Increasing Heart Attacks in Indian Subcontinent

Do you know that Indian Subcontinent occupies 3.5% of the world's land and it is host to almost 25% of world's population. This 25% population have 60% of world's heart patients.

If you belong to Indian Subcontinent then you are prone to heart diseases. Being from this region of the planet makes you four times more vulnerable to heart diseases than rest of the world, twice more vulnerable than an American and 12 times more vulnerable than a Japanese person. Here Indian Subcontinent doesn't mean just India, but other countries as well. It includes natives of India, Pakistan, Bangladesh, Bhutan, Maldives, Nepal and Sri Lanka. If you belong to this region then you must read this article. It will definitely help you in making right decisions to save yourself and your family members from heart diseases.

Some recent studies have shown that people of Indian Subcontinent were genetically more vulnerable to Cardio-Vascular Diseases (CVD). During past decades, some recent lifestyle and dietary changes have made the condition worst. Apart from that the recent COVID19 pandemic has also left some side-effects that put people of Indian Subcontinent even at more risk of heart diseases. 

A few years ago a research was done in United States that was named "MASALA Study". MASALA means "Mediators of Atherosclerosis in South Asians Living in America". As this full-form suggests it was about the health of South Asians living in America. This study found several factors responsible for bad heart health of South Asians. Some of them are :

• Normally researchers suggest BMI(Body Mass Index) value of over 25 as a risk factor for diabetes or heart diseases. But this danger-mark is number 23 among South Asians, as people of this ethnicity develop weight-related diseases at a lower body-weight than rest of the world. 
• MASALA researchers found that 44% of normal weight South Asians suffer from metabolic abnormalities like high blood sugar, high triglycerides and hypertension (high blood pressure). This percentage is just 21% among white-Americans of normal weight. 
• When we talk about age-factor, then heart diseases are diagnosed in South Asian around 10-year earlier than rest of the world. High blood pressure, high triglycerides, abnormal cholesterol and Type 2 diabetes are diagnosed more among South Asians at lower body weights and lesser age.
• High levels of coronary artery calcium, a marker of atherosclerosis, is more common among South Asian men. Calcium deposit in arteries is far more dangerous than cholesterol deposition and may lead to heart attack and strokes.
• Normally our body stores fat under the skin. But South Asians have a greater tendency to store fat in liver, abdomen and muscles (known as visceral fat). This visceral fat causes greater metabolic damage and it is responsible for Type 2 diabetes, which promotes heart diseases.

While writing this article for betterhealthfacts.com, we found some factors that need to be discussed in detail to make you better understand why south-asians are at more risk of heart diseases.

Genetics : Some genetic predisposition in the population of Indian Subcontinent makes people more vulnerable to heart diseases. This genetic fault might be a reason that people of this region store more visceral fat (fat in liver, abdomen and muscles). Fat in these regions gets the ability to generate hormones that disturb normal metabolism and often result in diabetes and heart diseases. 

Diabetes: India is diabetes capital of world, so is Indian Subcontinent. Diabetes often results in heart disease after sometime due to poor monitoring of sugar level. As we told earlier that South Asian population become prone to diabetes if their BMI (Body Mass Index) is above 23, while most of them live in a confusion that danger mark is 25. It makes one-third of the population tension-free, while they live with lifestyle diseases like diabetes and hypertension for years. People of this region often get diagnosed for these diseases after surviving with these diseases for years. It also makes them prone to CVD (cardio-vascular diseases).  

Tobacco: Tobacco consumption degrades our heart health. Instead of  decreasing, tobacco usage is increasing in Indian Subcontinent among the age group of 20 to 35 years. Most of the tobacco addicts are from low-educated communities. Almost one-third (35%)  of Indian Adults use tobacco in some form, either chew-able or smoking. Overall smoking prevalence is 14%, which includes 24% men and  3% women. It might be a reason behind men being more prone to heart diseases.

Fruit and Veg intake: 40% of Indian Population is totally vegetarian, which is generally considered as a heart-healthy diet. But inspite of that, that population is at more risk of heart diseases. Here the point to be noted is that a large part of the population can't afford the eat fruits and vegetables due to their high cost. According to National Family Health Survey-3 (NFHS-3) half of the population consumed zero or just one serving of fruit in a week. Only 25% population of Maharashtra (one of the most prosperous states of India) consumes more than 5 fruits and vegetables daily, as recommended by WHO.

Over-cooked Vegetables : Those who can afford to eat vegetables on daily basis often consume it over-cooked. Over cooking of vegetables often lead to vital loss of micro-nutrients. Most of the people consume more salt and spices in vegetables than recommended levels, which leads to hypertension over the years.

