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The blue-collar worker and the corporate executive are both equally susceptible to heart problems. But the good news is preventive programmes are on the rise.

Despite advanced medical technology available in the country, India's crusade against Coronary Heart Disease (CHD) still has a long way to go. "Cardiac care in India is at par with global standards, but unfortunately this is restricted to six-eight metros only," according to Dr D. Premachandra Sagar, Chairman and CEO, Sagar Apollo Hospitals, Bangalore. India has geared up significantly in cardiac diagnosis in terms of the tools available for detection and surgical management, he says. But unfortunately, most patients seek medical help when they are in a breakdown condition. Dr Sagar says, "About 25 per cent of the patients that come to us are candidates for elective surgery." History has shown that the South Asian community is at a larger risk to CHD because of certain genetic factors.

According to Dr Vivek Jawali, Chief Cardiovascular Surgeon, Wockhardt Heart Institute, Bangalore, "An increasing number of Indians in the age group 40-50 are undergoing either angioplasty or a bypass." While the average age for the white Caucasian suffering from heart problems is 65 years, the Indian is ahead of other races by almost a decade. Says Dr Sagar, "Generally it's the 50-70 year-olds who are more susceptible to heart problems . But also we find that there is a larger sprinkling of people from the age group of 35 onwards."

A study of the profile of people who suffer from heart ailments shows that the blue-collar worker is as susceptible to the disease as the corporate executive. And increasing number of women in the post-menopausal stage is falling prey to the `attack.' But the good news is that in cardiac care, preventive programmes are assuming greater importance. Dr Sagar says, post-35 when the signals start showing is when people should opt for lifestyle and diet changes, look for genetic predisposition and tackle the most obvious contributors such as lack of physical activity, stress, obesity, and the like.

Dr A. Gopi, Interventional Cardiologist and Co-ordinator, Cardiovascular Services, Sagar Apollo Hosiptal, says it is worthwhile to take stock of factors such as diabetes, hypertension and cholesterol to make the detection and diagnosis early on. Apart from medical preventive measures such as regular checks and saying no to cigarettes, young people need to know that a wrong kind of food intake can cause a significant damage to the heart. Information about the right intake of food should be made public, like, say, food high in essential fatty acids (EFA) are said to be ideal for a healthy heart. EFAs are fats that humans cannot manufacture or synthesise and have to be obtained them from our diet. They produce prostaglandin that regulates many of the body functions including heart rate, blood pressure, blood clotting, immunity, fertility and conception. There are two families of EFAs — the Omega 3 and the Omega 6. Omega 3 fatty acids are made from Alpha Linolinic Acid (ALA), and the Omega 6 fatty acids from Linolinic acid. Food sources of ALA include fish, as well as plant sources such as flaxseed and flaxseed oil, soybean oil and nuts. ALA is found in black walnuts, soybeans, legumes, and seaweed. Flaxseed is the world's richest source of ALA. Flaxseed oil also contains omega 6 fatty acids. High levels of ALA are also found in fish such as mackerel, herring, salmon, bluefish and halibut.

Apart from food, physical activity plays a crucial role in the onset or progression of the disease. Unfortunately, the average Indian is indifferent to the `workout' aspect, says Dr Jawali. A brisk morning walk of 45 minutes keeps the blood pressure normal for at least 7-8 hours. But, asks Dr Sagar, "Where are the parks and jogging tracks in India for the common person to workout?"

However, he says, "The good news is that all the predisposing factors can be tackled and the progression of cardiac problems can be delayed." At any preventive programme, the progress of the disease is picked up early on as biochemical changes are noticed. Sagar Apollo, for instance, has enrolled 150 corporates in this programme. "We conduct talk shows for them. This week we are having an online chat for Infosys employees where we give lessons in stress management, diet and lifestyle changes, etc."

Dr Sagar points out that the thing to remember is that CHD is no longer a life threatening disease. "There is a greater degree of survival even in case of incidence of the attack, if the patient is brought within the golden hour." For instance, if the ambulance can reach the patient within 35-40 minutes of the attack, then recovery is certain. "Most of our paramedical staff have the required equipment to start the ICU treatment at the patient's home."

But this privilege is available only in the urban areas. "For this kind of treatment to reach the rural areas, we need effective private-public partnership," says Dr Sagar. Talking of the affordability factor, he says any new medical technique with a high level of instrumentation is expensive. But it's a catch-22 where if you wait for the treatment to become cheaper, then it will become passé, because soon a new technique will take over. The answer to rising medical costs is the access to insurance, he says. The cost of drugs and medical personnel form 60 per cent of the hospitalisation costs in case of a bypass surgery, which costs around Rs 90,000, says Dr Sagar. "The Government should extend itself to bring down medical costs through cut in sales tax and customs duty on drugs and equipment," he says.

Picture by G.R.N. Somashekar

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