Heart of the matter

Even well-informed urban Indians are mostly ignorant about what the heart wants and needs, say experts. The curious case of men younger than 50 succumbing to cardiac arrest is thankfully spurring a discussion on the connect between head and heart

The news of 40-year-old actor and reality TV star Sidharth Shukla’s passing away on Thursday came like a bolt out of the blue. The Bigg Boss 13 winner who had recently gained attention for his role in Ekta Kapoor’s web series Broken but Beautiful 2, died of cardiac arrest the same morning. He had been feeling uneasy the night before. The post-mortem report revealed that he had suffered a heart attack and died in his sleep.

Television actor-model Sidharth Shukla’s post-mortem reports revealed that he had died in his sleep due to a heart attack on Thursday

Barely two months ago, director Raj Kaushal, 50, died of a massive heart attack; Gujarati actor Amit Mistry, 47, suffered a similar fate this year, as did 44-year-old actor Inder Kumar back in 2017. 

Arti Shroff

The Indian Heart Association data reveals that when heart disease strikes Indians, it tends to do so at an earlier age—almost 33 per cent earlier—than other demographics. Here’s another starling statistic: Almost 50 per cent of all heart attacks in Indian men occur under 50 years of age and 25 per cent, under 40. An ongoing study by the researchers at the University of California, San Francisco and Northwestern University, known as Masala, which has been following more than 900 South Asians in Chicago and the Bay Area, has found that South Asians tend to develop high blood pressure, high triglycerides (fats from the food we eat that are carried in the blood), abnormal cholesterol and Type 2 diabetes at lower body weights than other groups. South Asian men are also prone to high levels of coronary artery calcium, a marker of atherosclerosis—the buildup of fats, cholesterol and other substances in and on your artery walls—that can be an early harbinger of future heart attacks and strokes. 

This means we are disadvantaged by race. 

Uday Kumar, 44, who suffered a heart attack in 2019, used to smoke 15 cigarettes a day for over a decade, and drank almost every evening. He quit smoking, drinks socially and has identified stress triggers since. Pic/Anurag Ahire

Uday Kumar, 44, is the head of chemical trading in India for the Toyota Tsusho India Pvt Ltd. In 2019, Kumar suffered from a myocardial infarction, after returning from a vacation in Europe. During his trip, he had trekked and driven around, and remembers being rather stress-free. He had even done taken an annual health test at work, and except for borderline cholesterol and mild high blood pressure, his reports seemed normal. “Two days after I returned, I was feeling restless; I checked my blood pressure, which was 200/130 mm Hg [normal is 120/80 mm Hg]. A friend advised that I should rush to the hospital, where I was told I was going into cardiac arrest. They then performed an angioplasty, and thankfully everything went fine.”

Dr Aashish Contractor

Later, over a conversation with his doctor, probable causes emerged—he had been smoking 15 cigarettes a day for over a decade, he drank almost every evening, and he slept only three hours a night. “It was a combination of it all—a very fast-paced life.”

Recent news reports have highlighted the death of men under 50 due to heart failure—director Raj Kaushal (pictured here with wife Mandira Bedi) was 50

Ever since, Kumar has quit smoking, drinks a beer once a month, and has stopped caring about anyone, who isn’t important. “I read The Subtle Art of Not Giving a F*ck [by Mark Manson], and I decided to not stress ever again. It’s just not worth it. But, if you are 40, please get a medical check-up done every six months.”
Poor lifestyle habits—smoking, drinking, eating junk, surviving a hectic job—have led to a growing number of younger men becoming prone to heart disease, with many staring at the risk of dying due to a heart attack even before they turn 50.

Actor Amit Mistry 

Research has shown that smoking increases heart rate, tightens major arteries, and can cause an irregular heart rhythm, all of which make your heart work harder. All of these factors combined, lead to diabetes, high cholesterol and blood pressure, which are three of the main reasons for heart attacks among younger men, says Dr Aashish Contractor, Director, Rehabilitation and Sports Medicine, Sir HN Reliance Foundation Hospital. Obesity, lack of physical activity, stress, which unfortunately can’t be measured, and even air pollution, as new research has shown, are other contributing factors.

Music composer Narendra Bhide were 47. Pics/Instagram

“Know your numbers,” says Contractor. That’s the only way, he says, you can protect yourself and your heart. Contractor says we need to subscribe to a holistic approach. Working out in the gym to beat a sedentary life isn’t enough to fight heart disease. “Fitness may be protection against heart disease, but doesn’t give you immunity.”

Mohit Mathur and Kalpana Patil

Dr Sudhir Pillai, cardiologist with Hinduja Hospital, Mahim, is of the same opinion. “People die on the treadmill. I have even known young cardiologists who have died while working out.” Pillai explains the connection between rigorous exercise and heart attacks. He says that most of us are living with clots in our arteries—men start forming clots at age 20, as was seen in the post-mortem on bodies of soldiers in the Second World War. Put the heart under pressure, and these clots can burst. “We call it a plaque rupture. Any extra stress on the heart will cause these clots—caused due to sedentary lifestyle, eating habits, smoking, stress, etc—to burst. This can go from a minor situation to a major one in a matter of minutes. So exercise, while great when done consistently, needs to be scaled up slowly and steadily. You can’t lift 100 kg one day, and then move on to 200 kg the next. You need to give your heart and body time to adapt. Exercise, but do not be aggressive.”