More Oil and fat: Most of the vegetarian population of Indian subcontinent like to consume dairy products (milk, curd, paneer, cheese), fried snacks and sweetened beverages which are considered bad for cardiovascular health, especially when you are not physically very active or doing a desk-job.  

Degrading lifestyle over decades: 

• If we look at the findings of National Sample Survey Organization in India, then the calorie consumption didn't increase from 1972 to 2000, but fat intake increased from 24 to 36 g/day in rural population and 36 to 50 g/day in urban population. 
• The population that belong to lowest socioeconomic status often consume partially hydrogenated vegetable oils that contain high levels of trans-fat which is bad for heart health. 
• Increasing trend of fast-food and hotel/restaurant among the middle-class is degrading their heart health, as such food is often deep-fried and most often partially hydrogenated vegetable oils are used there. 
• According to Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study done in 2014 that involved people above 20 years of age found that 54.4% were inactive. Less than 10% of the population is engaging in recreational physical activity. 
• Now farmers are not as much physically active due to introduction of agricultural-machinery like tractors. On the other hand urban-desk-jobs are increasing day by day as the technology is evolving. If we compare the changes in past few decades, then physical activity levels have declined in both rural and urban areas, but the fat consumption has increased and the quality of fat got degraded to make the condition worst.
• Consumption of whole grain has reduced, while the refined grain has increased. Whole grain is considered good for heart health but major population of Indian subcontinent is shifting from whole grain to refined grain.
• Those who recovered from COVID19 during the pandemic are also at the risk of heart diseases due to over-consumption of steroids (prescribed by doctors to save your life) and some lesser know side-effects of the COVID19. To know more about this risk you may read : Increase in Heart Failures are COVID19 recovery. 

Apart from the above factors there is a factor that a fitness-enthusiast must know. Steroids in the Protein Powders, that are consumed by the gym-going-youngsters are further deteriorating the heart health of young people. On the one-hand their muscles look bigger, but their heart become weaker. We have a separate article on this topic to explain it further : Bodybuilding is Killing - The Dark Secret.

How people of Indian Subcontinent can save themselves from Heart Diseases ?

• BMI below 23 : Don't think that below 25 BMI is good. If your BMI is above 23, then you need to reduce your weight, as the excess weight is getting deposited as visceral fat in your liver and abdominal region. A major portion of the adult population of your region have a BMI between 23 to 25, who thinks that they are on safer side, while actually they are either prone or already carrying some lifestyle disease. Un-diagnosed diabetes or hypertension sometimes result in severe health problems like heart attack.
• Annual Health Checkup after 30 : On an average people of Indian Subcontinent develop CVD(Cardio Vascular Diseases) a decade earlier than European population. The factors described in this article are mainly responsible for it. So it is advised that you must get your annual health checkup done after attaining the age of 30, to make sure you are on safer side.
• Eat Green Vegetables and Fruits: Eating fruits is good for your overall health as most of the fruits are consumed raw, thus providing vital nutrients without any loss that happens during cooking of vegetables. If you think that you don't consume fruits on daily basis then having salad with your regular diet is a good option to get those vital nutrients. When it comes to vegetables then try to eat more boiled vegetables instead of deep-frying them, that results in almost burning of vegetables. 
• Eat less fat and good quality fat: Fat is a necessary part of our diet as some fat-soluble vitamins can't be absorbed by our body if we don't eat fat. But over-consumption of fat is equally harmful as it results in weight-gain and cholesterol deposition in blood vessels. Our physical activity has reduced over decades due to technical advancement, but our fat consumption has increased. Apart from that the quality of fat consumed by economically lower-society and that is used in fast-food restaurants is bad for heart health. The fat used there is partially hydrogenated vegetable oils, which should be totally avoided if you care for your heart.
• Exercise regularly: Regular workout of 30 minutes per day is recommended by doctors to keep you healthy. Only 10% adults do it, while rest of the population think that either their life is already very hectic or they can't waste time on that. The truth is that workout of any form is must to keep your heart healthy. Gym, Yoga, aerobic exercise, jogging, running, walking and dancing are all good forms of workout. It depends on your health and age, which type of workout you choose. 
• Be aware of your ancestry: If someone in your direct blood relation is suffering / suffered from some heart disease or diabetes, then you must take extra care of your lifestyle and implement the above mentioned precautions to stay healthy.

Reference : 

• https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.114.008729
• https://www.nytimes.com/2019/02/12/well/live/why-do-south-asians-have-such-high-rates-of-heart-disease.html
• https://www.researchgate.net/publication/260397601_Physical_activity_and_inactivity_patterns_in_India_-_results_from_the_ICMR-INDIAB_study_Phase-1_ICMR-INDIAB-5