On rise of sudden heart attacks among younger population in Kashmir

By Sheikh Umar Ahmad –

 There is a general surge in the number of heart attack and stroke patients brought to Kashmir based hospitals in winters.

Elderly people with underlying cardiovascular and diabetic conditions are prone to these attacks in winters wherein frigid temperatures constrict blood vessels increasing blood pressure which in turn likely increase the chances of heart attack or stroke.

The blood in elderly population group tends to be thicker and stickier with increased viscosity during extreme cold weather conditions notably during chilla-e-kalan in valley which makes it easier to clot. Not to everyone’s surprise, even the young and healthy individuals are brought to hospitals during winters with these conditions and most of them are brought dead. As per the doctors working at Kashmir based hospitals, they have a say on it that there are up to 53 percent more heart attacks in winter compared to summer what infact research says and for every 2.9 degree centigrade decline in temperature, the number of strokes in general population goes up by 11 percent and that may further go upto 30% in persons who are already at higher risk due to different associated comorbid conditions like those from metabolic syndrome.

This year they also have a say on Covid-19 as a risk factor in increasing rate of heart attacks and stroke in general population and in Kashmir valley in particular moreso in winters. As SARS-COV2 viral infection causes acute and severe inflammation building up fat deposits in the blood vessels and on dislodging can easily get stuck in heart and/or in brain wherein they could potentially block the blood flow and thereby increase chances of attacks.

Moreover, flu in general acts as a risk factor in winter and lack of sunlight during winter leaves people vitamin D deficient which is associated with increased risk of dying from heart attack or stroke. People in winter as an adaptation consume more calories building up bad fats and intake more salty foods. Besides extreme weather conditions also limit regular exercising and outdoor activities which promotes sedentary lifestyle and may lead to increased chances of heart attacks.  

Off late this year to everybody’s surprise, there has been a sudden surge and an unexpected increase in heart attack/stroke rates among young population in Kashmir. Different theories are propounded and being put forth accounting these deadly takeovers and there is a greater perception among majority of population that abrupt decrease in physical activity from past two years initially due to lockdown imposed in wake of demographic changes in Jammu and Kashmir and more recently due to the coronavirus pandemic that has brought everything to standstill for about a year now are the potential contributing causes for this deadly surge in valley. There is no denying of this fact that the uneventful episode of demographic changes initially and epidemiological changes later on due to SARS virus pandemic has severely affected the mental and physical health of every individual in Kashmir. But this is not everything, there are many other risk factors involved that have seriously impacted the heart health among kashmiri population and more so among younger age groups. Following are some detailed risk factors involved put forth based on theoretical as well as on practical grounds that can be accounted for this increased rate of heart attack and stroke in young population in Kashmir.

• Cardiovascular problems due to sedentary lifestyle/occupational life style changes

High blood pressure is a major risk factor for heart disease and if not controlled, can affect one’s heart and other major organs of body, including kidneys and brain. It is often called a “silent killer” because it usually has no symptoms. LDL (Low-density lipoprotein) or unhealthy blood cholesterol level build up in the walls of arteries, including those of the heart decreases the blood flow to vital organs the heart, brain, kidneys, and other parts of the body and in turn increase the chances of heart attack. As majority of Kashmiri population in addition to elderly group are suffering from cardiovascular problems and the cases have even increased in the past few years or so due to sedentary mode of life style adopted in wake of frequent lockdowns in Kashmir due to one or the other reasons. This factor could have contributed in significantly upregulating the heart attack cases in Kashmir. Further obesity is a new problem featuring young age population in Kashmir due to occupational life style changes which is linked to higher bad cholesterol and triglyceride levels and can inturn lead to high blood pressure and diabetes as well as heart disease. A sedentary lifestyle is another risk factor for heart disease and sitting is considered as another kind of smoking. A study published by the end of 2017 in the journal Annals of Internal Medicine has collected evidences that consistent and long period sitting is a risk factor for early death. According to the study, the more time one sits, the greater the risk for early death becomes.

