Mail Today, New Delhi, Sunday, February 28, 2010 Mail Today, New Delhi, Sunday, February 28, 2010 Review Page 22 Page 23 Boys become angry young men Page 24 The Maharani and her Munshi Page 26 W HAT’S common to Rohit Bal, Arun Jaitely, Nirmal Pandey, R. Ravimohan and Ranjan Das? Your immediate response will be that they are success- ful men who have many professional achievements to lay claim to. Bal is a high-profile fashion designer. Jaitley is one of BJP’s most eloquent leaders. Pandey was an intelligent actor. Ravi- mohan was the face of CRISIL, the country’s premier credit rating agency, before he was inducted into the RIL board. Das was the CEO of SAP India. That is not why they figure in this story. They are all pointers of a disturbing trend — heart attacks striking younger men at the peak of their professional life. Bal, 42, suffered a heart attack this week and is now recuperating in a city hos- pital. Das, who was 42, however, was not that lucky. So was Pandey, 46, who passed away last fortnight. Jaitley underwent a heart surgery in 2005 at the age of 52. Heart disease in India is taking on dangerous proportions. More and more Indians are suffering from it and they are doing so at least 10 to 15 years earlier than their peers in the developed countries. Over 70 per cent of the heart attacks occur after 70 in devel- oped countries; two-thirds of the heart attacks in India take place among people below 60. For heart attacks in India, 40 is the new 60. Not only is heart disease occurring among Indians at a young age, it also comes with a very high death rate. The rising graph of heart attacks has given a new life to the myth that Indi- ans are genetically predisposed to heart disease. The basis of this myth is the theory of ‘thrifty genes’ — which Indians seem to have acquired, over centuries, to cope with long spells of drought and famines. These lead to slow metabo- lism and conservation of fat in the blood — both risk factors for heart disease. This hypothesis — and new genetic connections identified in recent years — cannot explain the spurt in heart disease in last quarter of the 20th century, when Indians have had the same genetic pool for centuries. Surely, something else is acting, along with faulty genes. “Family history is important because you are growing up in a cer- tain environment. And now we know that this environment is likely to cause certain epigenetic changes that could cause heart disease when you grow up,” explains Dr K. Srinath Reddy, cardiologist and chairman, Public Health Foundation of India. “Epigenetics changes the way genes are expressed without altering the underlying DNA,” he says. “For instance, if a father smokes in the presence of children it does more harm than just what is normally caused by passive smoking. It can change the wrapping of certain genes and make them express themselves in a different way.” Recent studies have also shown that human genes interact with the envi- ronment to heighten disease risk. “We know that genes and environmental factors influence the occurrence of heart disease, diabetes and cancer, but most research has focused on unraveling genetic components of dis- ease risk and ignoring the effect of environmental stimuli. We have shown how the molecular interaction between the two leads to heart dis- ease,” points out Jake Lusis of the University of California, who pub- lished his paper last week in American Journal of Human Genetics. I F IT’S NOT genetic predisposi- tion, then what’s causing this tsunami of heart disease in India? What’s happening is that traditional risk factors — smoking, unhealthy diet, lack of physical activity and so on (see graphic) — are working against young people. As much as 80 per cent of heart attacks among those below or around 40 can be explained by smoking alone. “Smoking is the number one reason for heart attacks under 50,” says Dr Dorairaj Prabhakaran, director, Cen- tre for Chronic Disease Control, New Delhi. “If you are under 40 and smoke 20 cigarettes a day, you are seven times more likely to get a heart attack than a non-smoker.” Typically, smok- ers also are victims of sudden heart attacks, as they may not have exten- sive coronary disease but develop arterial plaques that lead to sudden clot formation. The second most important rea- son is unhealthy diet. Abdominal obesity and lack of physical activ- ity are key risk factors among the middle and rich classes, Prab- hakaran points out. And although women have natural protection against heart disease in their pre-menopause years, the cover goes if they’re diabetic or smokers. Physical inactivity is another major risk factor. A study of physical activity among 350 persons who suffered an acute heart attack and 700 healthy individuals in Delhi and Bangalore has revealed a direct relationship between physical inac- tivity and heart disease. Those down with heart disease had spent more time on activities such as watching TV, listening to music, reading and writing, with bulk of the sedentary time spent — an average of 3.6 hours a day — on watching television! The writing is on the wall for all to see. The time has come when we take population-wide steps through public policies that encourage peo- ple to quit tobacco, eat healthy and step up the level of physical activity. Otherwise, India’s