Dr K. K. Aggarwal
Padma Shri and Dr B C Roy National Awardee
President, Heart Care Foundation of India
Wild animals do not get heart attack, blood pressure, diabetes or stroke. These are all lifestyle disorders. But they can occur in a lion caged in a zoo, a rabbit in a laboratory or a pet dog in the house.
The biggest challenge, therefore, in cardiology internationally is – how to prevent getting lifestyle diseases including heart attack.
Most lifestyle disorders are linked to abdominal obesity which is the latest epidemic in the society in the west and is also becoming an epidemic in urban India which is now gradually shifting to middle class. It is linked to eating white sugar, white rice, white maida and not exercising.
The other challenges at an international level in cardiology involve safer alternatives for surgery and angioplasty. Today, most angioplasties with stenting and bypass surgeries last 6-10 years. We want such procedures to last lifelong, obviously with control of risk factors. Stents are needed which can be resorbed completely.
A large number of patients die because cardiac transplant facilities are not available in many countries, especially the Asian countries. Every country should have all transplants friendly laws so that any patient who dies in an accident with death of brain but living heart ends up as a heart living brain dead donor. In India, thousands of patients die every year for want of a heart donor.
Diastolic dysfunction, heart failure and atrial fibrillation are other new epidemics of the society. In diastolic dysfunction, the heart does not relax properly and leads to breathlessness on exertion. It is again linked to obesity. If not treated in time, it ends up in the enlargement of the left smaller chamber of the heart called left atrium. This over a period of time gets enlarged and ends up into new epidemic of the society called Atrial Fibrillation where the heart beats are irregularly irregular. This is the commonest cause of paralysis in elderly age group.
Most of the lifestyle disorders are also linked to eating high salt diet and/or a diet high in transfats. Every country must come out with its policy and guidelines in which they must restrain various restaurants and hotels from using trans fats in their food and limiting the content of salt in their dishes.
They are also challenges for cardiologists. A cardiologist must practice what he preaches. A patient will not listen to the cardiologist if he ( the cardiologist) is overweight and has abdominal obesity, drinks excessive alcohol or smokes.
Cardiologists internationally also face legal threat. Most of the law suits in the west are on cardiologists, especially linked to the need of putting a stent or doing bypass surgery. Clear cut guidelines should be laid down and an impunity should be given to doctors, if they follow those guidelines.