Young hearts in India –not so young !
A few days ago, I was invited to release at a press conference, results of a study carried out over the last 4 years by the research team of Saffolalife, a not- for- profit organization and "Via Media" along with Indian market research bureau. They collected data from about 1,200,000 people who responded to their site. When a person logs in to this site, he/she has to enter his/her own data about weight, height, recent cholesterol, BP and sugar values etc. From these values, as per the Framingham Risk Score and a logarithm, the person’s heart age is calculated. If this age of his/her heart is greater than his/her actual age, the person is said to be at risk for getting coronary heart disease in future.
Using this information and analyzing it, they came to the conclusion that about 70% of men, in age groups 30 to 60 were having their heart ages greater than their actual ages, ie they were at higher than average risk of getting coronary heart disease. In case of females about 60% were at risk. The major factors increasing their risk were low levels of the “good” HDL cholesterol and increased Body Mass Index (BMI) –in other words- obesity. What was most alarming was that the younger lot was equally at risk as the older people, in fact in the age group 40-44, the risk is 80%. Most of the causation lies with our lifestyle of eating and lack of physical activity. All this got a good and prominent press coverage the next day in most of the city’s prominent newspapers.
Although the study suffers from the disadvantage of a selected sample (only those who log in to the site) and that of self reporting, its strength lies in the large numbers involved. This strength will increase all the more with passage of years as the numbers increase. Another area of strength is the simplicity of its methodology. In addition, it conforms to our experience in clinical practice in that we do see many patients in the 30 to 50 age group coming with severe coronary artery disease.
The very fact that someone has thought to do such a study on a pan India scale is commendable.
Of course, some refinements can be brought about, such as addition of waist hip ratios for one. It is now known that obesity by itself is not that important a risk as abdominal obesity which can properly be quantified by the waist circumference and its relation to the hip circumference. (Normal waist to hip ratio is 0.9). There are many people who appear misleadingly lean but have a high or abnormal waist to hip ratio. The exact method to measure hip and waist circumference will have to be described. The other factors to add would be family history of premature heart disease ( heart disease below 55 in a male first relative or below 65 in a female first relative), hs CRP measurement, fasting triglycerides (TG) and non HDL cholesterol if TG are above 200 etc.
The study highlights why preventive efforts are so important. In a country where the incidence of coronary heart disease is high and increasing, (2 to 4 times the western developed nations), where the young are disproportionately more affected than the western counterparts, where the disease is already severe when first diagnosed and above all, where most of the times, the medical expenses of treatment is not covered by third party reimbursements, prevention is so very important. Add to this the enigma of sudden coronary deaths where there is NO TIME available for treatment. And there is ample proof of the benefit of preventive measures . .Deaths due to heart disease in the west have reduced by more than 50% in last few decades and a major cause of this reduction is risk factor management (with life style changes and medications) besides the high tech treatment methods.
Thus, prevention is the key to this epidemic of heart disease and it is estimated that more than 80% of heart disease is preventable.
Studies such as this one are the first step in that direction.
Dr Akshay Mehta
A few days ago, I was invited to release at a press conference, results of a study carried out over the last 4 years by the research team of Saffolalife, a not- for- profit organization and "Via Media" along with Indian market research bureau. They collected data from about 1,200,000 people who responded to their site. When a person logs in to this site, he/she has to enter his/her own data about weight, height, recent cholesterol, BP and sugar values etc. From these values, as per the Framingham Risk Score and a logarithm, the person’s heart age is calculated. If this age of his/her heart is greater than his/her actual age, the person is said to be at risk for getting coronary heart disease in future.
Using this information and analyzing it, they came to the conclusion that about 70% of men, in age groups 30 to 60 were having their heart ages greater than their actual ages, ie they were at higher than average risk of getting coronary heart disease. In case of females about 60% were at risk. The major factors increasing their risk were low levels of the “good” HDL cholesterol and increased Body Mass Index (BMI) –in other words- obesity. What was most alarming was that the younger lot was equally at risk as the older people, in fact in the age group 40-44, the risk is 80%. Most of the causation lies with our lifestyle of eating and lack of physical activity. All this got a good and prominent press coverage the next day in most of the city’s prominent newspapers.
Although the study suffers from the disadvantage of a selected sample (only those who log in to the site) and that of self reporting, its strength lies in the large numbers involved. This strength will increase all the more with passage of years as the numbers increase. Another area of strength is the simplicity of its methodology. In addition, it conforms to our experience in clinical practice in that we do see many patients in the 30 to 50 age group coming with severe coronary artery disease.
The very fact that someone has thought to do such a study on a pan India scale is commendable.
Of course, some refinements can be brought about, such as addition of waist hip ratios for one. It is now known that obesity by itself is not that important a risk as abdominal obesity which can properly be quantified by the waist circumference and its relation to the hip circumference. (Normal waist to hip ratio is 0.9). There are many people who appear misleadingly lean but have a high or abnormal waist to hip ratio. The exact method to measure hip and waist circumference will have to be described. The other factors to add would be family history of premature heart disease ( heart disease below 55 in a male first relative or below 65 in a female first relative), hs CRP measurement, fasting triglycerides (TG) and non HDL cholesterol if TG are above 200 etc.
The study highlights why preventive efforts are so important. In a country where the incidence of coronary heart disease is high and increasing, (2 to 4 times the western developed nations), where the young are disproportionately more affected than the western counterparts, where the disease is already severe when first diagnosed and above all, where most of the times, the medical expenses of treatment is not covered by third party reimbursements, prevention is so very important. Add to this the enigma of sudden coronary deaths where there is NO TIME available for treatment. And there is ample proof of the benefit of preventive measures . .Deaths due to heart disease in the west have reduced by more than 50% in last few decades and a major cause of this reduction is risk factor management (with life style changes and medications) besides the high tech treatment methods.
Thus, prevention is the key to this epidemic of heart disease and it is estimated that more than 80% of heart disease is preventable.
Studies such as this one are the first step in that direction.
Dr Akshay Mehta
