Rising heart attacks among young people in Jammu and Kashmir

Bhavya Dhyani and Taitreyi Biswas

The COVID-19 pandemic has created havoc around the globe by claiming more than one and a half million lives and infecting more than seventy-six million people, at the time of publishing this commentary. The impact of COVID-19 in terms of case numbers and deaths is devastating as the pandemic is considered the biggest challenge the world is facing since World War-II and also an important turning point in the history of humanity. However, heart disease continues to be among the leading causes of global morbidity and mortality.

Nowadays, heart disease remains the most common cause of death in the country, especially in the erstwhile state of Jammu and Kashmir. A study carried out by the Global Health Research Institute suggests that J&K has recorded 29.6% deaths due to heart-related ailments. The study further reports that 25% of deaths occur in the age group of 25-69 years. Out of these, 32.8% deaths occur in the urban areas and 22.9% in rural areas. These percentages shoot up in winters as compared to summers owing to the extreme weather conditions limiting regular exercising and outdoor activities as a sedentary lifestyle leads to increased chances of heart attacks. Lack of proper equipment, senior medical professions, inaccessibility of immediate medical help and ambulances have been included, by the health professionals, among the contributing factors that may lead to serious complications, including the death of the heart patient.

Clearly, there is much that our health sector needs to do to prevent heart-disease-related deaths in Jammu and Kashmir. Apart from creating a robust health system and infrastructure across Jammu and Kashmir on a priority basis, enhanced public awareness campaigns to educate the community and give an overview of issues concerning heart ailments is an immediate necessity.

 CAUSES AND NATURE OF HEART AILMENTS IN JAMMU AND KASHMIR

Health experts point out the widespread prevalence of heart disease in Jammu and Kashmir and assert that the problem is neither widely recognized nor there is adequate infrastructure in place to deal with it. According to the doctors in Kashmir, there are up to 53 percent more heart attacks in winter compared to summer and for every 2.9 degree centigrade decline in temperature, the number of strokes in the general population goes up by 11 percent and that may further go up to 30% in persons who are already at higher risk due to different associated comorbid conditions like those from metabolic syndrome.

The ischemic heart disease, which contributed 4.3 per cent to total deaths in 1990, has now increased to 8.7 per cent in 2016, reveals a recent study, by the Indian Council of Medical Research (ICMR), on disease burden trends across the country. “At least 3,256 people out of 1 lakh have died in 2016 due to the heart disease in J&K,” reveals the study, which attributes smoking and stress as major causes for it. In ischemic heart disease, also known as Coronary Artery Disease, the blood vessels become narrow or get blocked due to the deposition of cholesterol on their walls, eventually resulting in a heart attack.

The general surge of heart attacks in Kashmir is explicitly visible in the elderly population. The blood of the elderly population is thick and sticky, and with increased internal friction during the cold winters make the blood easier to clot. The drop in temperature also impacts those who have underlying cardiovascular and diabetic conditions wherein frigid temperature constricts blood vessels, thereby increasing blood pressure which in turn likely increases the chances of heart attacks or strokes.

Different theories over these deadly takeovers are put forward which provides an insight suggesting that the abrupt disruption in physical activities since the past two years, initially due to the lockdown imposed by the central government and the recent COVID-19 pandemic has kept life at a standstill. As majority of Kashmiri population, in addition to the elderly group, is suffering from cardiovascular problems and the cases have even increased in the past few years or so due to sedentary lifestyles adopted in wake of frequent lockdowns in Kashmir due to one or the other reasons. This factor could have contributed to significantly upregulating the heart attack cases in Kashmir.

Further, obesity is a new problem featuring young people in Kashmir due to occupational lifestyle changes which is linked to higher bad cholesterol and triglyceride levels and can, in turn, lead to high blood pressure and diabetes as well as heart disease. A sedentary lifestyle is another risk factor for heart disease and sitting is considered another kind of smoking. Cardiologists say the improved economic condition has made the lifestyle sedentary and consumption of red meat, sweets and fatty foods have also increased. They, however, say life has become stressful, leading to rise in smoking, which is the leading cause of the disease in J&K. High blood glucose levels that aren’t easily managed can increase the amount of plaque within the walls of the blood vessels and can hinder the blood flow to heart and people with diabetes are also more likely to have other underlying medical conditions that raise the risk of heart diseases. Chemicals in cigarette/tobacco smoke cause the cells that line blood vessels to become swollen and inflamed. This narrows the blood vessels and can lead to many cardiovascular conditions which in turn makes a person susceptible to heart attack and stroke. Cardiologists say lack of awareness about the seriousness of the factors causing heart attacks was a major challenge. “People are not aware of the risks of hypertension, diabetes and obesity. People don’t even realise how dangerous smoking can be for them,” they said.

