What about insulin resistance and diabetes prevalence?
Indians develop diabetes 5 to 10 years earlier than the diabetics in the western population. Even non- diabetics have high insulin resistance, leading to increased risk for coronary artery disease.
Is there a higher prevalence of metabolic syndrome?
Central Obesity that is high waist circumference is high in Indians. The excess abdominal fat leads to insulin resistance. This ultimately leads to hypertension, dyslipidemia, and diabetes. This ultimately leads to increased risk for cardiovascular problems in young Indians.
Is there a inherited prothrombotic tendency?
Higher fibrinogen and PAI-1 levels make Indians prone to clot formation. This leads to higher rates of acute myocardial infarction.
Is there a difference in coronary arteries?
Indians have smaller coronary arteries then the westerners. With small plaque burden this leads to faster and more blockages. Westerners have more of focal stenosis making stenting easier. Indians have diffuse multi vessel disease requiring bypass surgery more often. Indians have higher coronary calcium burden at younger age, more non calcified soft plaques making them prone to plaque rupture and myocardial infarction.Indians have higher prevalence of left main and multi vessel disease.Indians more frequently have left main coronary artery disease associated with higher mortality and worst outcomes
Are there lifestyle and environmental factors?
High carbohydrates in diet is quite common. Traditional Indian diets are high in refined carbs and sugar, leading to insulin resistance. Deep fried foods and excess use of ghee are dangerous as they have high saturated fat intake
What about physical activity in Indians ?
Indians have low physical activity and more sedentary lifestyle than Western populations.
What about dietary habits in Indians?
Indians have a high carbohydrate and sugar that is refined leading to insulin resistance. Deep fried food and excess use of ghee increases saturated intake of fats. Indians have a low physical activity, lack of structured exercise leads to early development of coronary artery disease.
How do coronary arteries in Indians differ from the Western population.?
Coronary artery size is smaller in Indians, atherosclerosis pattern is diffuse, multivessel focal in western population. More soft plaques in Indians as against more stable plaques in western population. Left main CAD is more common in Indians. Acute MI risk high due to small arteries and high Lp(a) at young age. There is increased tendency for thrombosis due to increased fibrinogen.
What about higher stress levels and poor sleep quality!
Chronic stress and urbanisation increase sympathetic over activity. Poor sleep quality further increase cardiovascular risk.
Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.
