"Indians are facing an acute health crisis with cardiac concerns escalating. One out of every four heart attacks are occurring among people below 45. Is Covid the culprit? How to reduce the risk by being fit? Host Kiran Somvanshi speaks to Dr. Nihar Mehta, leading Interventional Cardiologist and leading pharma experts from Lupin, Sidharth Srinivasan, CEO (Digital Health) and Sourabh Agrawal, Senior Vice President - Sales and Marketing (Lupin Limited) as we seek answers to a growing. Tune in to the episode to know more on how to take care of your heart. 

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This is an audio transcript of The Morning Brief podcast episode: World Heart Day Special: India's Dil Ki Baat

BG 0:01

This is the morning brief from the economic times

Kiran Somwanshi 0:12
did you listen? We need to listen to this. And quite literally so no, this is not Valentine's Day episode is the World Heart Day. And it's quite a special day for us Indians. Why? Because even though we are 5th of the world's population, India accounts for 60% of the world's heart disease burden. Do you know we South Asians are genetically more prone to suffer from heart diseases than others in the world. In fact, the rate of heart disease among Indians is double that of the West. And when we talk about heart attacks, they start at a much younger age for us.

BG 0:58
In the West, patients get heart attacks on an average at the age of 65. In India than average we've seen heart diseases around one decade earlier.

Kiran Somwanshi 1:09
According to Indian Heart Association, around half of the heart attacks in Indian men occur below the age of 50 years. And 25% of these attacks occur before the person turns 40. This is not to say that Indian women have it any easier.

BG 1:26
In India, we realize woman death rate for heart disease twice of that of men than the prevalence is equal.

Kiran Somwanshi 1:34
And for a heart patient, getting the right doctor is a challenge

BG 1:40
We have all of perhaps 7-8000 interventional cardiologists for a country of 1.4 million people, but almost 300 million people have the risk of heart disease.

Kiran Somwanshi 1:51
And if you thought the problem is only with our genes and our healthcare system, wait

Sourabh Agrawal 1:57
on an average Indian diet has around 10 grams of salt and the recommendations close to four to six grams.

Kiran Somwanshi 2:03
It's Thursday 29th of September from the economic times I am your host Kiran Somwanchi and today on the World Heart Day, we discuss India's Dil Ki only on the morning brief. In today's episode, I speak to Dr. Nihar Mehta who is a consultant cardiologist at Jaslok hospital and a few other hospitals in Mumbai. Mr. Sourabh Agarwal, senior vice president sales and marketing at pharma company Lupin and Mr. Siddharth Srinivasan CEO of Lupin digital health will look into the growing incidences of heart diseases in India. Why being fit and exercising is not enough the latest trends in cardiology and how can cardiac treatment become more accessible and affordable

BG 2:59
Mashoor singer KK ka acchanak nidhan ho gaya hai bataya ja raha hai ki unki maut heart attack ki wajah se hui hain

BG 3:07
Jani Mani Car Company BMW India ke mukhya Karyakari Adhikari Yanni CEO Rudratej Singh ka dil ka Dora padne se nidhan hua tha bies April ko.

BG 3:17
A comedian Rajesh Shrivastav died today in Delhi over a month after he had suffered a cardiac arrest while he was working out in the gym. He was on the treadmill.

Kiran Somwanshi 3:27
Right from celebrities, to CEOs from marathoners to the Aam Aadmi, younger and apparently fit people dying of heart attacks is no longer a surprise. I spoke to Dr. Mehta about how he sees the situation day in and day out as a cardiologist. Thank you, Dr. Mehta for joining in you are welcome to the Morning Brief.

Dr. Nihar Mehta 3:53
Thank you so much.

Kiran Somwanshi 3:55
We are having this discussion of the World Heart Day. And we have been seeing increased incidences of you know, growing heart issues in the Indian population, especially among the young, among the apparently healthy people. How do you as a cardiologist see the trend?