Researchers from the European Society of Cardiology has found teens who struggle with anxiety and depression could be at a 20% increased risk of a heart attack when they reach middle age since symptoms of such mental illness include increased heart rates, sweating, hyperventilation and other related symptoms. In this sense, the association of mental illness and heart attacks can easily corroborate the increased rates of heart attacks in the Kashmir Valley where the current political, social and economic situation has taken an obvious toll on the population, especially the youth leading them to suffer from depression and anxiety which eventually, in most cases, leads to heart attacks.

COVID-19 and Heart Diseases

COVID-19 pandemic is changing our lives in unprecedented ways. As per researchers, the risk of dying of a heart attack is much greater than that of dying of COVID-19. Cardiologists across the world are reporting a marked increase in sudden cardiac deaths even as the current focus has shifted to the challenges from COVID 19 and other communicable diseases. COVID19 infection increases the tendency for heart attacks and strokes. Pre-existing heart diseases is a risk factor for high mortality associated with the coronavirus. However, it has been observed that the virus stems and creates heart diseases, which eventually leads to death, in people who had no history of underlying heart diseases. Moreover, a large chunk of patients admitted with the cases of COVID-19 experienced stroke. As SARS-COV2 viral infection causes acute and severe inflammation building up fat deposits in the blood vessels and on dislodging can easily get stuck in heart and/or in brain wherein they could potentially block the blood flow and thereby increase chances of attacks. Moreover, flu in general acts as a risk factor in winter and lack of sunlight during winter leaves people vitamin D deficient which is associated with an increased risk of dying from a heart attack or stroke. People in winter as an adaptation consume more calories building up bad fats and intake more salty foods. Besides extreme weather conditions also limit regular exercising and outdoor activities which promotes a sedentary lifestyle and may lead to increased chances of heart attacks. Covid infections activate blood cells and clotting the system leading to increased cases of blood clots. Even though 17 lakh people have died of cardiovascular diseases this year in India (against one lakh COVID deaths), the scare over COVID is obvious given its highly contagious nature, says Prof Ambuj Roy, professor of cardiology, at AIIMS, Delhi. “Acute (immediate) care always wins over chronic (long-term) care,” he says. “With COVID inducing a kind of unhealthy and fear-ridden lifestyle, it calls for greater caution because, in the long run, heart health can be impacted in many ways. We should not neglect what is not apparent.” Researchers from the European Society of Cardiology have found teens who struggle with anxiety and depression could be at a 20% increased risk of a heart attack when they reach middle age. In this sense, the association of mental illness and heart attacks can easily corroborate the increased rates of heart attacks in the Kashmir Valley where the current political, social and economic situation has taken an obvious toll on the population, especially the youth leading them to suffer from depression and anxiety which eventually, in most cases, leads to heart attacks.

PREVENTING HEART DISEASES

One of the major initiatives called the ‘Save Heart Initiative’ was started by the doctors of the Kashmir valley. Under this initiative, top cardiologists of the Valley would give advice and suggestions, via WhatsApp groups, to doctors at different district-level hospitals. However, at several places, patients suffering from heart failure are forced to walk for over 10 km before they could reach the hospital because the ambulance and the concerned technician are usually not available. Till the time they reach hospital, they get decompensated which ultimately leads to their death. Moreover, cardiac death is largely preventable if patients with a heart attack come to the hospital in time to get treatment. Even if a heart attack doesn’t kill a patient immediately, experts say that delaying treatment could lead to life-altering ramifications, including heart conditions like cardiomyopathy and congestive heart failure. This is the reason why swift action is necessary.

The non-availability of the cardiologist in north Kashmir is forcing thousands of patients with cardiovascular disease to visit various hospitals in Srinagar and outside the UT. The non-availability of cardiologists is not only putting the lives of cardiovascular patients in north Kashmir at great risk but travelling to other places for treatment is draining them out economically. North Kashmir comprising of Baramulla, Bandipora and Kupwara districts has a population of 22,70,625 souls as per the 2011 census. And to combat the cardiovascular disease of such a huge population, not a single cardiologist is available.

 

 RECOMMENDATIONS

The cardiologists and senior surgeons can draw a road map of their house and paste it in the hospital. In case any patients require their assistance when they are home or at the time of blackouts, they can follow the map. This would help the patients in reaching the concerned staff and get their treatment done on time. Moreover, a safety guide should be issued by the government which could include all the do’s and don’ts and the emergency contact list. Many NGOs and public organizations can help in doing so along with the government.

