November 18, 2007
Except for an occasional stomach ache—the result of a gall bladder stone removal surgery 11 years ago—Ashok Pandey had no health problems.
A few months ago when the pain recurred, his doctor made him undergo a few tests, just in case it could be something else.
That evening Pandey, 35, was shifted to the Asian Heart Institute in suburban Mumbai. The tests had revealed three blockages in his arteries. Pandey was shocked. Though he did not exercise regularly, he had no family history of heart disease and is a pure vegetarian, who does not even eat egg.
Doctors are quick to blame changing lifestyles for many health problems. But how much does this really contribute to ill-health? Hectic work schedules have done wonders for the economy, but have taken their toll on people's health. Sedentary jobs, late working hours, lack of exercise and a diet of fast food have become commonplace.
This unhealthy lifestyle has been blamed for the increased incidence of heart disease in young Indians. High cholesterol level is one of the key factors responsible for heart disease. This was a problem commonly associated with people above 50.
Today, however, it is not uncommon for someone who is 30 to be affected. Many doctors report that a lot of people in their 20s and 30s are being diagnosed with cholesterol-related health problems. “Sometimes, when a father and son come to me, I assume it is the father who is the patient, but am told it is the son who has the problem!” says Dr Ramakanta Panda, cardiovascular and thoracic surgeon at the Asian Heart Institute. He has noticed a 10 per cent increase in the number of young patients coming to him in the past 20 years. Of them, 30 per cent need surgery or angioplasty and 70 per cent can be helped with medicines.
Dr Ashok Seth, chairman and chief cardiologist at the Max Heart and Vascular Institute in Delhi, blames a changing lifestyle for the increase in heart ailments among youngsters. “Heart disease has increased 200 per cent in youngsters in the past 15 years,” he says. “People in their 20s and 30s have been exercising less, and there is more competition at work and in school. Eating out has become a norm, and people consume more fast-food than before.”
According to him, it is a global phenomenon. Such problems appeared in the west before they did in the east. “People in the west, however, have become more aware of health,” he says. “In the last 30 years, heart disease has decreased in the west.”
Dr Kaustubh Vaidya, cardiologist and coronary interventionist at Jaslok Hospital in Mumbai has had a few patients who are in their 30s. “I don't want to quote any figures because there has been no study or survey to corroborate this finding,” he says.
One of his patients, media professional Niranjan Rajadhyaksha, 42, was not overweight, never smoked and rarely drank. But he developed high cholesterol, and, in spite of medication, underwent an angioplasty four years ago to remove two blockages. Rajadhyaksha now sees a pattern when he recalls the times before his problem was detected. “My weight had increased by 10kg in a few months, since I had begun eating out and eating richer food. Job-related stress was another factor.”
Alok Tanwar, 34, is a non-smoker, and teetotaler who exercised fairly regularly. In September last year, he was feeling fatigued, and decided to go for a check-up. His echo-cardiogram was normal, and the doctor even laughed at him, telling him to go home and not worry so much. Ironically, the next day, he found himself in the emergency room of Apollo Indraprastha Hospitals in Delhi after suffering a heart attack. When the doctors suggested an angiography right away, he informed his family and moved to Max Hospital, under the care of Seth, who had treated his father. “I am a foodie and a worry wart,” says Tanwar. “These are the only things which could have put me into trouble.”
K. Shrikrishnan (name changed), a media professional, had a job that he enjoyed, a loving wife and a house of his own. He thought he had everything when he turned 30. Thinking it to be another milestone in his life, he decided to have a medical check-up. While his blood pressure and blood sugar levels were normal, his cholesterol level was abnormally high. He was prescribed some drugs and given instructions on controlling his diet.
“Around 20 per cent of patients with coronary heart disease, high cholesterol and obesity, are below 40 years of age,” says Dr Rakesh Yadav, cardiologist at the All-India Institute of Medical Sciences, Delhi. “This was not the case 10 years ago. People have started smoking at a younger age, obesity has started striking children and food habits are uncontrolled, thereby leading to youngsters having high triglyceride values.''
Ajit Bhargawa, 37, who owns an optical shop in Allahabad, came to Apollo Indraprastha Hospitals with diabetes, high triglycerides levels and high blood pressure. Bhargawa's high cholesterol was first detected when he was 31. From a whopping 1,000mg/dl, he has been able to bring it down to 250mg/dl, but the problem persists. Says Bhargawa: “I am a vegetarian, a teetotaller and don't eat out often. But I have a family history of diabetes and heart ailments. Both my father and grandfather had diabetes, and my father died of heart attack.”
High cholesterol increases the risk of a heart attack, but it is not a killer by itself. It could be lethal when accompanied by a bad diet, smoking and high blood pressure and diabetes.
Like in all warfare, it helps to know the enemy. Cholesterol is a lipid found in the cell membranes of all body tissues. It is a soft, white, fat-like substance made in the liver. The name originates from the Greek chole (bile), stereos (solid). The chemical suffix -ol stands for alcohol.
All animals and humans have cholesterol in their blood. They cannot survive without it. In humans, 15 per cent of the cholesterol-level is from food and 85 per cent from the liver, which is genetically determined. Cholesterol helps in the production of cell membranes and hormones as well as in the digestion of some foods. It is required to maintain membrane fluidity.
Cholesterol aids in the making of bile (which is stored in the gall bladder and helps digest fats), and is important for the metabolism of fat soluble vitamins, including vitamins A, D, E and K. It is the major precursor for the synthesis of vitamin D and steroid hormones.
