Mumbai: On the occasion of World Heart Day, Dr Ramakanta Panda, Chairman & Chief Cardiac Surgeon, Asian Heart Institute, Mumbai interacted with ETHealthworld’s Prabhat Prakash on the rising incidence of CVDs among young adults and the role that corporations can play in preventing CVDs. He highlighted that hypertension and diabetes are significant factors leading to heart disease. He further shares how promising emerging therapies are improving cardiac care and how preventive health measures, technology can enable early detection, management of heart conditions at a lower cost. Edited excerpts:With the rising incidence of CVDs among young adults, how can corporate health plans address the increasing cardiovascular risks within the workforce?
Promoting heart health among employees has become part of the HR brief! Corporates can encourage heart health in many ways. One way is to reimagine office canteens and promote a culture of healthy eating. This can significantly impact the employees’ heart health. Office cafeterias and break rooms must offer heart-healthy meal options. Another second proven technique is to make health play by rolling out comprehensive wellness programmes with a fun twist. Fitness challenges such as ‘biggest loser wins’ embedded with educational programmes on the side that focus on heart health can encourage participation.Regular health screenings can be a friendly reminder that your company cares about you. Detecting latent health problems while the patient is still asymptomatic, coupled with a good insurance provider, can go a long way in prompt treatment. Flexible work hours boost employee morale. Hence, encourage employees to take regular breaks and incorporate physical activity into their daily routines. Offering flexible work hours can help them accommodate exercise, such as walking meetings or short workout sessions, reducing stress and promoting overall well-being. Adjustable office infrastructure has become the norm. Employees can choose to sit or stand while working. Also, community standing areas for meetings, outdoor areas, gyms and meditation rooms within offices are now being built, offering employees a way to stand and move more.What are the significant risk factors due to hypertension and diabetes for heart diseases in Indians? How can ‘heart age’ assessments help in early intervention?
Heart age is an indication of an individual’s overall risk of heart attack, as compared to a defined healthy range. A heart age that is higher than the individual’s biological age may be suggestive of elevated CVD risk or the presence of at least one risk factor. Just this month, a young IT professional aged 36 came to see me. His heart age was 66. So I asked him, ‘how many years do you think you have left to live given that the average life expectancy would be about 80-85?’ He was stunned when he realised how dangerous the prognosis was.
Two important parameters in the calculation of heart age are hypertension and diabetes. This is truly a vicious circle because hypertension is approximately twice as frequent in patients with diabetes. Conversely, recent data also suggests that hypertensive persons are more predisposed to the development of diabetes than normotensive persons. Hence, it is important to self-monitor sugar and blood pressure levels by adopting heart-healthy habits and maintaining the numbers within the normal range.
How can preventive health measures help in improving heart health? What initiatives can be implemented for better awareness of heart health?
The good thing about heart disease is that no matter how advanced your heart age is, the harm done can be reversed. The nine-fold path to a healthy heart can help eliminate improper behaviours. The first is sedentary behaviour with more time sitting in front of screens, followed by lack of sound, fitful adequate sleep. Third is eating ultra-processed foods /fast foods as the norm rather than the exception. Fourth, continuous late nights accompanied by alcohol/unhealthy food. Fifth, smoking/vaping or any other addictive habit. Sixth, lack of an exercise/yoga routine at least five days a week. Seventh, poor interpersonal empathy thanks to ‘WhatsApp bonding’ instead of personal bonding with friends. Eighth, feeling disconnected from the real world on account of replacing hobbies like reading/gardening with mindless social media scrolling. Ninth responding to excessive stress with stressors, instead of adopting mindful living/ meditation/breathing techniques.
You have to consult a doctor, find risk factors specific to you and embark upon a personalised treatment plan. The doctor will also suggest medications if required.
How is India adhering to the global trends on CVDs? What are the opportunities and challenges?
Tobacco use is the single largest modifiable and reversible risk factor attributable to CVD. The prevalence of current tobacco smoking in Indian males (23.6 per cent) is higher than the global prevalence (22 per cent). Among Indians, one of every ten persons aged 18 years has increased blood glucose levels. There were more than 73 million cases of diabetes in India in 2017. One in every four individuals older than 18 years in India has increased blood pressure levels. Hypertension is the cause behind 10.8 per cent of all deaths in India. The prevalence has been on a steep rise over the past three decades both in urban and rural areas.
India is next only to China when it comes to tobacco use. The massive scale of our population makes even a small percentage prevalence of a disease translate to massive numbers. There is unyielding pressure on the public health system; which needs to be shored up on priority. There is also the need to educate people about heart risks and go back to our traditional wisdom of yoga, meditation and satvik practices. India has the opportunity to reverse its present burden of disease and become a world leader when it comes to heart-healthy practices.
How are newer technologies helping to address the accessibility and affordability disparities in CVDs? Please elaborate.
Technology is a big enabler. The problem is ensuring continuous engagement- people get excited about a piece of technology for a few days and then stop using it. Wearable devices, such as heart rate monitors and smartwatches, provide real-time health data, enabling early detection and management of heart conditions at a lower cost. Mobile health apps facilitate self-monitoring and education, empowering patients to manage their heart health proactively.
In terms of access, telehealth services help patients in remote or underserved areas to consult with specialists without the need for travel, thus overcoming geographical barriers.
Within hospitals, advancements in artificial intelligence and machine learning are improving diagnostic accuracy and personalising treatment plans, making care more effective and efficient. These technologies also enable remote monitoring, reducing hospital visits and associated costs.
What are some of the most promising emerging therapies for CVDs and how close are they to becoming mainstream?
Most of the innovations are occurring in the space of preventive care and making treatment less invasive. We have come a long way since 1990, when statins were introduced which significantly has reduced cardiac complications.
Innovations in the field of medicines to further reduce cholesterol in patients who don’t tolerate statins or where statins are not effective are:
PCSK-9 inhibitors work by inhibiting a protein in the liver that reduces the number of cholesterol receptors, allowing more LDL cholesterol to be removed from the bloodstream.
Inclisiran – a small interfering RNA (siRNA) therapy that targets the production of the PCSK9 protein in the liver, plays a key role in regulating LDL cholesterol levels. By reducing PCSK9 production, Inclisiran increases the liver’s ability to remove LDL cholesterol from the blood.
They not only reduce cholesterol far better than statin by 40-60 per cent but also are given at longer intervals like once a month or once in six months depending on the type of medicine. This improves compliance.
The other innovations that will become mainstream medicine soon are in the areas of precision medicine, AI-augmented therapies, gene therapy, immunotherapy and nanotechnology.
How can the global medicine community collaborate for better prevention and treatment of CVDs?
There are several initiatives already happening. The very idea of World Heart Day started in 1978 by the World Heart Federation is a collaborative effort with 200+ member organisations and over 1.9 billion people have been impacted by it.
My friend Jagat Narula is the President-Elect of the World Heart Federation. They also conduct the World Congress of Cardiology (WCC), which brings the global medical community together and offers a global perspective on cardiovascular health and brings together thousands of cardiology professionals from all over the world with one common goal: to reduce the global burden of cardiovascular disease and help people live longer, healthier lives.
- Published On Sep 29, 2024 at 08:43 AM IST
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