Use Heart, Know Heart

Heart is a unique pump made up of human tissue mainly muscle supplying oxygen and nutrients through the blood which it pumps by beating about 100,000 times in one day and about 35 million times per year and pumping 7600 litres per day and 10 million litres per year untiringly. Its disease especially because of blockages of the arteries nourishing it led to around 20.5 million deaths due to heart attacks and its associated problems worldwide in the year 2021 (data of World Heart Federation, 2023) 

One third of the deaths universally are due to cardio vascular causes. Most of these deaths can be prevented for decades by preventive measures. World Heart Day is observed to spread awareness of these measures to masses. The measures are simple, cost effective and doable but are most often ignored till one gets involved when it is often too late. The preventive measures are: No use of tobacco, keeping body weight in check ( Over weight is BMI > 24.9 Kg/ m2), consuming plenty of fruits and vegetables, regular exercise for at least for 30 minutes 5 to 6 times /week, keeping cholesterol low (Total cholesterol< 150 mgs/dl), Keeping BP as close to 120/80 but at least less than 130/80 mms Hg, keeping fasting blood sugar less than 100 mgs/dl (or Hba1C < 5.7%), using relaxing techniques for an hour every day in addition to having a good sleep for around 6 to 8 hours/day.

History and Purpose of World Heart Day:

The idea of having a day to remind these measures was conceived of in 1999 by Prof Antoni Baie de Luna a Spanish Cardiologist and former president of the World Heart Federation and it was readily endorsed by the World Health Organization. The first World Heart Day was celebrated on Sunday the 24th September 2000 and then it was followed on the last Sunday of every September till 2011, when it was changed to a fixed annual date of 29^th September. By 2012, 90 countries had joined this movement and it was resolved to reduce the mortality due to non-communicable diseases by 25% by the year 2025.

CV Disease prevalence in India and why so high?

Unfortunately, the burden due to CVD in India is remarkably higher than the global experience. The figures are the age standardized for death rate for CVD in India (282 deaths/100,000) was higher than the global level (233deaths/100,000) and it is not showing any signs of respite. This has been a matter of lot of discussion and has been ascribed to several factors: Population level change from predominantly a communicable disease predominance to non-communicable diseases in the last 30 years. It is the epidemiological transition.

Improvement in healthcare has no doubt resulted in improved longevity. The figures of an average of 49.7 years of 1973, have risen to 67.9 years as of 2012. It is estimated that by the year 2050, while the total population is expected to grow by 56%, the population in the age group more than 60 years will grow by 326%. The rapidly ageing population adds to the high propensity of premature CVD, and the large burden of CVD in India, the Demographic Shift.

This is followed by the Nutritional Transition, characterized by the change in the dietary habits from simple coarse cereals, pulses, vegetables and fruits to energy dense, ready to eat high salt foods with increase in meat consumption which are easily available and very affordable.

Migration of population from villages towards industrialized cities with mechanized life styles leading to improvement in economy but life style problems of sedentary life style and increase in risk factors like obesity, high BP, diabetes, high cholesterol, substance abuse and living in polluted areas all lead to increase in CV diseases because of socio-cultural and economic transition

Finally, the environmental transition due to increasing pollution of finely particulate matter, deteriorating ambient air quality, household air pollutants not only lead to respiratory diseases but also there is a strong feeling that it has a significant correlation ship with the increasing CV disease in our country. Air pollution though maximum in big metro cities is becoming a cause of concern even in the smaller cities and towns. At least one third of our population lives in cities at present as compared to around 19 % in 1970.

In addition to these factors extensive research on the subject of CVD in Indians has found inherent Biological and Genetic differences in the glucose metabolism (leading to a very high prevalence of diabetes and pre-diabetes), Disturbances in lipid metabolism (High triglycerides and Low HDL cholesterol), Increased levels of inflammatory markers (like Hs CRP) and a genetic predisposition of getting CVD. These when combined with several transitions as listed above lead to this disturbingly increasing trend of increasing incidence and higher death rates.

To combat this huge problem it needs a concerted effort of multiple agencies joining together at various levels starting from the population level to control the known risk factors and going on to modifying the biological factors becoming increasingly known to us. World Heart Day is a day to remind us the task ahead and propagating this message to as many as we can.

Acknowledgement: The author gratefully acknowledges the literature provided by the recent article “The burgeoning cardiovascular disease epidemic in Indians – perspectives on contextual factors and potential solutions” Ankur Kalra et al Lancet Regional Health
https://doi.org/10.1016/j.lansea.2023.100156

Prof Upendra Kaul, Founder Director Gauri Kaul foundation