Premature Heart Disease

• Most heart attacks in the US and the western countries occur among senior citizens (65 years and older). Heart disease is considered premature (early) when it is first diagnosed before age 65 in women or before age 55 in men.

• Of the 404,000 CAD (coronary artery disease) deaths in the US in 2007 only 19% deaths occurred in people <65 years of age.¹ Only 1% of deaths from heart attack occur among white Americans younger than 45 years of age.^{1, 2}

• Of all the deaths from CAD in India, 50% of deaths occur in people <50 years of age, 30% in people <40, and 14% in people <30 years of age.³ (See Tsunami of Heart Disease)

• Premature heart attacks are very common among Asian Indians. In general, heart attack develops 6-10 years earlier in Asian Indians than in other populations. Approximately 30% of heart attacks in men in India occur in very young Indians (under 40 years of age).^{1, 3, 4} For comparison, only 3% of the heart attacks occur among Americans younger than 45 years of age.²

• Heart attacks before age 45 is 5 to 10-fold higher among Indians than Europids and carry a high mortality.^5-10 In one Canadian Study, 49% of heart attacks occurred in South Asians <65 years compared to 31% in Chinese and 37% among white Canadians.¹¹

• The excess cardiac mortality in Asian Indians and South Asians increases paradoxically with decreasing age. For example, compared to Europids in the UK, CAD mortality is 3 times higher among South Asian men younger than 30 years of age and two times higher in those 30 to 40 years of age but only 50% higher in the older age group.^{6 12} Even Indian doctors die 15 years earlier than their white colleagues in the UK.¹³

• In Singapore, the CAD mortality among Indians <30 years of age is 10-fold higher than Chinese (see Heart Disease Singapore).^{9, 14}

• During the past thirty years, the average age of a first heart attack decreased by more than 10 years in India¹⁵ but increased by more than 10 years in the US and 20 years in Finland.¹⁶

• India is a young population with only 5% of the population >65 years of age. Of the 47 million Indians with heart disease in 2010, 60% are under the age 50, 37% under the age 40 and 18% under the age 30 according to the official estimates from the Government of India and the World Health Organization (WHO).¹⁷

• By 2015, India is projected to have 62 million patients with heart disease and 2.95 million annual deaths from this disease.¹⁷ An alarming 1.5 million of these deaths will be in people younger than 50 years of age.¹⁷

• Premature heart attack is particularly common in people with a family history of such disease and is often mediated through high levels of lipoprotein(a). It appears that Asian Indians have a national history of early heart disease mediated by lipoprotein(a) and shared by all South Asians.

• There is diversity within the South Asian subpopulations (Bangladeshis, Pakistanis, and Sri Lankans), with differing risk and disease patterns, including many without premature heart disease.

• For more information see classification of CAD, malignant heart disease, and severity of heart disease. 

Sources

1. American Heart Association Heart and Stroke Statistical Update2010.

2. Jolly S, Vittinghoff E, Chattopadhyay A, Bibbins-Domingo K. Higher cardiovascular disease prevalence and mortality among younger blacks compared to whites. Am J Med. Sep 2010;123(9):811-818.

3. Indrayan A. Forecasting vascular disease cases and associated mortality in India. 2010;http://www.whoindia.org/LinkFiles Sept 25,  2010.

4. Mammi MV, Pavithran K, Abdu Rahiman P, Pisharody R, Sugathan K. Acute myocardial infarction in north Kerala–a 20 year hospital based study. Indian Heart J. 1991;43(2):93-96.

5. McKeigue PM, Ferrie JE, Pierpoint T, Marmot MG. Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia. Circulation. 1993;87(1):152-161.

6. Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. Bmj. Mar 9 1991;302(6776):560-564.

7. Chaturvedi N, Fuller JH. Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes? J Epidemiol Community Health. 1996;50(2):137-139.

8. Hughes LO, Raval U, Raftery E. First myocardial infarctions in Asian and White men. BMJ. 1989;298:1345-1350.

9. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. Clin Cardiol. Mar 1995;18(3):131-135.

10. Khan NA, Grubisic M, Hemmelgarn B, Humphries K, King KM, Quan H. Outcomes after acute myocardial infarction in South Asian, Chinese, and white patients. Circulation. Oct 19 2010;122(16):1570-1577.

11. Gupta M, Brister S. Is South Asian ethnicity an independent cardiovascular risk factor? Can J Cardiol. Mar 1 2006;22(3):193-197.

12. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: Thoughts on pathogenesis, prevention,  and treatment. Clinical cardiology. 1995;18:131-135.

13. Wright DJ, Roberts AP. Which doctors die first? Analysis of BMJ obituary columns. Bmj. 1996;313(7072):1581-1582.

14. Enas EA, Yusuf S, Mehta J. Meeting of the International Working Group on Coronary Artery Disease in South Asians. 24 March 1996, Orlando, Florida, USA. Indian Heart J. Nov-Dec 1996;48(6):727-732.

15. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2010.

16. Enas EA, Jacob S. Decline of CAD in developed countries: Lessons for India. In: Sethi K, ed. Coronary Artery Disease in Indians – A Global Perspective. Mumbai: Cardiological Society of India; 1998:98 -113.

17. Indrayan A. Forecasting vascular disease cases and associated mortality in India. 2007;http://www.whoindia.org/LinkFiles Sept 25,  2010.