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COVER STORY: HEART ATTACKS
The X Syndrome
New research shows that a mysterious set of genetic
factors put Indians at high risk. Can anything be done?
By Neeraj Mishra
And Supriya Bezbaruah
 To
the outside world, Amar Banerjee, 42, was at the prime of his career and
seemingly in good health. Banerjee, a Bhopal-based sales executive, was
careful with the way he treated his body-he was a regular at the gym,
rarely smoked, went easy on the sweet stuff and avoided late nights. A
heart attack was the farthest thing from his mind though a few years earlier,
his ageing mother had suffered one.
Then one evening, while returning home, Banerjee
felt a sharp pain sear through his left chest and felt his arm turn limp.
It was so intense that he almost lost balance and dashed his scooter against
the sidewalk. He felt nauseated and knew there was something terribly
wrong with him. He was rushed to a local hospital where doctors diagnosed
his condition as a myocardial infarct caused by excessive clogging of
the arteries in his heart.
Banerjee was stunned. Given the fact that he
led a relatively healthy lifestyle, being diagnosed with a serious heart
problem was incomprehensible. But the doctors were not surprised. For
them, Banerjee was one more victim of Syndrome X-a condition that predisposes
Indians to a whole repertoire of biochemical bullets blasting the heart.
Syndrome X is now increasingly seen by experts as the prime culprit for
the alarming rise in heart diseases in the country. Ironically the understanding
of its potential for mischief came from several recent studies of Indians
living in the US. The most important is a recently concluded 10-year study
of 4,500 patients by the Coronary Artery Disease Institute (CADI) in Lisle,
Illinois, that found the Indian community had much higher levels of a
deadly genetic factor called lipoprotein A, or LP(a), than other ethnic
groups. It is 10 times deadlier in causing clogged arteries that lead
to heart attacks than bad cholesterol such as Low Density Lipoproteins
(LDL).
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Fresh Findings
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# Syndrome X makes Indians four times more susceptible to heart
attacks than Europeans, Americans, Japanese and Chinese.
# It puts Indians under 40 at a tenfold higher risk than others.
# Indian women are as vulnerable to the disease as men.
# WHO predicts that by 2010 India will have 60 per cent of the
world's heart patients.
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Spearheaded by LP(a) the extraordinary factors
called Cardiac Syndrome X by specialists leave Indians four times more
prone to heart disease than Chinese, Japanese, Caucasians and Hispanics.
"We're in the midst of a heart disease epidemic," says Professor
S.C. Manchanda, head of cardiology at the All India Institute of Medical
Sciences (AIIMS), Delhi. "In India, approximately four people die
of heart attacks every minute because Indians are genetically predisposed
to the disease."
But how exactly and why? Like FBI agents probing
abnormal phenomena in the popular TV serial, the medical fraternity is
racing to discover the cause and effects of Syndrome X. At the heart of
the matter is the heart itself. The fist-sized organ is among the most
hard working in the body. As precise as a clock, it pulsates almost every
second, pumping 10-15 tonnes of blood a day-enough to flood a basketball
court-to keep the body alive. For doing this, the heart muscles require
enormous amounts of energy. Oxygen-drawn from the respiratory system and
absorbed by blood that reaches the heart through the blood vessels-is
its main fuel. Much like water seeping through a blocked pipe, the blood
flow slows down when the arteries are clogged. When large clots reduce
blood flow to a trickle, the oxygen-starved heart muscles start dying.
The result is a heart attack. Similar blockage in brain arteries causes
a stroke. Other organs have more vessels, so the blood/oxygen flow is
not throttled.
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SAMEER KUMAR, 30,
Sales Executive, Bhopal
While playing cricket recently, Kumar collapsed on the field.
In the hospital, doctors told a surprised Kumar that he had suffered
a heart attack. An avid sportsman, Kumar did not smoke and was a
teetotaller. Doctors see him as a victim of cardiac Syndrome X,
a disease that strikes Indians more than it does others.
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Every day, the heart and its circulatory system
are engaged in a battle of biblical proportions to keep the main highways
of blood transportation free from blockage. The cloggers-in-chief are
cholesterol-soft, waxy substances produced by the liver. Their daily job
is to maintain cell walls, hormones and other tissues. As they piggy-back
on proteins in the blood, they are named according to the type of carrier
they associate with and can be classified as the good, the bad and the
ugly.
First, the bad: excess LDL cholesterol fall
along the arterial wayside and create havoc. Accumulated LDL cholesterol
then clings to the walls of blood vessels and (HDL)-rush in, modifies
its form, damaging and scrapping off the cells lining the vessel. All
this activity attracts immune cells which then get trapped. LDL cholesterol,
immune cells, vessel-lining cells and other substances jammed together,
form a thick, hard, deposit called plaque, which gets thicker with time
to clog the arteries. Cheering LDL on in its malevolent ways is a fat
called triglyceride (TG), an ugly customer obtained from foods like butter,
and present in blood to provide instant energy or stored as body fat for
future use. As the arteries watch helplesslessly, the good cholesterol-High
Density Lipoprotein (HDL)-rush in, preventing clogging by mopping up the
littered cholesterol and shuttling them back to the liver. So plenty of
HDL cholesterol and less of LDL cholesterol and TG would be the condition
of choice to prevent a heart attack.
Among Indians, it's as if all the worst conditions
for heart disease were hand-picked and clubbed together to complicate
matters as Syndrome X. It bombards Indians with high levels of LDL, low
levels of HDL, high TGs and insensitivity to insulin (a cause of diabetes),
to compound their susceptibility to hypertension and "central"
obesity.
International studies detected this Indian peculiarity.
In 1958, research conducted in Singapore first established that Indians
have thicker blood and more of LP(a) than the Chinese. The significance
was not well understood, till 1990, when Dr Enas K. Enas, CADI's director
studying over 4,500 patients, found that the US-based Indian community
displayed similar tendencies that doctors began to pay heed. A subsequent
10-year study conducted by Enas confirmed that one out of four Indian-Americans
had high levels of LP(a) as compared to the Japanese, Chinese, Caucasians
and Hispanics.
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