Dr. Nihar Mehta 4:11
You're absolutely right. There are a lot of patients who are coming at a very young age with more and more severe heart problems. Indians are more prone to heart problems, because we are more prone to the risk factors of the heart problems. Now what do I mean by this that India is now the diabetic capital of the world, every one out of eight or 10 people is suffering from diabetes. And when we think about that diabetes is the foremost risk factor for heart disease. The second thing is blood pressure is even more common than diabetes. In India, close to around 25% of people suffer from high blood pressure in cities, which means one out of four people suffer from high blood pressure additional to that smoking, stress, obesity, less physical activity. These are all additional risk factors, which you know, all of us are, are sort of culprits of when this whole sort of milieu of risk factors comes in, that comes in at a very early age. And in India, we see something called the prematurity of heart disease. When we talk about heart attacks, they start at a much younger age, around 50% of the heart attacks we see are below the age of 40-45, and 25% are below the age of 40. Which means that so many of the people who we see in the age of 30/35/40, come to us with a massive heart attack. And that is a really astounding demographic, you know, so it really something to worry about.

Kiran Somwanshi 5:49
But that means something like exercising or living an active life, isn't that enough to kind of, you know, or control this.

BG 5:58
In general, it's really very important to lead a healthy lifestyle, which includes taking care of your health and your diet, you know, making sure you're eating enough fruits, veggies, salads, nuts, cutting down on the red meat on fried and fatty food, things which are junk food, processed food. And it's also important to make sure that you're not physically inactive. So you may be being thin doesn't mean you're fit. So even a person who is not overweight still needs to exercise and needs to regularly do some kind of aerobic activity for around 30 to 45 minutes a day, because lack of physical activity itself is a risk factor. Now having said this, if someone is following all this, then why should they ever suffer from a heart problem, because there are other risk factors which will come into play, there are some things which are not in our control, like our genetics, our family history, sometimes we are just prone to getting these blockages, if our parents have had blockages, usually you would get them at a younger age. So when you have a mixture of all these issues, sometimes you can get a heart disease in spite of being healthy. But if you are healthy, the risks of having a heart problem are lower, and the risks of having a severe heart problem and lower.

Kiran Somwanshi 7:16
Right. And tell me something like during COVID We saw this and you know, post COVID How have you seen this, like we already are naturally predisposed. So how does COVID make it worse,

BG 7:28
as cardiologists what we've seen, the amount of people who had COVID, who actually died of heart attacks, or heart blockages was very high. Patients who had normal hearts ended up having weakness in their heart muscle because of COVID. So a young 30 or 32 year old would come to the emergency with a heart attack. And the next after we do the emergency procedure, we realize the next step Oh, they've turned COVID positive because COVID itself led to clots, blockages, thrombosis, a lot of cardiac problems all the way from clots in the heart to clots in the legs and clots in the lungs. So this was a really big problem during the COVID pandemic. After the COVID recovers, maybe a month, two months, three months later, people came back with heart problems, the incidence of blockages goes up, the incidence of heart weakness and heart failure goes up. Although this is not a very large number. But we do see a significant amount of people who after COVID have had either acceleration of their pre existing heart problems, or have started developing new heart problems later, you know,

Kiran Somwanshi 8:32
your grandfather was a cardiologist, a leading cardiologist and now it's you if you were to kind of compare your practice now and compare it with what your grandfather's practice was, you know, how have things changed.

BG 8:44
My grandfather was a physician and my father was a physician. And, you know, there is a very, very big difference between the way they practice and the way we practice. Now, when in my grandfather's era, there was no angiography, there was no angioplasty, when a patient had a heart attack, the treatment was bed rest for four to six weeks, lie on the bed and pray to God, because all they had was aspirin. Today, patient comes to the emergency within seven to 10 minutes, yes, they are taken to the cath lab, within around 60 to 70 minutes, the artery which is blocked is opened up this is called a Palmy, or a primary angioplasty in heart attacks. This whole procedure is done from the hand. So at the end of the procedure, they are ready to sit up they having a cup of tea and they say, oh, when can I go home and this is all within one or two hours of a massive heart attack. So the face of medicine has changed. I also think one more thing is very different is that the doctors today have to be far more accountable. They have to keep themselves updated really well because you know on an average. If you want to keep yourself completely updated, you need to read 16 to 19 articles every single day. Because that is how much medical literature is coming out. So it is still an uphill task for us as well, but in different perspectives.

Kiran Somwanshi 10:04
So ya things have changed. What are the latest digital mechanisms through which handling and tackling diseases easier. Now,

BG 10:13
I think a very, very important innovations have comes in terms of procedures. So there's been a new innovation called Tavi, I was trained in Budapest for this procedure. And it's basically a procedure by which you go from the leg, reach the heart, and open up your heart valve all via the artery in your leg, and the patient has is awake to the procedure, they're talking to you, the entire hardware comes out, and within an hour, the valve has changed. So this is just one. There are innovations in stent technology. There are innovations in pacemaker technologies, which are amazing. Now we have these pacemakers, which are, which are the size of a little bullet, and they go and reach in your heart. And that's all you need to maintain your heartbeats.

