‘Checking cardiac risk is easy but underestimated’

Heart disease strikes Indians nearly a decade earlier than Western populations — and many don’t see it coming, making prevention the only armour against crisis, says Prof Satyendra Tewari, president elect, Cardiological Society of India (CSI), and a senior faculty in the department of cardiology at SGPGIMS, Lucknow.

In an interview with Shailvee Sharda, Prof Tewari, who is also the chairman of CSI’s Scientific Committee, explains what is driving premature heart disease in India and why prevention through schools, workplaces, and everyday habits is critical to managing the next decade’s cardiac burden. Excerpts:India is reporting prevalence of heart disease at much younger age. What is driving this shift?Over the past three decades, India has witnessed around five-fold rise in coronary artery disease (CAD), with a disproportionately higher burden in South India and urban populations, though rural India is now catching up rapidly.

Data from the ICMR–INDIAB study show that cardiovascular risk factors like obesity, diabetes and hypertension are increasing even in villages. The most concerning trend is premature CAD, often beginning silently from childhood.

Physical inactivity, air pollution, tobacco use, unhealthy diet, and chronic stress play a major role. According to the Global Burden of Disease (GBD) 2019 study, air pollution alone contributes to nearly 20% of cardiovascular deaths in India.

Heart disease is also appearing earlier in women, partly due to metabolic risk factors and post-pregnancy weight retention. In about 10-15% of young patients, a strong family history points to inherited risk.Are Indians genetically predisposed to heart disease, or are lifestyle choices overwhelming biology?Both play a role, but lifestyle is accelerating genetic vulnerability. Indians are known to have higher levels of Lipoprotein(a), Apolipoprotein B, and certain ACE gene polymorphisms, all of which increase the risk of early atherosclerosis.

Studies published in ‘The Lancet’ show that South Asians develop heart attacks 5-10 years earlier than Western populations, even with similar cholesterol levels. However, genetics alone cannot explain the sudden surge.

Sedentary lifestyles, central obesity, smoking, poor sleep and extreme work-related stress are tipping the balance. Genetics loads the gun, but lifestyle pulls the trigger.Why do most cardiac patients still reach hospitals only after a major event like a heart attack?In younger individuals, symptoms are often atypical — fatigue, palpitations, indigestion, or breathlessness rather than classic chest pain.

This leads to delays. Among diabetics, nearly 50% of heart attacks are “silent”, without classical angina, as shown in multiple Indian cohort studies. Lack of awareness, denial, and misinterpretation of symptoms remain major barriers. Every minute lost increases heart muscle damage, yet many patients reach care far beyond the golden hour.How wide is gap between cardiac care in metros & non-metros?The gap remains significant. Nearly 50% of Indians experiencing a first heart attack never reach a hospital, mainly due to lack of infrastructure, trained personnel, and emergency transport.

Even in developed countries, about 30% of patients fail to reach hospitals, highlighting the critical role of pre-hospital care. While metro cities have advanced cath labs and cardiac ICUs, many districts are still under-equipped.

That said, govt investment over the past decade has substantially improved district-level cardiac facilities.Is sudden cardiac death among the young truly rising, or is it over-reported?There is growing evidence that it is rising. Many young individuals ignore warning signs such as arrhythmias or palpitations, dismissing them as anxiety or emotional stress.

Studies suggest that nearly one-third of patients misinterpret early cardiac symptoms. In the remaining two-thirds, delayed response is the main issue. Survival depends on reaching medical care within the golden hour. Underlying conditions like diabetes, obesity, and smoking worsen outcomes.Are routine heart screenings starting early in India?Not really. Routine cardiac screening should begin at 45, at least annually.

However, individuals with diabetes or a strong family history should start screening at 40, or earlier, as recommended by CSI guidelines. Early detection can prevent catastrophic first events.How effective is Ayushman Bharat in covering high-cost cardiac procedures?Ayushman Bharat has been transformative. It has significantly reduced catastrophic health expenditure, preventing millions of families from slipping into medical poverty.

According to govt data, cardiac procedures are among the most-utilised services under the scheme, offering real financial protection.What role should schools and workplaces play in prevention?Prevention must start early. CSI has initiated screening of schoolchildren with strong family histories of heart disease. Schools should promote physical activity, stress management, and healthy eating habits. Workplaces can play a life-saving role by keeping emergency medicines like sorbitrate and antiplatelets, encouraging regular health checks, and fostering a culture that values work-life balance.Is India prepared for the cardiac disease burden of the next decade?Infrastructure has improved significantly, with cardiac ICUs and cath labs now available in many districts. However, manpower remains a challenge. Training cardiologists, nurses, and technicians takes time. If case numbers double, workforce shortages may break the system first. That is why prevention and awareness are our strongest weapons.What is the most underestimated heart-health mistake Indians make?The belief that home food is always healthy. Excess oil, poor sleep, unmanaged stress, and lack of relaxation are routinely ignored. Quality sleep, yoga, meditation, and stress management must be integrated into daily life — and taught early in schools and colleges.