On World Heart Day, Dr. Murar Yeolekar, a noted academician and Doctor of General Medicine with more than 39 years of experience shares a note on coronary artery disease.

Coronary Artery Disease (CAD) poses one of the most important challenges in India. Essentially multifactorial, it provides ample opportunity for prevention and treatment at individual and public health levels.

Basically, the process of atherosclerosis is central to CAD and it can be tackled and slowed from the beginning that is the second decade of life itself. Few mechanisms that need be addressed include- myocardial ischaemia which is as a result of imbalance between myocardial oxygen supply and demand, during activities and later even at rest, forming the basis of the stress test.

At any stage, the atherosclerotic lesion may erode or ulcerate, fissure or rupture, finally resulting in coronary thrombosis and acute myocardial infarction. In Asian Indians, the CAD appears to be diffuse, extensive and premature affecting many in the prime of their life. Nutritional epidemiologic transitions over last 3 to 4 decades have ensured spurt in metabolic syndrome- the main components being diabetes, hypertension, and hyperlipidaemias, that can all be pre-empted through early lifestyle measures.

The Indian phenotype with apple type obesity, elevated blood TgL, elevated Lp(a), and reduced DHL is sufficiently well known.

• In the first decade, birth history may help: whether a large (overweight) baby of a mother with gestational DM/hypertension of pregnancy. Eating habits develop in the first decade and right feeding and nurturing is important.
• The second decade with puberty and several hormonal changes and commencement of atherosclerosis demands focussed attention. Childhood obesity and hypertension could be sowing seeds of future vascular health. Whether childhood obesity causes adult CAD directly or does so by persisting as adult obesity or both is less clear.
• Persons with a strong family history of risk factors /premature CAD in any/both parents need to be screened in the third decade.
• Fourth decade onwards, regular screening- anthropometry/BMI laboratory profile for sugar, HbA1C, lipids are regularly necessary with rising professional/work-related stress. Effort intolerance sometimes with/without chest pain demands evaluation through ECG, CST, 2.D Echo, Angiography, and disease extent analysis.
• Sixth decade and onwards, patients may show development of atrial fibrillation, low EF, and arrhythmias necessitating Holter, implantable defibrillator/pacemaker as per the situation. Timely and rescue angioplasty and CABG for multiple vessel involvements have saved many lives.

Primordial prevention targeting risk factors, primary/secondary/tertiary preventive strategies have an immense role to play. Regular physical exercise, relaxation through yoga, cessation of smoking, limited calories balanced diet are all simultaneously conducive strategies best practised from adulthood itself.

In a promising study it has been noted that among patients with diabetes, who had all five variables- HbA1C, LDL cholesterol, albuminuria, blood pressure, and cessation of smoking, within target range, appeared to have little or no excessive risk of death, myocardial infarction, stroke as compared to the general population.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.