• Obesity/Diabetes

Diabetes causes sugar to build up in the blood as we all know. Over time, high blood sugar damage blood vessels and the nerves controlling heart. Adults with diabetes tend to have heart attacks at a younger age and are more likely to experience multiple heart attacks if suffering from insulin resistance and/or high blood glucose levels. High blood glucose levels that aren’t easily managed can increase the amount of plaque within the walls of the blood vessels and can hinder the blood flow to heart and people with diabetes are also more likely to have other underlying medical conditions that raise the risk of heart diseases. Research says that the risk of death from heart disease for adults with diabetes is higher than for adults who do not have diabetes.  Diabetics are twice as likely to have heart disease or stroke as someone who doesn’t have diabetes. The longer one has diabetes, the more likely he/she can suffer from heart disease which increases one’s chances of attacks. I state that if India is the diabetic capital of world, Kashmir could be the same to India due to unexpected increase in the cases of diabetic patients in last decade or so and that too in young age population group due to abrupt life style changes Kashmiris have adopted over years for reasons not known to anyone. This medical condition can be a main contributing factor in the increased rate of heart attacks in valley in past few years.

• Chest ailments-Hookah/Cigarette smoking

Chest related ailments are most common in Kashmir due to extensive use of cigarette and hookah smoking and the case rate surges even more in winters in both young and elderly population groups. A quite chunk of population in Kashmir suffers from ESRD and COPD as a long tern result of addiction to hookah/cigarette smoking. As Chemicals in cigarette/tobacco smoke causes the cells that line blood vessels to become swollen and inflamed. This narrows the blood vessels and can lead to many cardiovascular conditions which inturn makes a person susceptibe to heart attack and stroke. Research has found that smoking damages the heart and blood vessels very quickly, but the damage is repaired soon if one quits smoking and rapid health improvements have also been seen even in long term quitters. Within a year, heart attack risk has been found to drop significantly and within five years, most smokers can cut their risk of stroke to nearly that of a nonsmoker. So smoking has a direct relation to increase in chest related diseases which in turn increases one’s chances of cardiovascular diseases and heart attacks. 

• Stress and Depression

Studies have shown that people with depression develop heart disease at higher rates than the general population and can lead to a number of changes in one’s body that increase the risk of having a heart attack. Too much stress and depression for long periods together can elevate blood pressure and the chances of heart attacks. Depression raises the levels of C-reactive protein in body which is a marker for inflammation and it’s higher than normal levels have been found to predict heart health. Over the years and in particular from last 2-3 years, the depression and stress levels have significantly increased among the majority of younger age population in Kashmir due to certain factors that are associated with their jobs, land, property and even to fundamental rights of existence and the insecure sustainability due to various political and demographic changes that has swept valley from past few years have further worsened the situation and increased the stress levels. This is probably the most contributing factor among all that has increased the rate of heart attacks in valley in heart healthy persons who otherwise are free from ailments that increase the chances of attacks. Normally, body’s response to stress is to protect one from associated damage. But, if it’s constant, it is harmful to body. Studies have suggested that the high levels of cortisol released in body in response to long-term stress increases blood cholesterol, triglycerides, blood sugar, and blood pressure which are the common risk factors for heart disease and can also cause changes that promote the buildup of plaque deposits in the arteries. These changes in tandem increase ones changes of getting a sudden heart attack.

• Drug abuse

Illegal drugs use has adverse cardiovascular effects ranging from abnormal heart rate to heart attacks. Drug injections lead to cardiovascular problems, such as collapsed veins and bacterial infections of the blood vessels and heart valves. Drugs such as cocaine, heroin, cannabis and various forms of amphetamine, affect the central nervous system and impacts consciousness. Further excessive alcohol intake is associated with the increased risk of hemorrhages in the blood vessels of brain. Alcohol abuse further leads to cardiomyopathy and is also associated with the increased risk of high blood pressure and is a potentail risk factor in the development of hypertension. Off late, from past few years, quite lot of adult and young age population group have turned to substance abuse and could be contributing as potential risk factor in increased rate of heart attacks/stroke in Kashmir.

Take-home message

We all know that heart disease is dangerous. If not treated fully, it can be prevented first hand in many cases. Everyone must work to maintain a heart-healthy lifestyle, but those who are at increased risk must be extra cautious to keep themselves in check so as to prevent any untoward incident of heart attack or stroke. Few things and routine activities can greatly help maintaining a heart-healthy lifestyle and to keep one away from potentail threat of heart attack.

• As it is currently winter in Kashmir, people must avoid early morning walks so that it does not affects their heart health.
• Exercising regularly, taking in healthy diet and maintaing a healthy weight can help a lot.
• People must avoid stress, smoking and drug abuse to prevent emergence of heart related ailments.
• Following and maintaining a normal blood pressure, decreasing bad cholesterol levels and keeping blood sugars in control are necessary things to check in regularly and for this medication can help greatly.

The author is doctoral scholar and working as Senior Research Fellow (DST-INSPIRE) at CSIR-Indian Institute of Integrative Medicine Jammu. Feedback at [email protected]