Heart Attack and Cardiac Arrest

Why Does Heart Attack Become Common in the Young Age?

Last updated on October 20th, 2022 at 07:57 am

Most people think heart attacks only occur in people who are older. This is a misconception. Acute heart events also occur among young people, specifically those under the age of 50. Understandably, when such events occur, a sense of panic occurs.

What is a heart attack?

A heart attack or acute coronary syndrome occurs when blood flow to the heart muscle is suddenly impaired. This occurs either from a progressive narrowing of coronary arteries from atherosclerosis or from rupture or erosion of a plaque which was already present inside these blood vessels, leading to clotting and blockage of blood flow. When muscle cells die from continued lack of oxygen supply, it is called a myocardial infarction. Commonly triggered by unaccustomed exertion, it can also occur without prior warning.

What is a cardiac arrest?

Cardiac arrest, a commonly misused term, refers to stopping of the heart, somewhat like a water pump stalling because of a power cut. One of the common underlying reasons is a myocardial infarction. Abnormal heart rhythms because of multiple causes could lead to a cardiac arrest. Thus, a cardiac arrest can also occur for reasons beyond coronary artery disease, such as drowning. Therefore, such individuals need not always have blocked coronary arteries.

A person undergoing a sudden cardiac arrest often collapses on to the ground, unable to respond or breathe properly. It is important to do CPR (cardiopulmonary resuscitation) to immediately resuscitate such a person. This has to be continued until the patient reaches the hospital. Without CPR, there will be no blood flow to the brain; permanent brain damage will occur within minutes.

Who is more likely to develop a heart attack?

Even though a heart attack is more likely to occur in someone with the traditional coronary risk factors such as smoking, diabetes, hyperlipidaemia, sedentary lifestyle, obesity, hypertension and family history of heart disease, it can also occur in people without these conditions. The focus of this article is to distinguish between these two categories of heart attacks and attempt to estimate the odds of developing such a complication at a young age.

What percentage of deaths from heart attacks occur below 50 in India?

It is estimated that 50% of deaths from coronary heart disease in India occur below the age of 50. This information is published in the WHO paper ‘Burden of disease in India by National Commission on Macroeconomics and Health’.

Burden Of Disease In India By National Commission On Macroeconomics And Health
Burden Of Disease In India By National Commission On Macroeconomics And Health

While this statement might seem scary, it is important to look at the big picture before jumping to pessimistic conclusions. There are 2 caveats which explain this observation.

  1. Unlike western nations where the average age of the population is in the mid-40s, India is a young country where the vast majority of individuals are young – with an average age of only 28.4. In fact, approximately 75% of India’s population is below the age of 40. As a result, the total number of diseases – including heart disease – will be relatively higher in this age group.
    • Naturally, the average age of a person with heart disease will also be lower in India. That is one reason it is often claimed that “Indians develop heart disease at a younger age”. This is somewhat like saying, “all people in India are 28 years old”.
  2. Death reporting in India is not a uniform process. All deaths are not certified or registered. It varies between urban and rural regions, as well as between states. Overall, most large hospitals are in urban areas. Therefore, deaths that occur in urban settings are more likely to be correctly recorded. In contrast, a death occurring at home in a remote village might not be classified according to the correct cause. Thus, it is possible that many of the deaths occurring in older age groups from cardiac causes are not included in this calculation.
What are the odds or risk of developing a heart attack by age group in India?

A landmark paper was published in 2011 by CR Soman, Raman Kutty and others in Asia Pacific Journal of Public Health, looking at seven villages in Kerala over five years covering a population of 161,942 people, examining 4271 deaths, classifying them as objectively as possible. The authors have published the rate of coronary heart disease deaths in each age group, see table below.

The Rate Of Coronary Heart Disease Deaths In Each Age Group
The Rate Of Coronary Heart Disease Deaths In Each Age Group

The authors report that the chance of death from coronary heart disease in the age group 35 to 44 years was 59 per 100,000 persons among men, and 17 per 100,000 for women. From the table, it can be seen that this rate increases with each decade. This proves that the chance of developing a heart attack increases with age. Thus, although the individual risk or rate of heart attacks is lower among younger adults, the total number of individuals in this age group is large. Hence, the total number of events is also large.

What is the risk for someone in their forties dying from a heart event?

Risk is estimated as a rate, which is a fraction. A rate has a numerator (number of observed events) and a denominator (the size of the observed population). According to Dr CR Soman’s study, the rate is 59 per 100,000 people per year, or 1: 1700. In plain words, this means that 99,941 people out of 100,000 will not die from a heart attack. This is an extremely rare outcome in this age group.

What about a treadmill test?

A commonly asked question in this context is whether to go for a specialised heart investigation such as a treadmill ECG test.

Unlike a urine pregnancy test that always shows either a positive or negative result, heart investigations can sometimes be inaccurate and misleading. When done without the right clinical sign, the test might show a false positive result, even in the absence of heart disease. This leads to long-lasting anxiety and unnecessary further invasive tests.

The test could also give a false negative result by failing to detect heart disease, falsely reassuring the person. The solution is to undergo these tests only by the direction of a doctor, after assessment of an individual risk profile.

How has the pandemic affected heart events?

There is evidence of greater risk of heart events occurring for at least a year following COVID-19, likely because this virus affects the inner lining of blood vessels. While there is no preventive medication advised, it is safer to avoid strenuous exercises during the months following the SARS-CoV-2 infection.

Conclusion

All deaths are tragic. But when people hear about apparently healthy young individuals dying suddenly from a heart attack, it is common to feel a sense of panic that it could happen to anyone. This is called catastrophic thinking. The solution is to look at facts and figures and calculate the actual probability.

After analysing the above published papers, the chance (rate) of such an event occurring in a person under 50 is extremely small. Among all such events, 8% occur in people with no known risk factors.

Not all heart attacks are preventable. But this should not stop us from doing what we can to reduce our individual risk. Avoiding tobacco and excessive alcohol use, maintaining a physically active lifestyle with regular exercise, adequate sleep and reasonably healthy diet, specifically avoiding trans fats and excess salt intake are important.

Knowing one’s health parameters such as weight, blood pressure, blood sugar, lipid profile and discussing these with the family doctor are important.

Author: Dr Rajeev Jayadevan Published in OnManorama

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