Dr RG WISEMAN PINTO
Heart disease has traditionally been regarded as a disease of older adults. However, recent years have witnessed an alarming rise in cardiovascular diseases among young people in Goa, India and other Asian countries. This disturbing trend has major medical, social, psychological and economic consequences, affecting individuals during the most productive years of their lives.
Studies on the causes of death in Goa, conducted by the author at Goa Medical College, have shown that cardiovascular diseases are the commonest cause of death. Increasingly, heart diseases are being diagnosed in young adults, with some cases resulting in sudden and unexpected death.
This article excludes congenital heart diseases seen in children and young individuals. Instead, it focuses on acquired cardiovascular diseases affecting the young, including coronary artery disease, angina, myocardial infarction (heart attack), myocarditis and cardiomyopathy. Cardiac arrhythmias and sudden cardiac deaths are also increasingly being encountered.
These diseases are now being seen with greater frequency in people between the ages of 20 and 40 years. Around 20 per cent of all heart attacks in Goa, India and other Asian countries occur in this younger age group, with males being affected more commonly. The impact extends beyond health, disrupting education, careers, employment and family life while imposing a significant economic burden on society.
The causes are numerous and often interconnected. Major risk factors include diabetes mellitus, hypertension, elevated blood lipids, obesity and a positive family history of heart disease. Lifestyle factors play an equally important role. The increasing consumption of fast foods, junk foods, aerated sugary drinks and red meat, together with smoking, vaping and narcotic abuse, significantly increases cardiovascular risk.
Modern lifestyles have further aggravated the problem. Sedentary habits, chronic stress, inadequate sleep, prolonged screen time and frequent weekend parties at nightclubs all contribute to poor cardiovascular health. The misuse of anabolic steroids and growth hormones to build muscular physiques, excessive gym workouts without proper medical supervision, post-COVID-19 effects and COVID-19 vaccinations have also been discussed as possible contributing factors in selected cases.
Other recognised causes include congenital anomalies of the coronary arteries, hypercoagulable disorders, antiphospholipid syndrome, coronary artery spasm, chemotherapy, radiation therapy and infections. Autoimmune diseases and endocrine disorders are also known to cause heart disease in young individuals.
Among all these causes, atherosclerosis accounts for nearly 80 to 90 percent of coronary artery disease. This progressive narrowing of the coronary arteries remains the principal cause of heart attacks.
Metabolic syndrome deserves special attention because it is particularly common among Indians and Asians. It consists of high blood pressure, elevated blood glucose, excess fat around the waist and high triglyceride levels. Individuals with metabolic syndrome are at substantially greater risk of developing cardiovascular disease at an early age.
Prevention remains the most effective strategy. Young people should adopt healthy lifestyles that include a balanced diet, regular physical exercise, adequate sleep, sufficient water intake, meditation, reduced stress and a calm, balanced way of life. The traditional Goan concept of a relaxed and healthy "susegad" lifestyle has considerable value in promoting mental and physical wellbeing. Smoking, alcohol, narcotics, fast foods, preserved foods and aerated sugary drinks should be avoided, while maintaining a healthy body weight is essential.
Health education must begin early. Schools, colleges, the media, government agencies, NGOs, panchayats, municipalities and clubs all have an important role in educating young people about cardiovascular risk factors and preventive measures. Regular health check-ups, blood investigations, electrocardiograms and other appropriate investigations should be encouraged, particularly among individuals with a positive family history of heart disease.
The author has personally diagnosed heart attacks in young individuals during post-mortem examinations. These included a gym instructor from South Goa, tourists visiting Goa, deaths occurring in nightclubs and young persons who suddenly collapsed on playgrounds and football fields. The author has also conducted post-mortem examinations on young boys who died due to Short QT Syndrome associated with a family history, highlighting the importance of recognising inherited cardiac disorders.
Sports medicine also requires greater attention. With modern sport becoming faster, more demanding and increasingly professional, athletes are exposed to greater physical stress. Whether in football or other sports, today's competitions demand exceptional speed, power, endurance, technique and split-second decision-making. Regular medical examinations, blood tests, ECGs and other appropriate investigations should therefore be mandatory for competitive athletes.
The government and concerned authorities must further strengthen emergency medical services by improving ambulance services, providing widespread first-aid training, establishing defibrillators at designated public places, developing cardiac ambulances and enhancing the training of paramedical personnel.
Artificial Intelligence is expected to play an increasingly important role in evaluating cardiovascular risk and predicting heart disease in young individuals. Advances in technology, combined with preventive healthcare, will improve early diagnosis and timely intervention.
The youth of Goa are among its greatest strengths. Protecting their cardiovascular health must become a public health priority. Through healthy lifestyles, early screening, public awareness and coordinated efforts by healthcare professionals, educational institutions, sports organisations and government agencies, many premature heart diseases and sudden cardiac deaths can be prevented.
(The writer is a Professor of Pathology, former Head of Department at Goa Medical College, former Dean of Goa University, and the current President of the Asian Society of
