As Bollywood mourns the loss of Rituraj, the rare and brilliant talent, sadly (and surprisingly), his cause of death was not rare. Not really! 30% Indians in Rituraj’s age bracket (54-65) succumb to heart disease (& stroke).I am saying this with data, responsibility and respect, with an intent to wake you out of your slumber of the ‘kya-farak-parta-hai, ‘one-life-enjoy’, ‘death-is-destined’ attitude. Pardon the harshness.
As age-wise data in India is tough to get, I have used USA data to bring home the point. Here is what the mortality data says:
Atherosclerosis – cardiac arrest, heart failure, stroke – is the number one killer in India, killing 3 Indians every second. 45 lac Indians die every year of this.- Unlike popular wisdom, Atherosclerosis begins in the teens, and takes decades to manifest. When teenage soldiers’ bodies from War were autopsied, Atherosclerosis had begun.
- Death in the 25-34 age bracket is not trivial. ~7% deaths in this age bracket. It is not ZERO!
- At 35-44, it doubles to 15%. Post that it rises precipitously.
- Irony, it is a slow killer and compounds over time. The rate of compounding is a function of your lifestyle choices. Compounding is personal.
- 33% people face their first cardiac event as DEATH! They don’t get a second chance. Working in office, everything good, just had lunch and…game over…it is NOT sudden. It was compounding at work.
- A woman is 10x more likely to die of Atherosclerosis than Breast Cancer.
- After 45, the risk keeps growing. Rises to over 30% every decade. Know this: after 45, one in three Indians will die of Atherosclerosis.
- Good news: over the last few decades, we know almost everything there is to know about the pathology of Atherosclerosis (see below). And you can do a lot to reduce the risk.
How heart attack/stroke happens and why it takes decades to manifest:
There is no such thing as good cholesterol or bad cholesterol. All cholesterol is good. No cholesterol, no life. It is the ‘transportation’ of cholesterol + triglyceride inside a Lipoprotein that causes it (hydrophobic). Most dietary cholesterol cannot be used by the body. So eat your eggs. No problem there. But eat less sugar/junk.
Why?
The Lipoprotein (The last ‘L’ in LDL-C) that transports the Cholesterol (essential for life) and Triglyceride (sugar + processed food) together in the blood vessels often collide with the vessel surface (endothelial) ➡ penetrate it into sub-endothelial space ➡ get retained ➡ oxidizes ➡ dysfunction ➡ body sends soldiers to repair (monocytes) ➡ repair site keeps enlarging over years ➡ narrows the vessel ➡ obstruction ➡rupturing of the vessel ➡ clot ➡ blockage ➡oxygen robbed ➡Sudden death. Not so sudden right? Took years.
But we can prevent the No. 1 Killer:
- Age is the biggest risk. Know this.
- Take family history (parents, parent’s siblings, grandparents, their siblings). If the history of Atherosclerosis exists, you are at high risk. You must take action NOW.
- Measure your LDL-P (apoB) and Lp(a) and not LDL-C. LDL-C is not a predictor on its own. Only when concordant with high LDL-P or apoB.
- Your lifestyle is the biggest risk.
a.Smoking (weakens the endothelial)
b.Hypertension (weakens the endothelial)
c.Sugar/processed/junk food (increases triglycerides)
d.Exercise and movement (strengthens the heart, even enlarges it)
e.Sleep 8 hours every night, consistently, (betters heart health)
f.Stress (weakens endothelial)
Why die of something that can be prevented? Thrive. This is the best time to be alive.
That said, RIP Rituraj. Will miss you.
Author: Prashant Desai, Longevity Sherpa, Stanford School of Medicine (Nutrition Science, Exercise Physiology, Gut Health)
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