Consultancy Corner: Young adults below 30 can also get heart attack

Earlier known to be common only among older age groups, myocardial infarction is now occurring very frequently in the young adults. It is looming large as the new epidemic afflicting Indians at a relatively younger age. Coronary Artery Disease (CAD) affects Indians 10 years earlier than other communities.

The risk of CAD in Indians is 3-4 times higher than White Americans, 6-times higher than Chinese, and 20-times higher than Japanese. Rising affluence, rapid modernisation, associated with sedentary but stressful life and poor dietary discipline lead to the early onset of conventional risk factors namely hypertension, diabetes mellitus (DM), hypercholesterolemia, smoking and central obesity in the young. According to data released by the National Commission on Macroeconomics and Health, there was a nearly 30% increase in Myocardial Infarctions and deaths amongst those under the age of 40 years between 2010 and 2015. This is very alarming.

MI among those less than 40 years of age, is almost exclusively seen in male. Anterior wall MI is more common and most of the patients have single vessel disease. Though difficult to quantify, stress, adverse childhood experiences and psychological behavior also play an important role in the development of CAD.

Estimation of triglyceride level gives an indirect measurement of bad cholesterol particle size and number. This factor in combination with low levels of HDL and hypertriglyceridemia results in formation of small dense LDL which increases the risk of CAD more than three times. Insulin resistance syndrome (Metabolic Syndrome) which is common among Indians is another important risk factor for early development of CAD in Indian. Various infections, viral and bacterial, have also been implicated in the precipitation of Heart Attacks in patients who have CAD.

In asymptomatic individuals with background of coronary risk factors, after the age of 30-years, investigations including stress ECG/stress echo/stress thallium must be periodically performed.

From the policy point of view there is a need to plan strategies for preventing and halting coronary atherosclerosis which is fast spreading as a malignant epidemic amongst the young. In the industrialised countries there is a continuing decline of CAD during the last three decades.

The symptoms of an MI are not to be taken lightly among young adults. The symptoms include acute chest pain, excessive sweating, nausea, vomiting and shortness of breath. Smoking makes young adults most prone to sudden cardiac death (death within an hour of the onset of symptoms). The deaths following an MI can be due to large amount of heart muscle damage or Arrhythmia. (Irregular fast heart beats that occur due to oxygen deficiency in the heart muscle).