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COVER STORY: HEART ATTACKS
The Real Villain
Recently, a study in Singapore which took blood
from the natal chord of 5,000 babies of Indian origin, found extraordinarily
high contents of LP(a) present, indicating that genetics, not diet, was
the major cause of such abnormal levels of LP(a). "This test belies
theories about stress, high cholesterol and other essential Coronary Artery
Disease (CAD) indicators, as newborns could not have possibly endured
all that. Indians, per se, are at a high risk," says Enas.
Only now is research exposing just how big a
villain LP(a) is. According to Dr D.S. Gambhir, president of the Delhi
Cardiological Society, on its own, LP(a) causes arterial hardening and
blockage. Enas lists LP(a) as the little-known cousin of the LDL family,
15 times deadlier than total cholesterol in off-loading fatty debris in
blood. "Indians are in double jeopardy through nature and nurture-nature
has given them LP(a) which, in turn, is being nurtured by unhealthy lifestyles
associated with rising affluence and mechanisation," says Enas.
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RADHE SHYAM, 35,
Gardener, Thermal Power House, Faridabad
He wasn't in the category that doctors would put on the high
risk for heart attacks. Yet, on his way home from work one evening,
Shyam felt a sharp pain sear through his chest. He thought it was
gas but rushed to the hospital. After an examination, doctors recommended
bypass surgery.
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The presence of risk factors along with LP(a)
increases the incidence of CAD by five times among Indians as compared
to other communities. However, LP(a) alone cannot explain why Indians
are at such high risk because as a race, Africans, not Indians, have the
highest levels of LP(a) and the lowest rate of heart disease in the world.
Part of the reason is that Africans have much lower levels of LDL and
TG than Indians do.
What exactly LP(a) does to the blood is unclear,
but the process closely resembles a clotting factor that helps heal cuts.
Scientists suspect that it tricks blood factors within our vessels into
clotting into a thick slush. The LDL-induced plaque, generously scattered
along the length of the arteries, encouraged as usual by TG, reduces the
flow to excruciatingly low rates. This has the heart muscles gasping for
oxygen. Then, insulin, which normally helps by dilating blood vessels,
does the opposite in all the confusion-when the lining is damaged, it
encourages muscle growth which further narrows the arteries.
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ENAS K. ENAS,
Director, CADI, USA
"Indians face the highest risk. Genetics
load the gun, lifestyle pulls the trigger."
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Clearing the passage for the blood and oxygen
involves fighting enormous odds. Nevertheless, HDL in optimal strength
may have been up to it, quickly mopping it all up back to the liver. But
Indian genes ensure that HDL levels are below normal. A major heart study
of over 5,000 patients in the US in 1996 found that only 14 per cent of
Indian-American men and five per cent of Indian-American women had optimal
HDL cholesterol levels. It's a triple, sometimes quadruple, whammy. For
while Americans and Europeans often suffer from one blocked artery, double
or triple artery disease among Indians isn't uncommon. The fat deposits
in Indians also extend over a greater area, whereas in the west it is
generally in one region.
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BOB KIM-FARLEY
India representative, WHO
"India is now burdened with battling
diseases like TB as well as high rates of heart attacks."
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As a result, Indians across the globe, even third-generation
emigrants, fall like ninepins to cardiac disease-they are at least four
times more susceptible to CAD than Europeans, Chinese or Blacks, and this
risk increases up to ten times in those younger than 40. That's Syndrome
X.
Also, heart disease in India is now the malaise
of the young rather than the elderly. Today, one in four heart-related
problems in the country occur in a man below 42 years and heart disease
is the leading cause of death in urban areas. In comparison, the figure
is less than four in 100 for the same age group in the US where deaths
due to coronary disease have decreased by 40 per cent. Indian women are
also not unscathed. Attests Mumbai-based cardiovascular surgeon Sharad
Pandey: "Women between 30-35 years of age, largely considered safe
from heart trouble before menopause, are now being afflicted by the disease."
In India, CAD and diabetes are frequently locked
in a diabolic embrace, and to a certain extent insulin insensitivity of
syndrome X provides a clue. It's predicted that in the next 10 years,
one of four Indians will suffer from diabetes, and that heart ailments
will increase proportionately. Says Naresh Trehan, cardiac surgeon and
director, Escorts Heart Institute and Research Centre, Delhi: "The
increasing number of undetected diabetes is a major cause of CAD."
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