Interventional cardiologist Dr. P. Manokar highlights the strategies India needs to implement to reduce the incidence of coronary artery disease (CAD). While CAD rates are declining in Western countries, they are increasing in India.
Coronary Artery Disease (CAD) is the most pressing health crisis India faces today, according to Dr. P. Manokar, Senior Consultant in Interventional Cardiology and Clinical Lead of the Heart Failure & Transplant Program at Kauvery Hospital in Chennai, Vadapalani. While CAD rates are declining in Western countries, they continue to rise in India. On World Heart Day, themed “Use Heart for Action,” Dr. Manokar emphasizes the critical strategies India must adopt to reduce the incidence of coronary artery disease.
Risk Factors for CAD
“High rates of diabetes are the primary risk factor in India. Unlike in other countries, diabetes in India is more aggressive, affecting younger individuals and even those with a lean physique,” Dr. Manokar explains. “We are the highest-risk population globally for CAD, and diabetes plays a significant role in this.”
While a family history of heart disease is a significant risk factor, psychosocial stress also plays a crucial role in the development of Coronary Artery Disease (CAD). Many patients experience a coronary event following a stressful life event, such as job loss, financial difficulties, or marital issues. Additionally, a sedentary lifestyle and unhealthy habits contribute to the risk of CAD, while alcohol consumption can serve as an indirect risk factor, particularly among diabetics.
Diagnosis
The first step in diagnosing CAD is clinical evaluation. The treadmill test is the most reliable tool for ruling out heart disease. Dr. Manokar recommends that individuals over 40 undergo a treadmill test every two years, while those with diabetes should have it annually. When used judiciously, a CT Angiogram serves as a dependable diagnostic test to confirm or rule out CAD.
Treatment Options
Cardiologists advocate for lifestyle changes as the initial approach to treating CAD. Patients are encouraged to lose weight, engage in regular exercise, and adopt healthier dietary habits. This is typically followed by medication to manage risk factors such as diabetes, blood pressure, and high cholesterol. Depending on their condition, patients may be prescribed blood thinners, cholesterol-lowering medications, or drugs that enhance blood flow to the heart. If these measures are insufficient, invasive treatments like angioplasty may be considered.
Angioplasty
Balloon angioplasty, or percutaneous transluminal angioplasty, is a minimally invasive procedure that employs a small balloon to widen narrowed or blocked arteries. Recent advancements in angioplasty techniques have significantly improved patient outcomes.
Percutaneous Coronary Intervention (PCI) involves inserting a drug-eluting stent into the artery to clear blockages, allowing for unobstructed blood flow while the drug prevents stent rejection by the body.
In cases of persistent calcified plaque in the arteries, Rotablation Angioplasty is performed, where a catheter with a rotating burr is used to grind away plaque and widen the artery. Orbital Atherectomy (OA) is another advanced minimally invasive technique that removes plaque from artery walls, often used to prepare calcified plaques before PCI or peripheral interventions. Intravascular Lithotripsy (IVL) employs acoustic pressure waves to break up calcium deposits in the arteries. Laser Coronary Angioplasty uses laser technology to treat CAD. Interventional cardiologists may also use a retrograde technique to address chronic total occlusions (CTO) by guiding a wire into the artery beyond the blockage. Today, technically advanced angioplasty methods can effectively manage a wide range of complex blockages and heart conditions.
