Do take it to heart
State spending on health can’t keep pace with
cardiac diseases. Making the right lifestyle choices is the best preventive and
a cost-effective solution
Non-infectious diseases such as heart disease and cancers
kill more people in India than all other causes of death put together, with
heart disease taking the lead with 2.5 million deaths annually. It shows no
bias and is the leading cause of death across age, gender, incomes, regions,
and urban and rural India. No matter how old you are, how rich you are or where
you live, heart disease — which causes heart attacks and strokes — is more
likely to kill you than any other disease.
There are subtle variations, though. It is more likely to
kill men than women: 20.3% of all male deaths are caused by heart disease and
stroke as compared to 16.9% deaths in women, shows data from the Registrar
General of India’s study of One Million Deaths in India, which uses country-wide
Sample Registration System and verbal autopsy — asking the family about the
sickness, symptoms and treatment, especially if the death took place at home —
to identify the cause of death. Then there are regional variations, with deaths
being the highest in the more affluent states of Goa, Tamil Nadu, Andhra
Pradesh and Punjab, compared to Uttar Pradesh, Madhya Pradesh, Bihar and
Rajasthan.
The projected cumulative loss of national income due to
loss in productivity because of early death from noncommunicable diseases for
2006-2015 is $237 billion. By 2030, this productivity loss is projected to
double. This is far greater than the corresponding loss in the US, which has a
population a fourth the size of India’s. Add to this India’s expenditure on healthcare
— around 4.1% of its GDP, only 26% of which was government funding — and you
have millions of people pushed to poverty just to pay healthcare bills.
The sliver of hope in this litany of bad news is that
over 90% of heart disease depends on how we live our lives, our stresses, what
we eat and how active we are. Of course, genes have some role to play, but nine
in 10 heart attacks can be prevented by controlling blood pressure, cholesterol
and diabetes; eating high fibre-low fat food; staying fit; not smoking; and
managing psychosocial factors such as stress. Early detection and treatment of
hypertension (chronic high blood pressure), for example, reduces death from
heart attacks by 35-60%.
And it’s never too late to start. Even adopting four
healthy
Don’t miss a beat behaviors — eating at least five fruits
and vegetables daily, exercising for at least 2.5 hours a week, maintaining a
healthy weight, and not smoking — after 45 years reduces the risk of heart
disease by over one-third, reports a study in The American Journal of Medicine.
The study found that these changes lowered heart attack risk by 35% and death
from heart attacks by 40% in people between 45 and 64 years. The benefits were
there even for those who lived a decadent life till they decided to turn over a
new leaf and tread the path to health.
The heart-protective benefits begin the moment you make
healthy choices. The nutritional plan for a healthy heart is eating less of
saturated fats like butter and more of oils such as olive and mustard oils,
eating five or more servings of fruits and vegetables a day; six or more
servings of whole grains such as wheat and brown rice; low-fat milk products;
legumes and beans; and fish and lean meats.
But making diet changes alone are not enough to keep the
heart healthy and people need to have high activity levels, keep weight in
check and not smoke. Smoking is the biggest cause of heart attack in young
people with no other risk factors because it increases the risk of clot
formation in the blood, which can block arteries and cause a heart attack even
in healthy people. A review of heart disease incidence in 21 countries reported
in the journal Tobacco Control showed that smokers had a five times greater
risk of heart attack than non-smokers.
Obesity also perpetuates a chain of risk factors such as
diabetes, high blood pressure and high cholesterol, each of which individually
boosts the risk of heart disease. Keeping the body mass index (BMI) between 22
and 23 — a little lower than the internationally recommended cut off of 25 —
lowers a person’s heart risk substantially. BMI is calculated by dividing a
person’s weight in kilograms by the height in meters squared.
The reason why Indians need to keep their weight lower
than Caucasians is our warped fat distribution. A Canadian study of four ethnic
groups — South Asians, Chinese, aboriginal populations and Caucasians — showed
that for the same level of body mass (weight), South Asians had more body fat.
All South Asians also accumulate fat around their abdomen, which is the worst
possible place to put on weight. A waist size larger than 38 for men and 35 for
women may be a sign of the metabolic syndrome, which is characterized by a
group of risk factors such as diabetes, high blood pressure, elevated
trigycerides, low good cholesterol (HDL) and high bad cholesterol (LDL), and a
pro-inflammatory state (elevated levels of C-reactive protein in the blood),
showed study on ‘Waist circumference cutoff points and action levels for Asian
Indians’ in the International Journal of Obesity.
With diseases outpacing government spending on health by
giant leaps, prevention is the only practical way to save the country from an
avalanche of medical bills.
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