Heart attacks can occur when a piece of cholesterol plaque lining the arteries breaks off, a blood clot forms around it and this clot blocks a major artery to the heart. Now, cholesterol plaque starts building up in our arteries from the age of 10-11. "It's called fatty streaks at this age because these are very thin deposits," explains Mukesh Goel, senior consultant, cardiothoracic, heart and lung transplant surgery, Indraprastha Apollo Hospitals.
This is the normal course of events, and when someone is active from childhood to their adult years, that minimizes their risk of developing ischemic heart disease - the top cause of death in any age group worldwide. Of course, the cholesterol produced in our liver has a number of uses, including making vitamin D, hormones, bile acids and even the walls of our body cells. The problem arises when there is so much excess cholesterol deposited on the artery walls that it causes narrowing of blood vessels, poses the risk of a blocked artery or of pieces of plaque breaking away to cause arterial blockages.
"Heart attacks in the 40s and 50s are nothing new," explains Dr. Goel. "Any way India is the diabetes capital of the world." High blood sugar and high blood pressure, when unchecked, also affect the health of our arteries.
Dr Goel adds that while there has been an upward trend of younger people getting cardiovascular diseases (CAD), Indians aged 40 and above have always been prone to heart disease. This is partly due to genetics - Asians, as a race, have higher incidence of heart disease - and partly due to lifestyle, including, Dr Goel warns, a sudden shift from a no-exercise, sedentary lifestyle to weekend-warrior mode and working out to the point of exhaustion.
Dr Goel agrees that part of the reason why heart attack deaths seem even more shocking today is because people are getting married later. "Two generations ago, someone in their 50s could have been a grandfather," he adds. As lifespans increase, doctors and researchers are working on ways to improve what Peter Attia has called healthspan - how healthy you are even as you get older.
Advances in preventive healthcare and anti-ageing (even for our arteries) may take some time to catch up to the strides in human longevity. In the meantime, Dr Goel says there are three simple ways to prevent heart attack deaths in your 40s and beyond:
1. Never exercise to the point of exhaustion
Often people become more and more conscious about their weight as they enter a new decade of life. Jumpstarting a rigorous fitness routine from zero in your 30s, 40s, 50s, could increase the chances of an adverse health event. Instead, Dr. Goel suggests a more incremental approach to working out.
2. Don't ignore symptoms
Dr Goel says often you hear that someone who had a heart attack had been feeling uneasy for some days before the attack. He adds that ignoring symptoms like pain and uneasiness can cost you precious time when medical intervention can be most helpful. Additionally, taking an aspirin in case of heart attack can buy you a little more time but it is not a substitute for going to the hospital.
3. Health scans in your 40s and 50s
Get a simple lipid profile done, recommends Dr Goel. "A calcium scan is not necessary," he adds.
Indians are already more prone to heart disease than, say, Caucasians. Add to that the stressors of modern living and work, and it can be a recipe for some very poor health choices and outcomes.
Dr Goel, however, also warns against going to the other extreme - from a sedentary life to boot camps in one weekend, or from unchecked snacking to intermittent fasting.
"Any way there's no proof that intermittent fasting works," he says. Instead, eat everything in moderation in your 40s, Dr Goel adds. This is also the decade when you need to take regular health scans even more seriously.
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