While it has long been known that South Asia tops the world rankings in acute coronary syndrome cases, this is the first comprehensive research which quantifies the magnitude of the problem. "The study shatters the biggest myth that heart disease is an ailment of rich nations," says New Delhi-based cardiologist Dr K K Gupta. "It's a wake-up call for Indians to re-assess their lifestyles, work habits and diets. Most of us seem to have swapped the traditional healthy lifestyle for junk food loaded with trans fats, no physical exercise and 15-hour [a day] work schedules. This is an open invitation to heart disease and death."

According to research, heart disease kills about 8 million people globally each year. However, while Western nations have seen a 50% plummet of heart attack-related deaths since the 1960s - due to growing health awareness and an increase on government funding for health - Asian countries have, on the contrary, witnessed an upward spiral in such deaths and currently account for 80% of the world's heart disease-related deaths. By 2020, ischeamic heart disease (leading to brain strokes) will ratchet up by 137% for men and 120% for women over three decades in poorer nations, compared with 30-60% in rich economies, according to The Lancet.

Another huge disadvantage India faces in this context is its abysmal gross domestic product (GDP) spending on health. While most Western nations currently spend at least 6% of their GDP on health, India's figure is a negligible 0.9%. "It's almost like in a country of a billion-plus, putting food in people's mouths is far more important than their health concerns," says a senior bureaucrat at the Ministry of Health. "But this is a myopic view, as sickness can be a huge drain on resources which can in turn hamper the government's plans to feed people. It's a classic Catch-22 situation."

Complicating India's scenario further is a severe shortage of doctors which has literally paralyzed the state health machinery, severely impacting its billion-plus population, a third of whom subsist on a meager US$1 per day. According to a Planning Commission report released last month, India is short of a phenomenal 600,000 doctors, 1 million nurses and 200,000 dental surgeons. There is also a huge paucity of paramedical staff including radiographers, X-ray technicians, physiotherapists, laboratory technicians, orthopedists and opticians.

The situation is so bad that in some government hospitals untrained medical staff are being pressed into service to assist doctors. It's common that untrained staffers are asked to administer important functions like injections and stitching up wounds without any supervision while the harried doctors attend to critical patients.

Nationally, the glaring shortfall manifests itself in an abysmal patient-doctor ratio. India compares dismally with countries like Australia which provides 249 doctors for 10,000 people, Canada which offers 209, Britain 166 and the United States 548.

It is no surprise then that due to ill-equipped hospitals and unhealthy lifestyles, rates of coronary disease among urban Indian populations have surged from 4% to 12% over the past decade. Worse, obesity currently plagues about 30% of all urban Indians, most of whom have a [body mass index] BMI in excess of 25 as against the recommended limit of between 18 and 24. Moreover, according to a recent Women and Child Development Ministry survey, 13% of New Delhi's kids are obese and hence at an enhanced risk of heart disease, diabetes and obesity in adulthood.

This can be catastrophic as Indians, say doctors, already possess elevated levels of LDL (low density lipoprotein) cholesterol and triglycerides while being HDL-deficient (good cholesterol which removes fatty deposits from blood vessels). Environmental factors like low birth weight, malnutrition and desk-bound jobs further makes them susceptible to an enhanced risk of insulin resistance (leading to diabetes) and heart failure.

India is also home to 12% of the world's smokers and will witness 930,000 deaths in 2010, according to a study published in the New England Journal of Medicine. The study estimates that India has about 120 million smokers who will contribute to deaths mainly from tuberculosis, heart disease and cancer.

Oncologist Dr Swati Chopra stresses that smoking exacerbates the risk of heart attack as elevated nicotine levels spike the body's bad cholesterol or LDL making the blood stickier and the arteries harder. "This enhances the blood's chances to clot more readily. Sticky blood flowing through hardened arteries can lead to the formation of a clot and block an artery. A blocked artery in the brain," informs the expert, "can trigger a brain stroke which may lead to paralysis or even death."

What also puts Indians at a disadvantage is their genetic pool. In fact a recent Imperial College, London (UK) study has identified genetic variations (occurring commonly among Indian Asians) that make them on an average about three kilograms heavier than people of European ancestry. This, the study suggests, makes Indians prone to polygenetic ailments (controlled by multiple genes) like Type 2 diabetes, hypertension and cardiac trouble. Scientists say that the variants found in a specific gene identified as MC4R (a protein which regulates appetite and metabolism) and FTO also triggered a two-centimeter expansion in the waist circumference of adult Indians as compared to Westerners. This leads to "midriff obesity" which often climaxes in heart problems.

Vulnerability to heart disease can have devastating economic consequences. In 2000, for instance, India lost more than five times as many years of economically productive years to coronary diseases than did the US where most heart disease victims are past retirement age in any case. Contrarily, in India, nearly half of heart disease-related deaths strike people below the age of 70, compared with just 22% in the West.

"But while you can't fight your genes, you can certainly alter your lifestyle," advises Dr Gupta. Lifestyle modification, asserts the doctor, is thus the need of the hour. "We're sitting on a time bomb and unless we do something proactively about it, heart disease can literally kill India."

New Delhi-based independent journalist Neeta Lal has had her work published in over 70 publications across 20 countries .

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