Cardiovascular diseases (CVD) — particularly ischemic heart disease and sudden cardiac events — have emerged as the leading cause of mortality and disability in India. What was once considered a disease of older adults is now affecting young and middle-aged Indians, often silently and unpredictably. As clinicians and caregivers , our focus must extend beyond treatment and interventions to prevention — identifying risks early, modifying lifestyle factors, and fostering awareness.
The Burden of Heart Disease in Indians
Heart disease in India has reached epidemic proportions. National data show that heart disease is now the leading cause of death among adults, accounting for more than one-third of all deaths in both men and women. In the 2021–23 period, heart disease caused approximately 32.4% of male and 29.1% of female deaths — a staggering share compared to other causes like respiratory illnesses or cancer.
Indians develop heart disease earlier than many other populations. Studies by the Indian Heart Association and others report that Indians tend to experience cardiac events almost a decade earlier than Western counterparts — a reflection of susceptibility linked to genetics, metabolic profile, and environmental exposures.
Perhaps most concerning is the trend among younger adults. Contemporary hospital data suggest that a significant proportion of heart attacks now occur in individuals below the age of 40.
Understanding Ischemic Heart Disease — Causes and Risk Factors
Ischemic heart disease (IHD) — the most common form of heart disease — results from reduced blood flow to the heart muscle due to obstruction or narrowing of the coronary arteries. The primary causes and risk drivers include:
1. Metabolic Risk Factors
- Diabetes mellitus and insulin resistance are especially prevalent in South Asians, including Indians, amplifying the risk of atherosclerosis and coronary artery disease.
- Dyslipidemia, particularly elevated LDL cholesterol and low HDL, accelerates plaque formation.
- Hypertension (high blood pressure) damages blood vessels, promoting arterial stiffening and narrowing.
2. Lifestyle and Behavioural Risks
- Sedentary lifestyle: Physical inactivity is a major contributor to obesity, diabetes, and poor cardiovascular fitness.
- Unhealthy diet: High intake of processed foods, saturated fats, trans fats, salt and sugars supports lipid abnormalities and metabolic dysfunction.
- Smoking and tobacco use: These directly injure the endothelium (vascular lining) and accelerate plaque destabilization.
- Excessive alcohol consumption: Contributes to arrhythmias, hypertension, and cardiomyopathy.
3. Stress and Psychosocial Factors
Chronic stress, long work hours, sleep deprivation and high job strain have been linked with cardiometabolic disorders — a reality for many working professionals today, which in turn increases cardiovascular risk.
4. Genetic and Unique South Asian Susceptibility
South Asians have been shown to have a higher predisposition to early cardiovascular disease, sometimes independent of classical risk factors. This includes a higher likelihood of insulin resistance, abdominal obesity and small dense LDL particles — all contributing to earlier onset and more aggressive progression of atherosclerosis.
The Importance of Lifestyle Modification
The good news is that many cardiovascular risks are modifiable. Lifestyle changes are powerful preventive tools:
Nutrition
- Prioritise a heart-healthy diet rich in fruits, vegetables, whole grains, legumes, lean proteins and healthy fats.
- Limit processed foods, sugar-sweetened beverages, excessive salt, and trans fats.
Physical Activity
- Aim for 150 minutes of moderate aerobic activity per week, including brisk walking, cycling or swimming.
- Add muscle-strengthening activities twice a week.
Weight and Metabolic Health
Maintaining a body weight in a healthy range reduces strain on the heart and improves blood pressure, glucose and lipid profiles.
Smoking Cessation & Alcohol Moderation
Quitting smoking is one of the most impactful steps a person can take to reduce cardiac risk. Limiting alcohol reduces blood pressure and arrhythmia risk.
Stress and Sleep Management
Adequate sleep (7–8 hours nightly) and stress-reduction strategies like meditation, yoga or mindful breathing are integral to heart health.
Early Detection — Screening and Tests Save Lives
Prevention also means early detection of risk before symptoms arise.
Routine screening should begin in early adulthood and include:
- Blood tests: Lipid profile, fasting glucose/HbA1c, renal function and inflammatory markers.
- Blood pressure monitoring: Especially when overweight, stressed or sedentary.
- Electrocardiogram (ECG): Detects rhythm abnormalities and silent ischemia.
- Echocardiography: Assesses heart structure and function — especially in those with symptoms or family history.
- Treadmill (Stress) Test: Evaluates blood flow and cardiac response to exertion.
- Holter monitoring, CT angiography, or angiograms when indicated based on risk profile or symptoms.
Individuals with a strong family history of premature heart disease — first-degree relatives with heart attacks before age 55 in men or 65 in women — must be particularly vigilant and seek earlier screening.
Prevention Begins with Awareness
At the core of preventative cardiology lies awareness. Most people seek medical help only after symptoms become severe, often missing the “golden window” for lifestyle correction or early intervention. Educating patients about warning signs — chest discomfort, unexplained fatigue, breathlessness, palpitations — and risk-factor control is paramount.
Preventative cardiology is not merely a medical specialty — it is a public health imperative. With heart disease affecting Indians at younger ages and with greater severity than ever before, the onus is on healthcare providers, patients, caregivers, and communities to adopt a proactive stance.
Lifestyle modification, routine screening, and increased awareness can transform cardiovascular outcomes — reducing the burden of disease, saving lives, and improving quality of life for individuals and families across India.
At Baroda Heart Institute, we envision a future where hearts thrive long before they fail — and where prevention truly matters as much as cure.