Dr Bhaba Nanda Das is one of India’s most famous cardiac surgeons. He was the first person to perform a beating heart surgery in India. 
When we met him at 9 am at Indraprastha Apollo Hospitals, where he heads the department of Cardiothoracic & Vascular Surgery, he had already done two bypass surgeries—one on a 58- years-old and another on a 41-years-old man. As he came out of the operation theater, another 40- years-old patient was wheeled in. 

In between the two surgeries, he found time to talk about why coronary artery disease is becoming so common in India, why a lot of young people are falling prey to it, and what one can do to prevent it.  Excerpts…

What is the extent of coronary heart disease in India?

Heart disease, after cancer, is the second most common cause of death in this country. It is quite a worrying situation. Earlier, we would seldom see a patient in his 40s who would need any intervention—bypass or angioplasty for his cardiac problem, but now I perform at least two-three bypass surgeries every week on people around 40. These people may need two to three further interventions to keep them going till the age of 70. 

What is the reason for such increase in the prevalence of heart diseases in India?

Stress, I think, is the biggest culprit. People lead stressful life these days. Besides, smoking, sedentary lifestyle, diabetes, and a strong family history increase one’s risk of cardiac diseases. 

Children of people who suffer from coronary artery disease at a young age are susceptible to develop the disease at an even younger age. 

If people don’t take preventive steps, they might need to undergo surgical interventions as early as in their 30s. I feel sad when I say this because that’s the most productive age group, you have just started your family, you have small kids and any chronic disease can disrupt your life.

Who are more at risk—men or women?

Men are more at risk. Women are generally protected till the age of 50-52 because of their hormones, but now we get a lot of women patients as well. It could be because of a faulty lifestyle.

Can we reduce the incidence of heart diseases?

We can. The US has already done that. The incidence of coronary artery diseases in the US has come down dramatically  in the past few years. People there have changed their lifestyles—what they eat, how they exercise. They have made exercise an integral part of their daily routine. In America, a lot of  hospital employees come to hospital either walking or jogging. Many of them like to  have their shower at the hospital before they start their work. I have seen many women jogging during pregnancy.

On the contrary, in India, we don’t give any importance to exercise. We don’t teach our children the importance of healthy eating and exercise. And that’s the reason people are getting these diseases at such an early age. 

A lot of people tend to blame it on the bad genes that Indians are said to have. How justified is it?

Not only Indians, all south-east Asians are prone to have coronary artery disease at an early age. There are numerous studies to prove that. We cannot do much about genes, but we can still prevent diseases at an early age. If you are a diabetic and have a family history of coronary artery disease, if you smoke or lead a stressful life, you have to take precautions. It is as simple as that. 

Atherosclerosis – the hardening and narrowing of the arteries, which silently and slowly blocks arteries, putting blood flow at risk-- is the most common cause of heart attack. It  can start at an age of 15-20 years. The combination of atherosclerosis and diabetes is dangerous. 

Are we equipped to prevent the disease from progressing into a heart attack. When does one need an intervention?

We now have advance preventive medicine. In the mid-1990s, there were hardly 6 centers treating cardiac disease in Delhi, now there are at least 30.

When I was a student, we didn’t have many medicines to give to our patients. But now medicines have improved so much. If detected early, we can manage the disease with medicines only. 

I feel a complete health check up is a must at the age of 40 to give you an idea of your overall health.

Stress, I think, is the biggest culprit. People lead stressful life these days. Besides, smoking, sedentary lifestyle, diabetes, and a strong family history increase one’s risk of cardiac diseases. 

How do you decide between angioplasty and bypass?

A cardiologist, after a detailed assessment of the problem—the kind of stenosis you have, the number of blood vessels involved—take this decision. Stents are more popular and preferred method in most cases, but unfortunately the problem is quite severe in quite a lot of people, and they require surgical interventions.

Do people change their lifestyle after disease?

80 -85 percent people do change their lifestyle after they get the disease.

I feel that a large number of patients can avoid any intervention just by following a good lifestyle. Of course, it depends on the extent of stenosis-- 40-50 percent stenosis can be reversed by changing lifestyle in most cases. They are atherosclerotic plugs, and if you change your lifestyle, they may disappear. If stenosis is more than 70 per cent, an intervention may be required. 

How has technology revolutionised cardiac treatments?

I remember the night I did my first beating heart surgery. I was at AIIMS, when I got a call that a man was stabbed in his chest. It was in the middle of the night, the knife had cut the main artery going to his heart. We could not arrange the instruments and equipment to do an on-pump heart surgery and I was left with no other option but to perform a surgery on a beating heart. It was a matter of life and death. I never imagined that I would do a beating heart surgery in such circumstances. It has been around 25 years, this man is alive and healthy.

Now, I do it every day and technology helps me a great deal—better lightening, better magnifying glasses, sophisticated sutures, endoscopes which can tell us about the extent of stenosis. All this improves the outcome of a surgery. 

What do you prefer—a beating heart surgery or on-pump heart surgery?

Beating heart surgery is a solution for India as you don’t have to arrange a lot of sophisticated instruments that you need when you take assistance from a heart and lung machine.

You have stressed upon a stress-free life. How do you de-stress yourself?

It’s difficult to remain stress-free as a cardiac surgeon. We deal with blood vessels which are 1 mm to 1.5 mm in diameter. There is no scope for mistake as we are dealing with the life of a person. 

But I try to minimize stress. I pray every morning. Besides, a lot depends on your team and your hospital environment. If there is coordination and cooperation, stress goes down automatically. 

And what about your exercise…

It is walking in the corridors, the ICUs and wards of the hospital. Last year, my daughter gifted me a calories tracker which I wear all the time. I keep a track of calories I burn—at least 300—everyday.

This interview is produced by Healthpost Creative , our content and creative services studio,  and is promoted by Indraprastha Apollo Hospital, New Delhi, as part of its campaign to spread awareness about heart diseases in the run-up to  World Heart Day on September  29.