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Contrary to what would be an intuitive viewpoint is the fact that the South Asian population in general and the Indian population in particular have one of the highest risks for heart attacks among all ethnic groups in the world.
This impression that started several years ago is now a reality based on research data from India and the world over. The term ‘South Asian’ refers to people in the general area of India, Pakistan, Bangladesh, etc. The shock that this data elicits among the Indians is reflective of their faith in their presumed health safety based on simple lifestyles and non-indulgence. Nothing seems to be farther from the truth. The emerging Indian is suave, energetic and vibrant and yet increasingly susceptible to heart attacks and at younger ages, compared to the traditional risk groups.
A number of pioneering research studies conducted in countries with significant immigrant population of South Asian descent like the United Kingdom, Singapore, Canada and USA, have unequivocally shown the same consistent results. The initial impression that the change in lifestyle including food habits and stress levels could contribute to the increased heart attack risk has been tempered by sobering data from India itself, where research studies have shown that such susceptibility to heart attacks is not the sole bragging right of the emigrated Indian but is hotly contested by the domiciliary Indian as well.
The observed trend of the increasing heart related health care cost burden on the already overburdened healthcare systems of the developed world is forcing the focus on this emerging problem in those countries. Scotland, which already has a high risk for heart disease, has done studies that showed a 60–70% increased risk for heart attacks in its South Asian population compared to other ethnic groups. In USA a new trend is emerging in the health care systems. South Asian heart centres are being opened in hospitals where aggressive screening is offered to the South Asian groups and programmes are offered to modify their risk profile.
The emerging evidence is beginning to capture the attention of cardiologists around the world. The electronic edition of ‘Circulation’, one of the most prestigious journals in the field of cardiology, published an article that discussed the issue of increased risk of South Asians for heart attack.
The following are the facts that research has shown us so far:
1.The risk for heart attack and death from heart attack is 3–5 times higher for Indians as compared to other ethnic groups.
2.South Asians develop heart attacks at a younger age. Indian males are the largest numbers of heart attack victims under the age of 40.
3.Indians tend to have more diffuse and severe blockages in the blood vessels supplying the heart muscle compared to patients of other ethnic groups.
4.Heart attacks are a common reason for people to develop heart failure. This condition of heart failure occurs at a younger age in Indians.
5.Indian people’s risk for heart attack seems to be high even if the traditional risk factors of high blood pressure, high cholesterol, etc., are absent.
6.The heart attack risk raises significantly more if the traditional risk factors are also present.
7.The type of bad cholesterol (LDL cholesterol) that is seen in South Asians seems to be more prone to form blockages.
8.The good cholesterol (HDL cholesterol) is low in numbers in the South Asian population.
9.South Asians have a higher risk for diabetes, which in turn significantly impacts the risk for heart attacks. India is expected to experience the highest global increase in diabetics by 2025.
10.The increased risk for heart attack and death from heart attack applies to both the Indian male and the female.
11.Lesser degree of obesity increases the heart attack risk in Indians as compared to other ethnic groups.
12.The death rates from heart attack have decreased for most ethnic groups in the developed countries while the South Asians have actually experienced an increase.
The above are a few salient features of the important research data that is emerging at this time that should bring the focus on heart attack in a major way. The current recommendations emphasise the need to control the heart attack risk factors more aggressively in the Indian population and not blindly apply criteria that is applied in the developed countries.
Dr G Balachander
Cardiologist
Illinois, USA
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