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Heart

Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood flow. The plaque also can burst, leading to a blood clot.

Heart Attack​

‼️Wake up India: Epigamia co-founder Rohan Mirchandani, 42, died from a sudden cardiac arrest.

1 in 4 reading this in India will die of a disease of the heart (Atherosclerosis). 33% of these will experience their first cardiac event as ‘sudden death’ like Rohan Mirchandani or Ambareesh Murthy of Pepper Fry

Is Atherosclerosis really sudden? I lost my father (at 37) & my brother (35) to heart disease (not an attack). I am at high risk of the same. Thus, I have read a lot on heart attack + stroke. Here are some things every Indian must know:

  1. It is the no.1 killer in India & the world
  2. Atherosclerosis is ubiquitous & inevitable. You either die from or with it
  3. It starts in your teens (7% deaths) but takes decades to manifest
  4. Women are 10x more at risk to die from Atherosclerosis than breast cancer
  5. The medical world knows a lot about Atherosclerosis. We can delay it
  6. Your biggest risk = AGE
  7. We blame cholesterol but there is no such thing as good or bad cholesterol. No cholesterol = No life. Not more than 10% of dietary cholesterol makes its way into circulation

Then what causes it?🤨

Body makes its own cholesterol, some cells more & some less. Hence needs transportation to the ones that make less. It is the transportation of cholesterol and triglyceride inside a lipoprotein (both being hydrophobic) that starts the process of Atherosclerosis.

Every Lipoprotein vehicle that transports is wrapped with apoB. The number of vehicles = Lipoprotein/apoB is a predictor of risk. Sadly we measure weight as a risk. Wrong. The NMR technology that can detect apoB particles or LDL particles that predict the risk decades early is not available in India.

While travelling inside the blood vessel, apoB particles get stuck in the single layer endothelial and release oxidative stress. Body sends soldiers to fight➕repair the damage. The more damage (smoking/blood pressure/carbs/sugars etc) the more repair is needed. As the damage continues the repair process accelerates breaks open, and enters the blood vessel and body sends bigger tanks and aircraft to combat resulting in plaque, narrowing the blood vessel and restricts the flow of oxygen leading to heart attack or stroke

You can also see the blockage through the latest tech like CT scans

What can you do?

  1. Tests regularly. If you travel abroad, test for apoB/LDL-P
  2. If not, use LDL-C as a proxy. If high, bring it down. Speak to your cardiologist. Use medication like Statins or CPSK9 inhibitors.
  3. After age, big contributors = smoking & blood pressure.
  4. Exercise is the biggest weapon for heart health.
  5. Sleep for 8 hours. Under sleep even for 2 hours increases your risk of heart attack by 200%
  6. Eat less. Law of thermodynamics. All excess energy will be converted into fat (triglycerides). The more triglyceride, the more vehicles required.

5 Silent Causes of Artery Blockage​

20% of heart attacks happen in people with normal cholesterol and zero standard risk factors - perfectly fit, healthy people can still have arteries silently clogging.

Self-test - Capillary Refill Test: Press your fingernail until it turns white, release it, and count the seconds until it turns pink again. >2 seconds may mean circulation is already compromised.

  1. Genetics & family history - a parent or grandparent with artery blockage before age 55 means inherited risk that exercise can't fully override. Get a coronary calcium score (~₹4,000-5,000) to see actual plaque/calcium buildup in coronary arteries before symptoms appear; a score above 400 needs aggressive prevention.
  2. Insulin resistance - damages arteries daily even with normal fasting blood sugar and normal weight; ~25% of Indian adults have this without knowing it. See Insulin Resistance. Test: fasting insulin >10 μIU/mL or HbA1c >5.7% indicates insulin resistance even if blood sugar looks normal.
  3. Chronic inflammation - triggered by <5 hours of sleep (+30% arterial inflammation), AQI >300 (+20% heart attack risk even in healthy people), untreated gum disease (bacteria entering the bloodstream), and chronic stress/high cortisol. Test: hs-CRP (high-sensitivity C-reactive protein); >3 mg/L indicates inflammation that can damage arteries.
  4. Lipoprotein(a) [Lp(a)] - a genetic "sticky cholesterol" not covered by standard lipid panels; LDL and HDL can look perfect while Lp(a) is silently clogging arteries. ~20% of Indians have altered Lp(a) levels, raising heart attack risk 3-4x. Test: Lp(a) >30 mg/dL needs aggressive LDL lowering, possibly medication.
  5. Late detection - many wait for chest pain or breathlessness, but arteries are often already 70-90% blocked by then. ECG alone isn't enough for early detection.

Action plan: book fasting insulin, Lipoprotein(a), and hs-CRP tests to reveal hidden risks standard checkups miss; get a coronary calcium score if there's family history of early heart disease; maintain a heart-healthy diet, regular physical activity, and avoid smoking/tobacco.