Coronary artery disease (CAD) also known as coronary heart disease (CHD) is no longer a bane for the old and rich segment of society. Heart disease does not differentiate. The fact that far more Indians live in rural areas and are increasingly adopting western lifestyle without having to migrate to urban areas coupled with high treatment costs and limited access to healthcare increase the overall burden of coronary heart disease in rural India than urban. It does not discriminate and can even strike in people at low risk so if you think you are not at risk for heart disease because you don’t fit the stereotype of an older man experiencing a massive heart attack (like we often see on TV) then you may have a false sense of security.  It is a potentially damaging condition which may affect a family member, a friend or you. Cholesterol containing deposits (plaque) slowly narrow the coronary arteries, causing your heart to receive less blood and oxygen. A blocked coronary artery can result in a heart attack. The heart receives its own supply of blood from the coronary arteries. Two major coronary arteries branch off from the aorta near the point where the aorta and the left ventricle meet. These arteries and their branches supply all parts of the heart muscle with blood.

Over the past decade or more, the prevalence of traditional risk factors for cardiovascular diseases has been increasing in India. It is not restricted to a niche strata of the society anymore rather has engulfed male/female, rural/urban, young/old - all sections of society.

The facts are alarming
?Cardiovascular disease is the number one cause of death worldwide causing 17.3 million deaths. Over 80 per cent of these deaths take place in low- and middle-income countries (LMICs).

• There are an estimated 45 million patients of coronary artery disease in India. Heart disease in India occurs 10 to 15 years earlier than in the West.
• Cardiovascular disease  – heart disease and stroke – is the biggest killer of women globally, killing more women than all cancers, tuberculosis, HIV/AIDS and malaria combined.
• Globally, in 2010 the number of overweight children under the age of five is estimated to be over 42 million. Close to 35 million of these are living in developing countries.

The ubiquity of smoking, lack of physical activity and obesity, Diabetes and hypertension which has been gradually escalating, and is thought to be the driving influence behind the epidemic of heart disease faced today. In fact, smokers are 30 to 40 per cent more likely to develop type 2 diabetes than nonsmokers. And people with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and with controlling their disease.  

 Of the risk factors, diabetes has a distinctive association with CVD:

• There are at least 50.8 million diabetics in India, which is the highest ever reported number from anywhere in the world according to International Diabetes Federation.
• Indians tend to be diabetic at a relatively young age of 45 years which is about 10 years earlier than in West.
• Cardiovascular disease accounts for about 60 per cent of all mortality in people with diabetes. The risk of cardiovascular events is from two to three times higher in people with type 1 or type 2 diabetes and the risk is disproportionately higher in women (58–60).  

Patients with diabetes have higher co-morbidities and more challenging anatomy as their arteries are smaller and often tortuous, with longer lesions & diffuse disease which results in a higher rate of treatment failures. It is a known fact that diabetics take longer time to heal in case of any disease or ailment.

Diabetic people have special needs and require special treatment. The ubiquity of smoking, obesity, diabetes, and hypertension which has been gradually escalating, and is thought to be the driving influence behind the epidemic of heart disease faced today. Of the risk factors, diabetes has a distinctive association with cardiovascular disease. This occurs because of damage to the circulatory system from elevated blood sugars along with high blood pressure and abnormal blood cholesterol and fat metabolism.  Adult diabetics are two to four times more likely to have heart disease or suffer a stroke than people without diabetes and about 65 per cent people with diabetes die from heart disease and stroke.  Indians have an increased susceptibility to diabetes which can be attributed to genetic factors as well as environmental factors. In addition to several features of urban life such as physical inactivity and unhealthy dietary practices, outdoor and indoor air pollution tend to increase the prevalence of diabetes and cardiovascular disease also in urban India The association between physical inactivity and obesity and the prevalence of diabetes has been established.

If a diabetic is diagnosed for a high risk of cardiovascular disease, an angioplasty is an effective and quick treatment to treat blocked arteries. Resolute Integrity is one of the US FDA approved drug eluting stents, which has also got specific approval for diabetic patient and is the most deliverable drug eluting stent with a powerful clinical performance across the patient spectrum.

The Resolute Integrity drug eluting stent offers several notable benefits – starting with outstanding deliverability, which means it is exceptionally easy to navigate the stent on the delivery system through the coronary vasculature to the narrowed arterial segment that requires treatment, as already mentioned the arteries of the diabetics may be more tortuous and smaller and therefore difficult to navigate through for the operating surgeon. Secondly its’ biocompatible biolinx polymer, which is used to bind the drug to the stent achieves an extended 180 days drug elution, thereby meeting the longer healing time requirements of the diabetic patients.

Medical care is essential once heart disease is diagnosed, with the goals of stabilizing the condition immediately, controlling symptoms over the long term, and providing a cure. According to The American Heart Association, it is recommended that you start getting your cholesterol checked at age 20, or earlier, if your family has a history of heart disease.  
(Author is director, Fortis Escorts Heart Institute, New Delhi)