart attacks due to its harmful effects on the cardiovascular system. The chemicals in tobacco smoke damage the lining of blood vessels, leading to the development of fatty deposits on artery walls. These deposits sit on the walls and narrow the arteries, leading to reduced blood flow.
Smoking also triggers inflammation and oxidative stress in the blood vessels, making it easier for plaque to rupture.

When plaque ruptures, it can result in the formation of blood clots that obstruct coronary arteries, leading to a heart attack. Moreover, smoking raises blood pressure, promotes the buildup of LDL cholesterol (the "bad" cholesterol), and reduces levels of HDL cholesterol (the "good" cholesterol), all of which further contribute to the narrowing and hardening of arteries.

Covid-19
Inflammation due to coronavirus affects the cardiovascular system post-infection, shares Suryanarayan. Notable changes include increased blood clot risk and blood "stickiness." Elevated blood pressure, possibly related to the infection or its circumstances may also occur. A study, conducted in 2022, estimated that about 4 per cent of people who had Covid-19 developed a heart problem, such as irregular heartbeat, heart failure, inflammation or attacks.

Recent studies have suggested that those infected with Covid-19 may have an increased risk of developing cardiovascular complications, including heart attacks. The impact of the virus goes beyond respiratory illness and can extend into other vital organs including the heart, informs Mishra.

High Cholesterol Levels
Elevated levels of low-density lipoprotein (LDL) cholesterol, often referred to as "bad" cholesterol, contribute to the development of atherosclerosis. LDL cholesterol can infiltrate the inner lining of arteries, causing inflammation and the accumulation of plaque. Over time, this plaque can become unstable and rupture, triggering the formation of blood clots that can obstruct coronary arteries, leading to a heart attack.

Expert steps to mitigate the risk of heart attack
In the face of a rising incidence of heart attacks, individuals can take proactive measures to significantly reduce the risk and prioritise heart health. First and foremost, adopting a heart-healthy diet is crucial. Focus on consuming a variety of fruits, vegetables, whole grains, lean proteins (like poultry, fish, and legumes) and healthy fats (such as those found in nuts, seeds, and olive oil). Minimise intake of saturated fats, trans fats, salt and added sugars. A balanced diet helps control weight, lower blood pressure and manage cholesterol levels - all critical factors in preventing heart attacks.

Regular physical activity is another essential component of heart attack prevention. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week. Incorporate strength training exercises two days a week. Exercise helps maintain a healthy weight, reduces the risk of diabetes and enhances cardiovascular fitness. Even small changes like taking the stairs instead of the elevator or going for brisk walks can make a significant difference.

Quitting smoking is paramount for reducing heart attack risk. Seek support to quit smoking, whether through counselling, medication or smoking cessation programs. Quitting smoking not only lowers the risk of heart attacks but also offers immediate health benefits, including improved lung function and reduced risk of lung cancer