Air pollution, lifestyle factors why Indians suffer heart attacks 10 years earlier than Westerners, say cardiologists

Heart disease has emerged as one of India’s most serious public health challenges, with heart attacks striking Indians much younger than in the West. But unlike their predecessors, younger adults today are experiencing heart attacks and other cardiac events with little warning. This increasing incidence is due to a dangerous mix of genetic vulnerability, metabolic dissimilarity, swift changes in lifestyles, chronic stress and environmental pollution.

Two of India’s leading cardiologists, Dr Balbir Singh and Dr Amit Kumar Malik, share why Indians are at a greater risk for early heart disease—and how we can turn the tide through early prevention and screening measures.

“Indians seem to have some genetic factors that predispose them to coronary artery disease,” Dr Singh says. “That inherited risk is against Indians from very early in life, before they bring lifestyle into the picture.”

According to him, South Asians are more likely to have premature heart disease compared with other ethnicities, often with the accelerated spread of the disease and fewer early warning signs.

Obesity among Indians is very different from that in the West, says Dr Singh. “In the Western world, it is more of a generalized obesity in most people, but when we talk about Indians, you may see metabolic or central obesity. A lot of people have a normal BMI, but overly high abdominal fat,” he says.

This central obesity is, in fact, particularly dangerous because it has a very strong relationship with high triglycerides, low HDL cholesterol and early-onset diabetes — three primary instigators of early-age heart attacks.

“Trans fats in particular are associated with increased heart attack and stroke cases,” says Dr Singh.

Also contributing to this threat is a largely sedentary lifestyle. According to Dr Amit Kumar Malik, Director – Electrophysiology & Interventional Cardiology at Medanta Hospital, Noida, “In today’s scenario of modern work culture sitting too long has become primary choice coupled with very less physical activity and hence leads to obesity.”

He says, “Sedentary work, too much screen time, inadequate physical activity and disrupted sleep caused by stress are all contributing to rising levels of blood pressure, abnormal cholesterol readings, obesity and diabetes.”

“Chronic stress has a negative impact on blood pressure, blood sugar and overall cardiovascular health,” Dr Singh says.

Poor sleep, which has been associated both with stress and high levels of screen time, further erodes metabolic health and raises the risk for early heart disease.

There’s no such thing as clean air in these circumstances, and long-term exposure to dirty air causes inflammation, damage to blood vessels, and a significantly increased likelihood of heart attack — particularly among those already predisposed (genetically speaking) to having one.

“Regular physical activity — around 150 minutes per week of moderate intensity exercise – can keep weight, blood pressure and stress in control,” Dr Malik says.

Also, the key is a heart-healthy diet that includes whole grains, fruits and vegetables, fibre and healthy fats such as omega-3s, as well as not smoking and limiting alcohol.

Both doctors encourage early screening; for instance, annual blood pressure, blood sugar, and cholesterol checks should start by age 30 in people with a family history of heart disease.

Early identification, appropriate lifestyle modification and preventive strategies can greatly enhance longevity and quality of life -- reversing the tide against early heart disease in India.

(The author, Nivedita, is a freelance writer. She writes on health and travel.)