Are the young really young at heart?

Few days back, in his birthday party, bollywood famous Shahrukh Khan said that age is just a number. In his 42nd birth SRK can say this. He has built up a Bruce lee style body with regular exercise and by nutritious diet. But is it true for all young just 40?
Heart disease has since time immemorial been considered a disease of the middle aged and the elderly. But contrary to popular belief and recently proven by some extensive data, the young are not immune to heart disease and its complications.
Traditionally heart disease has been divided into broad categories of congenital and acquired heart disease. Congenital heart disease can present as simple structural heart defects like ASD and VSD (hole in the heart) or PDA (extra connection in the heart) or certain forms of complex structural defects which affect the newborns survival drastically like tetralogy of fallot (TOF) and transposition of great arteries (TGA) which lead to mixing of pure and impure blood in the heart.
Congenital defects can also affect the electrical conduction system of the heart (e.g congenital complete heart block) which may require a pacemaker to be put in a tiny heart for proper generation of electrical pulses. The reported incidence of CHD is 8-10/1000 live births according to various series from different parts of the world.
Acquired heart disease in the young is mainly of two types, Rheumatic fever / Rheumatic Heart Disease (RHD) and Coronary Artery disease (CAD).
Rheumatic fever is characterised by group A streptococcal (a form of bacteria) infection in early childhood which leads to multisystem involvement in a child with the most dreaded sequelae being rheumatic heart disease.
RHD manifest as progressive leakage and narrowing of the heart valves leading to significant reduction in life span. This type of heart disease can be curtailed best by primary prevention i.e. adequate maintenance of hygiene and preventing overcrowded surroundings which prevents the infection from spreading from person to person. Timely treatment of streptococcal sore throat is of utmost importance to nip the disease in its bud.
Though CHD and RHD have been known to plague the young for many decades, it is the burgeoning incidence of atherosclerotic coronary artery blockages which have afflicted the young (especially less than 40 years) in a big way.
It is not very uncommon these days to see youngsters in the age group of 25-35 years presenting to hospital with complaints of angina and in its severe form, acute heart attacks with some youngsters even succumbing to sudden cardiac death even before reaching any sort of medical help.
Especially in Bangladesh and in the Indian sub continent, the risk of CAD is 3-4 times higher than that of white Americans, 6 times higher than Chinese and 20 times higher than Japanese.
CAD also affects Bangladeshi 5-10 years earlier than other communities. Incidence of CAD in young is 12-16% in our country compared to 5% of young western population. In Bangladesh itself, prevalence of CAD is two times higher in urban than rural. The vulnerability of urban young to CAD is possibly related to different nutritional, environmental and lifestyle factors.
Newly acquired affluence is associated with a sedentary lifestyle and higher consumption of salt, smoking, alcohol and saturated fats. These factors make the young prone to develop traditional risk factors of CAD like obesity, hypertension, dyslipidemia and diabetes mellitus at an early age.
Therefore to detect CAD in young there has to be a high index of suspicion. Symptoms in any remote way resembling CAD symptoms like chest pain and breathlessness should not be ignored especially in those with risk factors. Risk factor evaluation must start earlier. There should be a lower threshold for prescribing investigations like treadmill, stress echo, Myocardial Perfusion imaging and coronary angiography.
More than anything else it is extremely imperative and important for the young to be aware themselves of the lurking dangers of CAD which in time can turn out to be the biggest epidemic we have faced yet.
So, take care of your heart. Do regular exercise, eat more vegetable, avoid stress. Quit smoking, avoid fat containing diet, and say like SRK that age is just a number.
The writer is an Assistant Professor of Cardiology at BSMMU and Fellow-Interventional Cardiologist of Max Heart & Vascular Institute, New Delhi, India.