Dr. Naresh Trehan's column: Heart disease can remain hidden for a long time without warning

A heart attack is considered to be a sudden unexpected event. But there is always a background behind it, which can often remain hidden for a long time without warning. Coronary artery disease is a slow and silent process, which is developing many years or several decades before the symptoms appear. Nowhere in the world is this condition more evident than in India. 20% of the deaths due to cardiovascular diseases worldwide occur in India alone. Coronary artery disease in Indians develops about a decade earlier than people in western countries. If the cases of heart attack are increasing at a young age, then there is also a fear that a large number of people unaware of this risk may be living with these diseases. Today we are also seeing heart attacks in people in their 30s. Among them are those who look perfectly fit. A review of health data between 2000-2024 shows that about 12% of Indians in urban areas were affected by some form of cardiovascular disease. The 2022 report of the National Crime Records Bureau recorded more than 32 thousand deaths from heart attacks, which shows an increase of more than 12% year-on-year. About 25% of heart attacks in Indian men occur before the age of 40. By the age of 50, this figure reaches 50%. Why are so many cases of cardiovascular diseases not identified in time? The reason for this is hidden in our basic vascular biology. Atherosclerosis, that is, the gradual narrowing of the arteries due to the accumulation of plaque in them, does not cause pain in itself. There are no pain receptors in the arteries. The three biggest factors in this process — hypertension, dyslipidemia and diabetes — are also silent health conditions in themselves. A person can live with dangerously high blood pressure or cholesterol for years and feel perfectly normal. Symptoms usually appear only when the artery is too blocked. But by then the disease has progressed significantly. Waiting for symptoms like chest pain, plaque-rupture, shortness of breath or fatigue is like waiting for a situation when the body's system has failed. In view of the rapidly increasing cardiovascular diseases in India, the risk assessment should be done at or even earlier than the age of 30-35, not after the traditional age of 40-45 years, as is the case abroad. Especially beyond the age of 30, basic lipid profile, blood pressure and blood glucose should be a part of every adult's regular health checkup. For people who have a family history of heart disease, diabetes or other risk factors, imaging-based tests can detect plaque in the arteries years before any abnormality is detected. These tests have their own advantages and limitations. Doctors can choose the appropriate test based on a person's health profile, symptoms and risk-factors. Timely screening is better than bypass surgery and stenting in an emergency. Employers should also take annual cardiac risk screening as seriously as workplace safety protocols. Insurance companies should also be encouraged to cover preventive diagnostics instead of incurring treatment after the disease occurs, as early detection of the disease is a more cost-effective way. Coronary artery disease in Indians develops a decade earlier than people in Western countries. If the cases of heart attack are increasing at a young age, then there is also a fear that a large number of people unaware of this risk may be living with these diseases. (These are the author's own views)