growth story will have a tragic ending. [email protected] By Gaurav Vashisht WHEN YOU are young, you believe you’re invincible. You live life king size: You work hard and party hard because you believe your body is in peak form and nothing can happen to you. I was no different from many other 37-year- olds with a senior marketing position in a media group. I was travelling five times a week trying to meet sales tar- gets with no time for exercise and proper meals. I was mostly eating junk food at odd hours and supplementing it with beer or whisky and my weight had gone up to 100 kilos. In fact, on some days I was drinking much more than eating, even though I knew I was prone to high BP and heart disease — the condition runs in my family. At this time I was under severe stress as I was still recovering from a stint in Oman that did not go well for me. On September 22, 2008, I was driving to my office at Lajpat Nagar when I experienced a severe pain in my chest. I was also sweating profusely. At that time, I was reminded of all those for- warded emails about things to do in case of a heart attack. The only tip that I remembered was to drink lots of water. I parked my car on the road side and drank a litre of water. After around five minutes, I felt better and drove to office. Once there, I dumped myself on the sofa but was still feeling uncom- fortable. I then asked a colleague to drop me at Moolchand Medcity. In retrospect, it’s difficult to believe that I walked by myself to the emer- gency ward and told them I was having a heart attack. They gave me pills and did the angiography which showed 40 per cent blockage but thankfully it was not in any main artery. The doctors implanted a stent and since then I have turned my life around. I quit my job to take up one that made fewer demands and didn’t require me to travel much. I eat on time, that too only home-cooked low- fat vegetarian food. I walk 7-8km daily and I have lost 25 kilos after going on this fitness regimen. I do get hassled even now when deadlines are not met, but liquor is no longer my stress- buster. I occasionally drink rum which my doctor says is better than beer and whisky. The good thing is I get more time to spend with my family and I also feel younger. I am full of energy and my blood pressure has also stabilised. Somehow, all that health advice you read in newspapers has started making sense. Wish I could respect my body earlier. — As told to Manu Moudgil THE YOUNG ARE NOT INVINCIBLE THOSE WHO SUCCUMBED... THOSE WHO SURVIVED... MYTH NO. 1 IT IS A DISEASE OF THE ELDERLY Heart disease is striking the young in India, even those below 40. It is now estab- lished that the disease occurs among Indians at least 10 to 15 years earlier than it strikes their counter- parts in developed coun- tries. Diabetes and hyper- tension — two major risk factors for heart disease — are occurring among Indi- ans in their 30s. MYTH NO. 2 WOMEN ARE PROTECTED TILL MENOPAUSE Though women enjoy a nat- ural protection against heart disease in their pre- menopause years, the cover disappears if they are dia- betic or smokers. The use of oral contraceptives too has been linked to heart disease among women. In India, the disease is occurring among young women as well. MYTH NO. 3 IT STRIKES ONLY THE RICH Heart disease has ceased to be the disease of the rich. Risk factors such as tobacco consumption and unhealthy diet are prevalent among the poor as well. Diabetes and hypertension have been reported from slum dwellers as well as in rural pockets. MYTH NO. 4 WE ARE GENETICALLY PRE-DISPOSED Traditional risk factors — smoking, unhealthy diets and physical inactivity — alone are responsible for heart disease epidemic in India. Some genetic factors have been implicated for heart disease, but scientists say these alone cannot explain the huge disease burden. Recent studies have shown that a healthy diet and physical activity can help people trump the impact of genetic adversity. HEART ATTACK MYTHS THAT MUST BE BUSTED Fat chance of growing up to be healthy adults IN INDIA, body fat has tradi- tionally been considered a sign of good health. In some parts of the north, particularly in Pun- jab, ‘healthy’ is synonymous with ‘fat’. It is normal to describe extra fat on the body as a ‘sign of prosperity’. It is this mentality that is making Indians ignore a major epidemic of lifestyle diseases that is building up. Children being raised on a deadly combination of junk food, television time and reduced physical activity — are all set to become victims of heart disease as they grow up. A survey conducted by the All- India Institute of Medical Sci- ences (AIIMS) among 16,000 school-going children in the age group of 5 to 18 in Delhi has shown that over 22 per cent of them who belong to high-income families fell in the category of what’s med- ically defined as overweight and obese. The level of engagement with leisure-time physical activity such as jog- ging and outdoor games of these children was higher than that of their peers, yet they had a higher Body Mass Index and weight. This is because their energy intake is higher and so is the use of energy-saving devices. Scien- tists say the situation is alarming as 70 per cent of obese children grow up to become obese adults, making them prone to heart