Controlling risk factors such as smoking and obesity and a focus on exercise are among the most important methods to help Indians manage heart disease, according to a new study that for the first time included a large number of Indian subjects.
The findings, while in line with similar research carried out in western nations, is significant since it reaffirms how global focus areas are equally relevant to India.
“There were some 5,000 heart disease patients studied for this trial that was on since 2012, and about 20% of the patients were from India, which makes the result very applicable to Indian population. This is the first time such a huge number from India participated in an international trial that makes it safe to say the results have never before been this relevant for Indians,” said Dr Balram Bhargava, director general, Indian Council of Medical Research (ICMR).
Dr Bhargava, as professor of cardiology at the All India Institute of Medical Sciences (AIIMS), Delhi, was the national leading investigator for the study— ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) that was presented during last week’s American Heart Association conference in the US.
Of the 5,179-patients recruited for the trial from about 30 countries, 941 were from India.
The other top sites belonged to China, UK, US, Brazil, Poland, Spain and Russia.
“Apart from controlling the risk-factors, which is a must, strict follow-ups with the doctor, and strict drug compliance will ensure cases of heart patients with severe but stable conditions not need any invasive treatment such as putting in a stent or a heart bypass,” said Dr Bhargava.
Stable conditions would include cases such as were patients have a “stable angina” (chest pain), which does not get affected by day-to-day activities such as climbing stairs.
The researchers also plan to start a long-term follow up of these patients to see how many of those stable patients would actually need a surgery or a stent as an emergency procedure later in life.
“There is enough data for us to start long-term follow up of these patients to know how many survived without any invasive intervention. It will be a telephonic follow up that is likely to begin in December,” said Dr Chandini Suvarna, scientist at AIIMS, who is also a part of the study.
For emergency cases, such as those patients having a heart attack or unstable angina, stents and by-pass surgery is still the live-saving treatment protocol.
“This study has put things to perspective in the Indian context, and confirmed what the medical fraternity believed that there’s not always need to put in a stent or conduct a surgery. A patient can be observed while being put on optimal medical therapy and made to undergo lifestyle modifications. However, it’s not true for all patients. The doctor needs to take a call on this,” says Dr Praveen Chandra, chairman, Interventional Cardiology, Medanta.