Three cardiac related issues in India are of major concern, which includes coronary artery disease (CAD), in young patients, with increasing life expectancy; valvular heart diseases of the elderly and the neglected inherited heart diseases.
The death due to CAD have doubled from 15 per cent to 29 per cent over the last four decades in the 29 to 70 years age group in the country. With increasing urbanization, unhealthy food habits, smoking, tobacco, alcohol, sedentary lifestyle, psychological stress coupled with high incidence of diabetes, hypertension and high cholesterol have brought in the occurrence of CAD and its associated high mortality which is two decades earlier compared to other developed countries.
The availability of quality tertiary care for treating patients with acute heart attack are concentrated in Tier 3 cities that limits access to patients in Tier 2 cities and towns for these high-quality services. Evidence from studies both from north and south India shows the average time from onset of chest pain to getting definitive treatment for patients suffering with heart attack, is six hours, while the evidence shows the best outcome will be achieved if the treatment is given within two hours.
Adding to this, less than 50 per cent of the patients receive and continue the treatment in hospital and after discharge. Due to this, there is still high mortality and morbidity (heart failure) in young patients in India. All these lead to end stage heart failure, needing heart transplant or death at a young age. At individual level, each person has the responsibility to maintain healthy lifestyle by adopting healthy eating habits, regular exercise, less stress and regular health check-up.
If any CVD risk factors are identified like hypertension, diabetes and high cholesterol, prevention measures should be taken to reduce salt, sugar intake along with increased intake of vegetables and fruits (5 portions per day), while avoiding high cholesterol foods and continuing medications prescribed by their physicians.
With improvement in life expectancy from 58 years to more than 68 years, over the last 50 years, we also have an ageing population with increasing incidence of valvular heart disease like aortic stenosis. Without surgery, the risk of death is more than 50 per cent within 2 years for these patients affected by severe aortic stenosis. Due to its associated comorbidities, many patients are not eligible for surgery.
The other alternative life-saving procedure for these patients are transcatheter valve therapies like Transcatheter Aortic Valve Replacement (TAVR). While these therapies are readily available and used in developed countries for the past two decades, the cost makes it non-affordable to many in India.
Inherited heart diseases like hypertrophic Cardiomyopathy (HCM), Aortic Aneurysm and dissections of Marfans syndrome and Bicuspid aortic valves are completely neglected in India, and it is emerging as one of the leading causes of sudden death at less than 40 years of age.
50 per cent of the family members of the affected person will carry the affected gene and may have the disease. While early diagnosis of treating the patient with an implanted defibrillator will prevent genetic diseases, testing the affected person will help in screening the family members for affected gene.