dis- ease. Another recent study in Delhi and NCR has found that eating out can be the single most important factor for chil- dren becoming obese. If they have three to four meals outside home every week, the risk of them becoming overweight is 12 times higher than that of chil- dren who eat out much less. Smoking rates among school- going children in Delhi and other metros are reaching alarming proportions. The Global Youth Tobacco Survey points out that the prevalence of tobacco use — in any form — among school-going children in the 13-15 age group is 17.5 per cent. Even those in the sixth to eight grades have been found to be regular smokers. The prevalence of smokeless tobacco use, mainly gutka, in the same age group is esti- mated to be 14.6 per cent. Nearly 37 per cent of these chil- dren initiate smoking before they turn 10 and daily, 5,500 children begin tobacco use. It is to discourage tobacco use among such vulnerable groups that the sale of tobacco is pro- hibited within 100 yards of an educational institution. Instead of seeking strict implementa- tion of this rule, some MPs have reportedly asked for waiving of this rule to protect the interests of retailers. Clearly, they’ve lit- tle time to understand the dan- ger looming ahead. HALE AND HEARTY: Life started at 37 for this marketing professional Are young and successful Indians genetically predisposed to heart disease? It’s more likely that your lifestyle is a killer trap. If a father smokes when his children are around it does more harm than what is caused by passive smoking. It alters the wrapping of certain genes. ’ If you’re under 40 and smoke 20 cigarettes a day, you’re seven times more likely to suffer a heart attack than those who don’t smoke. ‘ ’ — D. Prabhakaran, director, Centre for Chronic Disease Control HEART ATTACK WARNING 40 IS THE NEW 60 ‘ NIRMAL PANDEY Age: 46 R. RAVIMOHAN Age: 52 ARUN JAITLEY Age: 57 ROHIT BAL Age: 42 RANJAN DAS Age: 42 Graphic: MUKESH SHARMA KICK THE TOBACCO HABIT Nicotine raises the heart rate, BP and blood fats. It causes arteries to constrict, reducing blood supply to the heart. Tobacco use is responsible for almost 20 per cent of India’s cardiovascular deaths and is a major cause for premature heart attacks. QUIT THE COUCH A study of 350 persons suffering from heart disease and 700 healthy individuals in Delhi and Bangalore reveals that those admitted to hospitals had spent 3.6 hours on an average being couch potatoes. Spend at least half an hour daily engaging in some physical activity. REDUCE YOUR WAISTLINE The National Family Health Survey estimates 13 per cent of women and 9 per cent of men in the country are overweight or obese. Your risk of metabolic diseases increases with your waistline. Remember, fat cells aren’t just passive stores of energy in the body. GET YOUR DIET RIGHT Avoid excess of food items that are sugary, salty and fatty. A so-called typical Western diet — fried foods, salty snacks and lots of meat — accounts for about 30 per cent of the heart attack risk across the world. Trans fats present in bakery products and snacks fried in vanaspati boost bad cholesterol and lower good cholesterol in blood. YOU NEED TO KEEP A TAB ON YOUR BP Hypertension can slowly hasten the progress of any one or more of the several potentially fatal complications such as heart attack and stroke. You can control your BP by bringing down your salt intake, quitting tobacco and working on reducing your waistline. YOU CAN’T AFFORD TO HAVE DIABETES Every sixth diabetic in the world is an Indian. Diabetics may have fatty plaques in blood vessels but they may not be large enough to obstruct blood flow. These plaques can rupture as fatty plaques in diabetics have thin caps. This sudden rupturing of plaques can completely obstruct blood flow all of a sudden and cause a heart attack. YOU NEED TO CAP YOUR CHOLESTEROL LEVEL Too much of cholesterol in your blood can lead to a build-up in the walls of arteries and harden them over time. They become narrow and slow down blood flow to the heart. If enough blood and oxygen cannot reach your heart and if the blood supply to a portion of the heart is cut off by a blockage, the result is a heart attack. STRONG FAMILY HISTORY This means if your father or a brother developed heart disease or had a stroke before turning 55, or your mother or a sister suffered similarly before they were 65, you run the risk of developing heart disease. GENETIC PREDISPOSITION Recent studies show that many Indians have a genetic mutation — a deletion of 25 letters of the genetic code from the heart protein gene MYBPC3 — that predisposes them to heart disease. Future research may make it possible to detect this gene and offer possible treatment. THE ETHNIC DISADVANTAGE Indians settled abroad, or those living in Europe or America with genetic roots in India, Pakistan, Bangladesh or Sri Lanka, have an increased risk of heart disease compared to local populations. What you can do now… Why a visit to your doctor may be due… Risk factors you can do little about… HERE’S A CHECKLIST OF THE RISK FACTORS FOR EARLY HEART ATTACKS. MAKE SURE YOU ARE NOT ONE OF THE POTENTIAL VICTIMS. HAS YOUR HEART BECOME A TICKING TIME BOMB? By Dinesh C. Sharma Binging on junk food predisposes kids to early heart disease — K. Srinath Reddy, chairman, PHFI