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Kerala - Thiruvananthapuram Printer Friendly Page   Send this Article to a Friend

Heart of the matter

Mornings at the Museum grounds are crowded affairs these days. Young and old, they are all walking their way to health. Yet, almost all of them started their early morning routine after receiving one of those early warning signals - high blood pressure, diabetes or high cholesterol.

"Keralites are supposed to be very health conscious; only, they become conscious after some problem has already set in. The only saving grace is that today people rush to the hospital when a chest pain starts up, instead of sitting home and convincing themselves that it is a gastric problem," says Tiny Nair, chief cardiologist at PRS Hospital in the city.

Globally, Asian men are emerging as a particularly high-risk group for heart diseases. Over 10 per cent of urban Indians are suffering from coronary artery diseases (CAD). The incidence of CAD among urban males under 35 years is an alarming 11 per cent in the four South Indian States

In the last three decades, the average age at which heart attack occurs has gone up 10 years in the U.S, while in Kerala, it is steadily going down.

Enas A. Enas, a Keralite doctor in the U.S, and one of the first physicians to have zoomed in on the four-fold increase of CAD among Asian Indians, in his much-acclaimed Coronary Artery Disease among Asian Indians study (CADI study) in 2002 reported that 50 per cent of all heart attacks among Indians occurred below 55 years and 25 per cent under the age of 40 years -- something that is unheard of in any population sample.

The study found that the CAD prevalence rates in urban India was similar to the rates prevalent among affluent Indians overseas. Dr. Enas reported that in India, Kerala had the highest CAD prevalence rate, at 13 per cent in the urban areas and 7 per cent in the rural areas -- ahead of cities like Chennai (11 per cent) and New Delhi (10 per cent).

"The peak incidence of heart attacks in Kerala is between 35 and 45 years of age," says Dr. Tiny Nair.

Why are South Indians, especially Keralites, more prone to heart problems? "One theory that has been floating around since the 1960s is that a `thrifty gene' is responsible for making certain populations pre-disposed to obesity and its associated ills, including heart attacks," says Dr. Nair.

The `thrifty gene' theory was proposed in 1962 by a geneticist, James Neel. The theory is that some populations which relied on farming and fishing for food for thousands of years, were used to alternating periods of famine or plenty. To adapt to these extreme changes, these people developed a thrifty gene, which allowed them to store fat in times of plenty so that they can survive during famine.

In time, these populations have gone on to adopt a life style, wherein they always have access to plenty of high-fat food and have less physical activity. The `thrifty gene' is now playing up, hoarding unhealthy amounts of fat and making people pre-disposed to obesity.

The `thrifty gene' theory begins to make sense when one reads it together with the findings of Dr. Enas that Asian Indians (those from India, Pakistan, Bangladesh and Sri Lanka) are genetically pre-disposed to CAD.

Indians have been found to have low levels of high density lipoprotein (HDL) or good cholesterol that protects the heart and high levels of low density lipoprotein (LDL or bad cholesterol. They also have glucose intolerance (diabetes) and high levels of triglycerides or fat.

However, regardless of their genetic disposition, the incidence of heart attacks has gone up among young Indians in recent times because of the changes in life style, doctors point out. High-fat diet and little physical activity are proving to be the trigger for underlying genetic factors.

C. Maya

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