2. One of the major reasons for the increase in heart attacks in Kashmir is the highly hectic professional life of the population. For most people, this means sitting in one place for too long. This can be one of the major reasons for obesity thus leading to heart attacks. Therefore, there should be flexibility in the working hours so that people can devote most of their time to their physical fitness and health. With the temperature continuously dropping down to sub-zero levels in the valley, it is more important for people to remain in their homes, both physically and mentally fit.
3. The government must conduct thorough studies to get to the root cause of sudden heart diseases in Kashmir. A group of professionals who can interact with thousands of respondents and develop insights into the root causes of such diseases needs to be identified on an immediate basis.
4. The youth of Kashmir is globed by the neglected manifestation of mental illness. It has been statistically and medically proven that mental illness, especially anxiety and depression can contribute to increased heart attacks; a place where there is a constant threat to life and livelihood amid the political, social and economic situation. The services of therapy and psychological help should be extended over the valley. Moreover, people should be educated enough to understand the fatality caused by undiagnosed mental illness. Mental health services should be more promoted and acknowledged through campaigns and ceremonies. Subsidized and affordable therapy should be provided. In addition to that, many NGOs and organizations across the country can tie-up with the UT and help in providing these necessities.
5. There should be proper calculations of the rate of heart attacks occurring in Kashmir, precisely to estimate and gauge how much services, equipment, medications and specialists should be required. The precedence of such attacks should be recognized so that the necessary precautions could be taken beforehand.
6. Extreme cold weather is one of the predominant factors that allow the increased rate of heart attacks to occur. Cold weather cannot be eliminated for obvious reasons. There should be flexibility in employment and daily occurrence so that people can spend maximum time in insulated areas. Community bonfires should be set up so that insulation is accessible to everyone. Moreover, subsidized consumption should be made available in order to keep the body warm such as shelters for the poor since they are the most vulnerable in such cases.

CONCLUSION

Heart disease surely has an ugly face. More people die of heart diseases as compared to AIDS and all types of cancers combined. As this disease has many faces and forms, it is important to analyze the root causes and find the necessary solutions. However, changes in lifestyle can help to combat the disease at an early stage. Elderly people with underlying cardiovascular and diabetic conditions are more prone to heart attacks in winters wherein frigid temperatures constrict blood vessels increasing blood pressure which in turn likely increases the chances of heart attack or stroke. Strict invigilation by the higher authorities should be done on a regular basis so as to maintain the smooth functioning of the health sector. Necessary medical equipment should be provided to all the hospitals, both public and private sector. Moreover, there should be more highly specialized cardiologists, who have the knowledge to perform critical surgeries

Due to the lack of emergency medical care, many people lost their lives due to a heart attack. A feasible mechanism that also includes a sincere effort by the government, as well as the general public, is expected to help combat the dangerous health issue.

REFERENCES

Sudden Heart Attacks

https://www.goodmorningkashmir.net/sudden-heart-attacks/amp/

Kashmir registers 28.6% due to heart related ailments https://kashmirobserver.net/2016/01/08/kashmir-registers-28-6-deaths-due-to-heartrelated-ailments/

Heart disease maybe on rise

https://kashmirobserver.net/2017/09/05/heart-disease-may-be-on-the-rise/

‘Many may have died at home’: Amid communication blackout heart attack cases rise in Kashmir https://www.outlookindia.com/website/story/india-news-many-may-have-died-athome-amid-communication-blackout-heart-attack-cases-rise-in-kashmir/338457

No cardiologist for 22,70,625 souls of North Kashmir

https://www.greaterkashmir.com/news/health/no-cardiologist-for-2270625-souls-of-northkashmir/

On rise of sudden heart attacks among younger population in Kashmir – The Kashmir Monitor https://www.thekashmirmonitor.net/on-rise-of-sudden-heart-attacks-among-youngerpopulation-in-kashmir/

Rise in ischemic heart disease in state: Study

https://m.tribuneindia.com/news/archive/j-k/rise-in-ischemic-heart-disease-in-state-study505100

Why should you worry about your heart more than COVID-19 Soma Basu https://www.thehindu.com/sci-tech/health/worry-about-the-heart-too-with-covid-19-amdaltered-lifestyles/article32714086.ece

Covid19 increases risk of heart attacks, strokes’ GK News Network https://www.greaterkashmir.com/news/health/covid19-increases-risk-of-heart-attacksstrokes/