Why are Indians so prone to heart disease?

PHOTO: Why are Indians so prone to heart disease?

The weekend was coming to an end. It was an uneventful one for Singaporean Gulwant Singh, who works as an applications engineer with a Japanese firm.

He went to bed looking forward to the new work week but early in the morning, around 4am, he woke up. The little finger on his left hand had gone numb and he had difficulty breathing. It did not occur to him as anything serious and he decided to wait to see a doctor on his way to work later in the morning.

The 44-year-old had all along believed that he was in perfect health. He had been an active football player in his younger days and gone for a health screening two years earlier. The results indicated that he was healthy.

However, tests done at the Raffles Hospital where he saw a doctor for his condition that same morning, showed that he had actually suffered a heart attack.

Further tests showed that three of the valves in his heart had blockages ranging from 60 to 100 per cent. Mr Singh was admitted to the hospital and underwent angioplasty to clear the blockages in April last year.

He was lucky to get away and has since changed his lifestyle to focus on his health.

Two months later, Mr Singh’s older brother – a football coach aged 46 – also suffered an attack.

Raffles Heart Centre cardiologist Alvin Ng Chee Keong, who treated the younger Mr Singh, says: “His brother should have gone for a health screening soon after hearing about his younger brother’s heart attack. A treadmill test followed by a CT scan would have detected a blockage.”

Diet and genetics

Diet and genetics

Indians, he added, are more prone to heart disease for a variety of reasons, some among them being genetic causes and the diet they follow.

Mr Singh, who has two teenage children, also has a younger brother who is 41. His younger brother has since gone for a health screening and all seems to be fine.

Dr Baldev Singh, a cardiologist with the Parkway Group, says studies in Singapore since the 1950s have shown that more Indians here are prone to heart disease. He quoted a 1959 study done by Dr C.S. Muir which was published in the British Heart Journal in 1960. The study found that in Singapore, Indians were 10 times more likely to die of heart disease than the Chinese or Malays. It also found that Indian Muslims who consumed more red meat, in particular mutton, were 20 times more likely to die of heart disease than the Chinese.

Since then, health consciousness has improved but Indians still lead other races when it comes to falling victim to heart disease.

A Singapore Ministry of Health study in 2007 found that Indians formed almost 13 per cent of the total number of heart attack victims, despite making up only 8 per cent of the population at that time.

Dr Singh says that he has seen many young Indians seek treatment for chest pain and some even have to undergo bypass surgery – where a healthy artery or vein is surgically removed from the patient’s leg, arm or chest and inserted around the areas of the blockage. The graft vessel begins to supply oxygenated blood to the part of the heart that needs it, thereby “bypassing” the blocked arteries and restoring blood flow to the heart muscle.

Dr Singh attributes stress as one of the factors leading to youngsters getting heart disease. He tells tabla!: “Stress levels have been underestimated in the past. The young should start monitoring their health when they are in their 30s and not wait till they are in the 40s.”

National Heart Centre Singapore senior consultant (department of cardiology) Paul Chiam tells tabla! that, apart from genetic factors, obesity and diabetes increase the risk of heart disease in Indians. He points to statistics from the National Registry of Diseases Office to show that a disproportionately large number of Indians suffer from heart attacks.

In 2007, there were 433 cases of heart attacks among Indians here for every 100,000 people, compared to 187 cases among the Chinese. In 2009, the situation showed some improvement. Cases of heart attacks among Indians came down to 396 for every 100,000 people while for the Chinese the figure fell to 164.So what should Indians do to avoid becoming victims of heart disease?

More dairy, less exercise

Doctors' opinions

Dr Chiam’s advice is that Indians follow a healthy lifestyle (diet and exercise), maintain recommended body weight and avoid or stop smoking. He also recommends that they undergo regular screening for high blood pressure, diabetes and high cholesterol and says the “appropriate treatment will reduce the risk of heart disease”.

Dr Ng of Raffles Heart Centre is of the view that there appears to be a higher incidence of glucose intolerance among south Asians and suggests Indians cut down on carbs, a higher intake of which leads to obesity.

Parkway’s Dr Singh feels Indians do not exercise as much as others and tend to use more dairy products. “They should modify the risk factors like keeping their weight under control and watch their diet,” he says, adding that regular exercise may increase good cholesterol.

Dr Chiam says the good effects of wine on the heart are “well proven” and adds that “most forms of alcohol in moderation have been shown to be beneficial”.However, Dr Ng is cautious when it comes to alcohol, calling it a double-edged sword. “For the Caucasians, who drink regularly, the recommendation is one drink per day. However, we do not advocate drinking as a therapeutic option,” he says.

So what are you waiting for?

If you think you have done enough exercise in your younger days and can take it easy now, think again.

Mr Gulwant Singh, whose near brush with disaster which we discussed earlier in this article, says he gave up playing football when he was 35. Before he took on his present job, he had spent 11 years as an audio-visual contractor working odd hours with irregular eating habits. The recent heart attack has woken him up from his inactivity. He now goes for walks three times a week, eats more vegetables and tries to eat fish while giving red meat a miss completely.

If you are an adult Indian, it is time to put on those running shoes or hit the gym and do a reality check on what you gobble up to satiate your hunger. With Christmas and the New Year celebrations behind us, it is time to burn up those extra calories and get your heart pumping to keep the plaque in the arteries at bay.

Heart pumps 7200 litres a day

Heart pumps 7200 litres a day

The heart is a cone-shaped structure which lies in the middle of the chest, slightly to the left, behind the breastbone and between the lungs. The heart of a healthy 70kg adult pumps about 7,200 litres of blood daily at a rate of approximately 5 litres per minute.

The heart is enclosed in a sac called the pericardium. The wall of the heart is made up of three layers known as the epicardium (outer layer), myocardium (middle layer) and endocardium (inner layer) respectively. The epicardium and endocardium are thin protective layers. In contrast, the myocardium is a thick, muscular layer which provides the strength for the heart to function as a pump.

The average heart rate is roughly 72 beats per minute, which translates into approximately 100,000 beats per day. This figure may, however, differ widely among people of different age groups. For instance, the heart rate may be as high as 120 beats per minute in infants, and as low as 60 beats per minute in adults. The average adult human heart is about the size of a clenched fist and weighs about 300g.

The characteristic “lub-dub” of a heartbeat is caused by the movement of the heart valves during each cardiac cycle. In the first phase, which is known as the systole, the tricuspid and mitral valves close, producing the “lub” sound. In the second phase (the diastole), the pulmonary and aortic valves close, resulting in the “dub” sound.