Dr Sudhir Pillai, cardiologist, Hinduja Hospital

Exercising usually affects people with underlying health problems like diabetes, or unfit individuals who haven’t worked out previously. Some are not even aware that they have any kind of heart disease. As Contractor says, “With the kind of information available these days, I am shocked that most people continue to ignore symptoms and don’t go to a doctor. They remain undiagnosed, till one day, they suffer a heart attack.” He also points to another reason for heart disease among younger men—genes. This, unfortunately, isn’t in our control. But a study on why lifestyle is more important than genetics by the European Society of Cardiology, begs to differ. Dr Joao A Sousa of Funchal Hospital, Portugal, author of the study, stated that people with a family history of premature heart disease should adopt healthy lifestyles, as their poor behaviours may be a greater contributor to heart disease than their genetics. “That means quit smoking, exercise regularly, eat a healthy diet, and get blood pressure and cholesterol levels checked.”

Praveen Nair

Men who aren’t emotionally expressive can be doing themselves more harm than good. A study conducted in Iran last year found a link between hostility and repressed anger and cardiovascular disease in men. It said: “The role of anger and hostility in cardiovascular disorder is that anger and hostility can increase the heart rate and blood pressure, and over time, can damage the coronary artery wall and accelerate coronary artery dysfunction. In addition to potential physiological processes associated with hostility, it may impair certain behaviours such as smoking, eating a high-fat diet, and not exercising coronary artery function.”

Psychologist and psychotherapist Arti Shroff explains that because there is no healthy outlet, men, especially in the cultural context of India, are holding all their emotions inside. “That could result in chronic stress—which is one of the main reasons for heart attacks. It doesn’t happen overnight—our body is naturally equipped to handle stress. But over time, its systems break down, thanks to the stress hormone cortisol,” she says, adding that it’s also the urban culture of hyper competitiveness that is adding to stress levels. “There is so much competition in every sphere, and everyone glamourises the workaholic—it’s not helping.”

Shroff says practising “daily self-care” is important. And this goes beyond taking time out for oneself. Building a support system of a few people to share your concerns with is critical. “I just had a male client whose family member is battling cancer. I asked him to talk about it to a friend, and he said he didn’t want any sympathy. You need to find someone to talk to, without fear of judgment.”

A 2017 study by The Lancet stated that 197.3 million people were living with some sort of mental illness in India, 45.7 million depression, while 44.9 had anxiety.
In creative fields, where you are sometimes only as good as your last work, or your last picture on social media, stress levels can be high, says Shroff. The pressure to remain relevant can often be overwhelming.

Fitness expert and celebrity coach Praveen Nair says that those in the limelight have it harder. Sometimes, celebrities choose to use muscle-building enhancers. “That’s not bad, but it must be done after you know what condition your body is in, and what it can handle,” says Nair, who prefer that his clients take a blood test, before planning a workout schedule for them. “It all looks good on the outside, but what’s happening inside is what matters. I insist on them doing proper cardio, so that the heart gets pumping. We need to use our hearts more.”

Mohit Mathur Founder, CEO, OneFitPlus, a connected fitness company, says that heart conditions have increased because of the amount of processed foods we have started consuming. “Processed food is now available across shelves, and we don’t realise how much of that we are eating. We should remember that our bodies are built to move around and physical activities are vital to keep both mind and body productively engaged.” Processed food are low in fibre, vitamins, and minerals, all of which help prevent heart disease. Preservatives and other additives present in ultra-processed foods might also contribute to weight gain, prediabetes, and inflammation, all of which affect your heart.

“You are what you eat,” says wellness coach at Herbalife Nutrition, Kalpana Patil. “Men get their fitness knowledge from the Internet. Sometimes, they gym in excess, but don’t add to their nutrition. Instead they starve themselves. They don’t eat carbs, which offer us energy, and that is dangerous. When you sweat, you lose minerals and vitamins as well. It’s not just about packing your body with protein. They even avoid fats, which are so necessary for good health. We all need to find that equilibrium. In the end, ‘what you take from your bodies, you must return’.”

Meet the enemies 

Smoking: Increases heart rate, tightens arteries, can cause an irregular heart rhythm, which makes your heart work harder 

Eating unhealthy: Processed foods are low in fibre, vitamins, and minerals, all of which are important in preventing heart disease

Irregular/insufficient sleep: When you sleep, your body recuperates. During the non-rapid eye movement stage, your heart rate slows, blood pressure drops, and breathing stabilizes. All these help reduce stress 

High sugar levels: If you have diabetes, your chances of getting heart disease double. The high sugar levels in your blood can damage blood vessels over time. Body tissues use sugar stored in the liver as glycogen as a source of energy. Sugar could leak from liver into the blood, damaging the blood vessels 

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