Treatment hesitancy, poor lifestyle, lack of awareness contribute to high burden of CAD in India

Dr Hemant L. Khemani, Consultant Interventional Cardiologist, Heart and Mind Clinic, Mumbai talks about Coronary Artery Disease (CAD) and highlights that The prevalence of this disease is highest in Indians in the whole world. They are liable to get hospitalised 2–4 times more frequently for complications of CAD, in comparison with other ethnic groups, and admission rates are 5–10 times higher for populations younger than 40 years

Imagine a single arterial road being used every day. Now, imagine a steady load of rubble getting dumped on that road each day and with nobody to clean up. You may continue to navigate your way around it, ignoring the root of the problem, until one day you can’t anymore.

Now transpose this image onto heart health where arteries are the road and the obstruction is the plaque or cholesterol that blocks precious lifeblood from reaching your heart.

That is what a cardiac event – most common manifestation of which is angina and/or a heart attack – in people with undetected or unaddressed Coronary Artery Disease (CAD) looks like.

The prevalence of this disease is highest in Indians in the whole world. They are liable to get hospitalised 2–4 times more frequently for complications of CAD, in comparison with other ethnic groups, and admission rates are 5–10 times higher for populations younger than 40 years.

We also know that less than 10 per cent of people who suffer such an event undergo angioplasty or bypass surgery to correct these issues. Many more are living oblivious to the problem because it is uncommon for noticeable symptoms to occur before the blockage reaches dangerous levels (70 per cent and above).

So there’s an urgent need to help these untreated patients.

Ignorance is not bliss

You might have CAD for many years and not notice anything until you experience a heart attack. That’s why CAD is a “silent killer.” But that doesn’t mean that we have to totally play blind. There are risk factors that can help identify patients pre-disposed to CAD. And then, timely checkups and lifestyle management can really take us miles in ensuring longevity and quality of life.

These risk factors are: Obesity, hypertension, diabetes, family history, heavy smoking and/ or alcohol consumption, a diet heavy in fats and sugars, and a predominantly sedentary lifestyle. If one or more are applicable to a person then urgent lifestyle management, routine checkups, and tests as suggested by a doctor are advisable.

Treatment is important

According to one study, in the first month after myocardial infarction (commonly known as heart attack), only about a fifth of surveyed patients underwent coronary angiography, 8.1 per cent angioplasty and 2 per cent, coronary artery bypass surgery. This is the case when minimally invasive procedures such as angioplasty are available and the latest technological advancement in heart stents, such as next generation absorbable stents or bioresorbable heart stents, are available for metal free angioplasty.

Indians also take longer to reach hospital care in the event of a health emergency. The time from symptom onset to emergency department arrival in a cardiac event ranges between 110 and 140 minutes in North America, while in India, it is 180–330 minutes.

This is why there is a need for constant engagement and dialogue with larger public to first educate them about risk factors and preventive measures, to make them aware of symptoms and red flags, and then to remove hesitancy from seeking treatment and relevant cardiac procedures as needed.

Treatment options

Medical therapy: Your doctor can prescribe you a group of medications for lowering blood pressure, decreasing cholesterol, and blood thinning which may prevent sudden heart attacks and heart failure. This is generally the first intervention offered, especially if the blockage is small or detected before a cardiac event. These drugs are most likely to be taken lifelong and needs to be complement with lifestyle modifications. They are often continued in tandem with other cardiac procedures as well.

Angioplasty: It is a minimally invasive procedure to open blocked arteries. It’s often advised to patients who have a single blockage, or those who need urgent intervention but are considered inoperable due to age or other comorbidities. In the procedure, generally, a balloon-tipped catheter (or another device) pushes plaque back against the arterial wall to allow for improved blood flow in the artery. Many a times, a small wire-mesh tube (called stent) is also placed to support the arterial wall and to reduce the chance of it closing again. It takes 30 minutes to 2 hours, and promises a shorter hospital stay and recovery time.

Newer inventions like next generation absorbable or bioresorbable stents are designed to work like routine metallic stents. However, over time the stent dissolves in the heart artery bringing it back to its original state. Since it does not cage the artery, over long-term, adverse events associated with metallic stents may not be seen.

Bypass surgery: This is a complex surgery performed under general anesthesia by a cardiac surgeon. The surgery can take anywhere between three to six hours and requires the surgeon to make an eight to 12 inch-long cut on a patient’s chest. It is only advised to patients who have multiple major blockages and are good candidates for surgery.

Lifestyle management is key

While a cardiologist will be able to advise about the best treatment option based on history and individual anatomy, it is important to know that lifestyle modification is strongly advisable to further improve patient outcome.