Pollution emerging as a key contributor to heart attacks
For decades, we have relied on an outdated understanding of what causes heart attacks. It is imperative to fathom the new risks that result in heart attacks, the world’s number one killer of both men and women.
Pollution, a potent risk factor, has altered the landscape and a radically new approach is mandated. Without this, cardiologists and general practitioners will be doing injustice to a patient. A new approach in public health aspects of heart attacks is needed.
A simplistic understanding of the traditional risk factors assumed that heart attacks would occur among the section of the population that had diabetes, high blood pressure and cholesterol, and among smokers. Traditionally, heart attacks and strokes have been associated with older age groups. So, as doctors advocating heart attack prevention, we focused on this narrow group. Public health policies separated this group and devised pragmatic approaches to deal with this segment.
Today, this method is not only outdated but also dangerous. Now, without exception, the people living in heavily polluted areas of India are vulnerable to heart attacks. To make matters worse, it is not only heart attacks but also stroke (the number two killer of humankind) and cancers that will be attacking an entire population.
We have a crisis on our hands. Let us understand and tackle it. Let 2024 begin with a new approach to managing heart attacks amid their biggest risk factor: pollution.
Do the following scenarios appear familiar to you?
1) A 50-year-old farmer is awakened from sleep; he is clutching his chest in severe pain. By the time his wife summons the son, the patient has stopped breathing. He is no more — dead at a young age from a massive heart attack.
2) A 32-year-old engineer is rushed to a hospital; he is declared dead on arrival; a postmortem detects a heart attack and evidence of drug use.
3) A 56-year-old housewife, overweight and with diabetes, had been complaining of chest pressure for two weeks. When it gets worse, she is taken to a hospital, where doctors find that she had a heart attack recently.
Let us use these three real-life cases to discuss the rapidly rising incidence of heart attacks in India. There may be clues as to why heart attacks are on the rise among young people.
This public health crisis is exacerbated by two distinct but interconnected groups of factors: existing high-risk health conditions and the worsening impact of pollution. Understanding the nuances of these groups is crucial to addressing the growing challenge.
In India, these conditions are increasingly affecting the younger population. This shift is largely attributed to the high prevalence of metabolic syndrome — a cluster of conditions, including increased blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol levels — which accelerates the development of atherosclerosis, coronary artery disease and, consequently, heart attacks and strokes.
The number of diabetics in India is among the highest in the world. It further complicates this picture. Diabetes is a significant risk factor for heart diseases and is a key contributor to the high incidence of heart-related ailments.
A disturbing global trend is the high incidence of heart attacks in women. Long understood as a disease that predominantly affects men, heart attacks are very common in women too. In fact, more women die from heart attacks than from all cancers combined. Because of several cultural, social and financial reasons, heart attacks in women are ignored and there are longer delays in taking the affected women to a hospital.
The second group of factors worsening India’s heart attack epidemic is pollution. Pollution acts as a universal risk factor, affecting not just individuals with pre-existing health conditions but also the entire population. Its wide-reaching impact makes pollution a more significant contributor to heart diseases than traditional factors.
For instance, the recent spike in heart attacks among teenagers in Gujarat and studies predicting a reduction in life expectancy by 10-12 years for residents of Delhi due to pollution underscore the impact of environmental factors on heart health.
Public health approaches in India now face the dual challenge of addressing the pre-existing epidemic of heart-related diseases and mitigating the effects of pollution. This compound problem requires an integrated approach, focusing on both individual health management and broader environmental policies.
Fortunately, advances in medical science offer a ray of hope. Primary angioplasty, also known as primary percutaneous coronary intervention (PCI), has revolutionised the treatment of heart attacks. Available in most large hospitals, this emergency procedure is both effective and cost-efficient. Additionally, thrombolytics — drugs that dissolve clots — offer a viable alternative when angioplasty is not accessible.
However, the success of these methods of treatment hinges on early detection and prompt medical intervention. Recognising symptoms and seeking immediate care are critical, as is the availability of ambulances and 24-hour angioplasty services in larger hospitals. With these resources, the survival rate can exceed 95 per cent.
While medical interventions are crucial, long-term strategies focusing on risk factor modification are equally important. For patients with coronary artery disease, mitigating the risk of pollution poses the greatest challenge. This requires a multi-pronged approach, encompassing individual lifestyle changes, public health initiatives and environmental policies aimed at reducing pollution.
The heart attack epidemic in India is a complex problem compounded by the pervasive impact of pollution. By tackling the traditional risk factors as well as the challenge of pollution, India can hope to stem the tide of this epidemic and safeguard the heart health of its population.
