Sudden cardiac arrests among young Indians: What you must know

The death of three actors -- Aditya Singh Rajput, Vaibhavi Upadhyaya and Nitesh Pandey -- in a matter of just three days has sent shockwaves across the Indian television industry. Nitesh Pandey, widely known for his role in the popular television serial Anupamaa, passed away after a cardiac arrest on Wednesday, May 24. The death of the 51-year-old actor at a hotel in Igatpuri in Maharashtra's Nashik district has once again piqued the interest of many as to 'why more and more young Indian men are becoming vulnerable to sudden cardiac arrests and death?'

Globally death due to Coronary Artery Disease (CAD) has been identified as the second major cause of mortality due to non-communicable diseases, the first being cancer. In recent decades (starting from the early 2000s and by 2015 to be more precise) India has seen an increase in the incidence of CAD cases and deaths due to sudden cardiac arrests (SCA), particularly in young male adults (below 55 years of age). 

In this article, we discuss the probable causes and risk factors of CAD and SCA, the signs and symptoms that may help you identify the early signs, and the precautions and medical tests that help determine if you are at risk of CAD.

Risk Factors of CAD and SCA

Genetic predisposition: Studies have shown that Indians are genetically predisposed to developing cardiac problems at least by a decade earlier than their Western counterparts. Generally, cardiac problems in Indian adults begin to develop in the early to mid-40s and hence people of this age group are at greater risk of experiencing angina or cardiac arrest.

Indians are also genetically predisposed to hoard the bad cholesterol (LDL and triglycerides) in their body. The cause for this bad cholesterol hoarding is majorly attributed to certain enzymatic deficiencies and not dietary habits. LDL and triglycerides are bad for the heart as they increase the risk of CADs.

Diabetes: Currently, India is being touted as the 'Diabetes capital of the world'. As per recent statistics, India has about 77 million people above the age of 18 years living with diabetes, about 25 million are prediabetics which means they are at a great risk of developing diabetes in near future, and an alarming percentage of people are unaware of their diabetes status. Clinically diabetes is identified as one of the major risk factors for cardiac problems such as heart attacks and strokes.

Lifestyle factors: Vast majority of the population has a sedentary and unhealthy lifestyle from a very young age which again puts them at risk of many health issues and hidden cardiac problems. Any sudden changes such as starting vigorous physical activities such as HIIT (high-intensity interval training), gymming, etc., may exacerbate the hidden cardiac conditions and lead to cardiac arrests.

What triggers sudden cardiac arrests and death and why are men more vulnerable than women?

The triglycerides and LDL cholesterol accumulate within the blood vessels and form hard deposits within the arteries, which are known as atherosclerotic plaques. These plaques have a tendency to dislodge whenever there is a sudden load or stress on the arteries. The dislodgment can be triggered by any kind of physical or emotional stress. The dislodged plaques cause blockage in the arteries and lead to SCA and death.

In general, SCAs are more common in men than in women because the female hormone estrogen acts as a protective shield for women. Estrogen has potent cardiac protective properties due to which women are at a significantly lower risk of having cardiac arrests until the perimenopause and menopause age. 

After the menopause, there is no major difference between men and women. 

Signs and symptoms to look out for

There are no standard signs and symptoms that may help you identify the early signs of CAD. The signs are often very vague or non-specific and may even get masked with symptoms related to other problems such as acidity, epigastric pain, mild discomfort in the chest, or jaw pain. 

Precautions and medical tests that help determine if you are at risk of CAD

 A normal ECG may not be very effective in determining the CAD status. A CT-coronary angiogram is the gold standard test to determine if you are at risk of CAD. A CT-coronary angiogram showing a low calcium score and less than 30% blockages is an indication of low or minimal risk of CAD.

Also, determining your diabetes status (HbA1C is more reliable than the routine FBS and RBS test) and seeking medical treatment is one of the best ways to keep CADs at bay. Furthermore, if there is a family history of cardiac problems, it is highly recommended to undergo regular master health checkups. 

Apart from the above-mentioned tests, it is important to manage weight and follow a healthy lifestyle, have a well-balanced and nutritious diet, and stay physically active. When it comes to diet and exercise ‘moderation is the key’. Eating in moderation and dividing the large portion meals into small-sized meals (about 6 meals a day) may help you maintain your metabolism. Also, you can follow a 14:10 rule of intermittent fasting to manage weight. It is important to note that if you have not been exercising regularly or if you have been sedentary for a long, you will have to gradually increase your exercises and workout regimes rather than diving in straight. 

To conclude, it can be said that regular health checkups can help determine the risk of Coronary artery disease at the earliest and prevent complications and mortality. Any sudden and overzealous physical activity may put you at risk of sudden cardiac arrest. The best way to avoid such sudden collapse and death is to get a CT coronary angiogram and know the status of your coronary blockages before embarking on any sort of physical exercises and increase the intensity gradually.

The author is consultant for cardiovascular and thoracic surgery, minimally invasive cardiac surgery at Manipal Hospital in Yeshwantpur

• Coronary Artery Disease
• Sudden Cardiac Arrest
• cardiac arrest signs
• cardiac arrest symptoms
• cardiac surgery
• cardiovascular
• medical tests
• minimally invasive cardiac surgery
• precautions
• risk factors
• thoracic surgery