Indians have a high prevalence of ischaemic heart disease. What is more alarming is that it presents or manifests a decade earlier in Indians compared to our Western counterparts. Main reason for this is high clustering of risk factors like diabetes, hypertension, smoking or other forms of tobacco use, high levels of bad cholesterol or low levels of good cholesterol, physical inactivity, obesity, high carbohydrate/high fat diet and high levels of stress in Indians. Many times the first presentation of ischaemic heart disease is acute myocardial infarction and sudden cardiac death. In upto 7 percent of cases the first myocardial infarction is fatal. Many of these patients die before reaching the hospital because of cardiac arrhythmias.
The key to prevention and early detection of ischaemic heart disease lies in early identification of risk factors and their aggressive management and also early detection of the disease before it presents as a heart attack. Risk factors are present for many years before leading to the development of significant ischaemic heart disease. If risk factors are identified and aggressively controlled at early stages many cases of ischaemic heart disease can be prevented or their onset delayed.
This can be done by undertaking comprehensive cardiac evaluation periodically starting at 40 years of age. Comprehensive cardiac evaluation includes a detailed history and clinical examination by a cardiologist or a physician in addition to other tests. Detailed history and clinical examination helps to identify the risk factors and institute corrective measures to control them. Blood tests including fasting blood sugar, HbA1c, Lipid profile and hsCRP should be done. Electrocardiogram (ECG) and echocardiogram should be done for cardiac evaluation. Stress test like thread mill test will detect ischaemic heart disease in pre-symptomatic stage. For some patients who are unable to exercise due to some reason CT coronary angiogram and CT calcium score can be done. If CT calcium score is more than 300 risk of having significant blockages in heart vessels is high. CT coronary angiogram can directly visualise the coronary vessels and can detect even minor of blockages. If initial cardiac evaluation is normal further evaluation can be done every 3-5 years depending on patient's symptoms or risk factors.
This period cardiac check ups after certain age will go a long way in early detection of heart disease and instituting corrective measures early and saving many lives
(Author: Dr. Pawan Poddar, Director of Cath Lab and Senior Consultant Interventional Cardiologist, Yashoda Hospitals, Hyderabad)