Do you know your heart age?

GUEST COLUMN: Dr. N Prabhudev
Bengaluru, Jan. 11: The ‘average age of heart’ of Indians is five to seven years older than their actual or biological age. Indians have a handicap of five to seven years of Heart age as compared to many other nationals!
This Heart age deficit leads to heart attacks-in the young and old! The rates of Coronary Heart Disease among Indians are a staggering 50-400% that of any other ethnic group. While prevalence of heart disease in the West has gone down by 50% in the last three decades, the rates in India have doubled with no signs of abating. The average age at which the first heart attack occurs has come down by 20 years in Indians!

Let’s compare some hearts – an Indian heart with an American heart, a Chinese heart and a Japanese heart! The odds are heavily against the Indian heart. It will be at a greater risk of a heart attack despite the same head start of base level metabolic factors.
Short stature and associated small calibre of vital organ blood vessels, Childhood obesity and early onset metabolic syndrome play havoc on the severity of the heart attacks and its premature onset.
Japanese paradox: Despite a 74% incidence of smoking, Japan has a five-fold lower Coronary Artery Disease rate than the USA. Japan has reduced its heart disease rate by 60%. The factors contributing are a high level of HDL – the “good cholesterol” and low levels of triglycerides – the “ugly” cholesterol, along with a high consumption of fish.
The Indian heart will be two to three times more at risk of heart disease than Caucasians, six times than the Chinese and 20 times than the Japanese. Indians are also 10 times more prone to getting a heart attack below age 40, as compared to westerners. Indians tend to suffer from heart disease about 10 years before their global counterparts- almost 33 per cent earlier than other demographics, and very often without prior warning.
Homo-cysteine – This molecule has recently been identified as an independent risk factor for CAD in Indians! Apo lipoprotein B, Plasminogen Activator Inhibitor, Fibrinogen and C – reactive protein have been detected in higher levels in Indians than in other ethnic groups.
The metabolic syndrome is defined as the concurrence of obesity-associated cardiovascular risk factors including abdominal obesity, impaired glucose tolerance, hypertriglyceridemia, decreased HDL cholesterol, and/or hypertension -insulin resistance as a core feature! It is hypothesised on the ‘thrifty gene’. Urbanisation and modern lifestyles together bring about these risk factors.
In the coronary circulation, micro vascular dysfunction -diminished coronary flow reserve is a powerful predictor of major adverse cardiovascular events.

Furthermore, the Metabolic Syndrome significantly impairs the balance between coronary blood flow and myocardial metabolism in response to exercise!
The fast-paced lifestyle of modern India, coupled with the intense pressure to succeed, is imposing stressful toll on the health of young people. Anxiety and depression are common among the younger generation, and these stressors have a direct impact on the heart as it causes inflammation in the body and elevates levels of cortisol, a hormone that damages the heart and blood vessels.
Truth is often depressing more so on the heart front. Genetic predisposition, Family history, comorbidities, Diet rich in Trans fats, Stress with heightened systemic inflammation, Smoking and alcohol and Sedentary lifestyle are the major risk factors! COVID-19 has emerged as a risk amplifier! People who had severe Covid-19 are about three times more likely than uninfected people to face major cardiovascular problems within eight to twelve months of their hospitalisation.
Can Indians overcome their ‘heart age’ disadvantage?
We may not be able to change our genes, but certainly we can be very aggressive with lifestyle modifications and other treatments to counter our vulnerability.
To minimise the heart age disadvantage- Exercise regularly- 30 to 40 minutes a day to ideally include both cardiovascular and resistance exercises. Maintain normal body weight for the age- overweight puts you at higher risk of heart disease. Eat with heart in mind and Eat healthy! Get enough sleep – when body performs all the repair work! Don’t stress! Quit smoking and avoid alcohol! Get heart-related tests done regularly.

Unanswered questions
Why metabolic syndrome occurs at younger ages in Indians?
Is childhood obesity the reason for early metabolic syndrome?
Are these factors a result of gene-environment interaction?
What is the role of macro- and micronutrients in Indian Diet?
Do rural-urban migrants have increased obesity and diabetes?
What are the potential interventions to reduce the risk?

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