Cholesterol is produced in the body, but about 15 to 20 per cent is supplemented from the diet. Cholesterol attaches itself to a protein to travel to the cells. This combination is known as lipoprotein. Of the many lipoproteins, two are most important, LDL—low density lipoprotein, also called bad cholesterol, and HDL—high density lipoprotein, called good cholesterol. The value of LDL should be less than 100mg/dl. In case of heart patients, the LDL value should be below 70mg/dl.
HDL works to cleanse the blood vessels of excess LDL, so a higher number, anything above 40mg/dl, is desirable. Total cholesterol should be below 200mg/dl for optimal health. There are triglycerides or fatty substances. All these components make up the lipid profile. When a blood test is done to determine cholesterol levels, all these are included.
“Till a couple of years ago, only the levels of LDL and HDL were known but now the size of the particles has also been ascertained,” says Dr Ambrish Mittal, endocrinologist at Indraprastha Apollo Hospitals. “Greater the number of the particles, the higher the risk.”
According to experts, high cholesterol can be attributed to four reasons: genetic (if the family has a history of diabetes, high triglyceride values or heart diseases), food habits (fried and junk food increases triglycerides value), physical inactivity and age (80 per cent of cases are reported in the elderly people).
Health problems arise when there is too much total cholesterol in the blood, which prevents it from moving freely through the arteries. “Over time, excess cholesterol builds up against the artery walls and narrows the space through which blood flows,” says Dr Sanjeev Sharma, senior cardiologist, Batra Hospital, Delhi. “This narrowing of the arteries is called atherosclerosis. Eventually this passage becomes so small, it closes off blood flow. The result is a heart attack or stroke.”
Family history can play a role in a person's cholesterol levels. For Suresh Kumar, 36, a salesman, the symptom was pain in the shoulder. He drove to a nearby clinic where the doctor conducted some tests. He was shocked to learn that he had suffered a heart attack. He was a vegetarian, and did not smoke or drink. But his father had died at 58 of a heart attack.
Suresh suffered another heart attack the day after he was admitted, and had an angiography and an angioplasty done simultaneously. Today, he follows a strict regime of food without salt and oil. He is on medication and exercises regularly.
“It is imperative that cholesterol be kept under control with diet and regular exercise,” says Dr Kastubh Vaidya. “Some patients discontinue medicines when they feel better, which is wrong. Once you need treatment for cholesterol, you need it for life.”
Patients with high cholesterol are usually prescribed statins. “I am now on certain medicines for life,” says Pandey, who had two stents implanted. His family has made some changes in its diet. They now consume less ghee, and have switched to cow's milk. “Looking back, I think it was my consumption of dairy products that caused my problem,” says Pandey. “Of course, it could also be that I did not exercise regularly.”
He now eats on time, and has plenty of fruits and soup. He exercises regularly. He has also made some changes to his work-schedule, and avoids travelling to meet someone if he can speak to them over the phone. Rajadhyaksha, too, has made changes in his lifestyle. These include a daily 40-minute walk, changes in his diet and medication. Tanwar has stopped taking home-made butter, and exercises almost every day.
Doctors point out that the danger of high cholesterol is very subjective. Someone who has a high-risk diet and smokes, could have a high cholesterol-level and still live to a ripe old age, while another person may not. “Thirty per cent of deaths in the world are due to heart and brain problems,” says Panda. “The next highest killer is cancer, at about 14 per cent. AIDS deaths are only about 3 per cent, while tuberculosis constitutes about 2 per cent.”
The harmful effects of high cholesterol are not limited to heart disease. They can also affect the legs and the brain. When deposits clog the arteries in the legs, the patient may experience pain, and difficulty in walking. This could lead to gangrene. If the carotid artery in the neck is blocked, it can even lead to a stroke. The carotid artery can be opened up and cleaned if the blockage is small.
“It depends on the severity of the stroke,” says Dr Kumud Rai, vascular surgeon at the Max Devki Devi Heart and Vascular Institute in Delhi. “If it is a mild stroke, the patient may face short-term paralysis. He might not be able to walk for a week or so. In serious cases, the patient can die. About 5 per cent of my clientele are people below 30 years.”
More women, too, are subject to heart ailments, owing to lifestyle changes. Thanks to their hormonal make-up, they have added protection, but only up to menopause. “After menopause, the disease has more rapid progression in women than in men,” says Vaidya. “In India, many women do not come forward to get treated due to social reasons, and there is probably a wrong perception that women suffer less from heart disease than men. Women who smoke are at greater risk.”
What is the best way to fight cholesterol? Would regular blood tests help? Says Seth: “Blood tests will not decrease heart disease. Children should realise the dangers of heart disease at school itself. Just as students are counselled on AIDS or promiscuity, they should also be counselled on coronary heart disease. Every person should understand the importance of exercise, and a good diet. If there is a family history of the disease, then go for tests. Prevention will come from realisation.”
With bureau inputs
Heart attack is caused by the death of heart tissues owing to reduced or zero blood supply to the heart muscle. Heart attacks peak on Mondays and the peak time of occurrence is between 4 a.m. and 10 a.m.
A stroke occurs when blood flow to a part of the brain is interrupted for more than a few seconds, or when a blood vessel in the brain bursts, leaking blood into the brain. WHO says 15 million people suffer from stroke a year.