Kiran Somwanshi 10:58
So you know, it's a good, I think today being a heart patient is much better than probably 60 years ago. But on the other side, as a cardiologist, where do you feel that there are still unmet needs of the patients?

Sourabh Agrawal 11:11
The first unmet need, especially in India, is the financial aspect of it. Because while we have all these lovely therapies available to us, the finance of medicine sometimes is very hard on patients. Sometimes they don't have enough insurance, they don't have enough pension, they don't have enough savings. So that is something which really, you know, we need to look into our government needs to spend much more money on health care, especially to provide health care service to all taxpayers and all patients who are really needed because if you need a heart valve, which costs 15 to 20 lakhs, you know, you don't want to be in a position to say that, Oh, you know what, I can't afford this for my mother, she just has to accept it and die in a couple of years. And I think the second unmet need, which I think is also really important, is the faith that patients have on doctors and the relation that is there between doctors and patients, that is something which adds the heart back into the medicine part of treating patients that is a unique feature of India and Indian medicine. And I think that is getting lost in the commercial aspect of medicine. So this gap between patients and doctors in terms of the faith they have in terms of the relation that doctor and patient builds up, I think is a very important factor which should not get lost. When we talk about all these medicine advances. These are the softer aspects of medicines which are very important.

Kiran Somwanshi 12:40
Indeed, but when talking about the commercial aspect of medicine, one cannot really miss the role of pharma companies in the field of cardiology. The cardiac therapy market in India stands at over 22,000 crore rupees and is growing faster than the overall pharma market. Sourabh and Siddharth from Lupin give us a lowdown. Lupin is among the top three pharma companies in the Indian cardiology space. To begin with, I would like to know from you Sourabh as part of the pharma industry, how have you seen India's cardiac problem worsening?

Sourabh Agrawal 13:16
Thanks for asking this. In fact, it's a alarming situation, we have a unfortunate situation in India that we have among the highest population of people who are suffering from heart disease, if you look at in the market, it has been growing by a significantly higher proportion to that of the overall pharmaceutical market. So, if a market of drugs pharmaceutical grow by say 10% Then typically, hard care products or medicines in that category will grow by 12 to 13%. It only talks about the way it is spreading, and more and more younger people getting infected because of heart disease now, now, which is why the need for care is increasing.

Kiran Somwanshi 13:59
Siddhartht during the pandemic, we have seen the whole trend towards digitalization and people being aware and using all digital means, how digitalization has helped the cardiology therapy.

Sidharth Srinivasan 14:11
Overall, I think in time COVID, we've accelerated the acceptance of digital in healthcare right before even cardiac, I think where this entire space of digital therapeutics has really taken off is in diabetes. So I think taking a cue from diabetes, we've also tried to explore what can be done in the cardiac states, how can we partner with the cardiologist? Or how do we sort of complement their efforts? People are very, very poorly monitored. Even heart patients mostly end up taking readings, when they are experiencing some discomfort, or when they're actually having some pain. Periodic readings are hardly there with few people. And of course, these are not digitized, right? So even those who conscientiously take their blood pressure readings noted down in a piece of paper, there is no easy way For people to look at trends, you could look at a graph on your laptop screen, and you will be able to tell how the disease is progressing or how control is being. And that is something that we believe digital can do quite well make it easy for people to take readings and look at trends in a muchmore realistic way. We're also seeing the devices that are being used for these readings, becoming more consumer grade, more affordable, and more sort of multifunctional. So there are trackers now that also measure blood pressure, the first few devices got approved by the FDA, you have small strips that will actually take a six or even a 12 lead ECG sitting at home. So something that used to be used to sort of make a trip to the hospital, pay a good amount of money to take, that kind of tests can now be done from the comfort of your home. So I think there are multiple roles that digital is already playing. Going forward with more data, I firmly believe that digital will also acquire a predictive power. So build an algorithm and give it enough data to trade on and it will actually be able to give you a heads up in terms of what bite and I believe digital will then benefits.

Kiran Somwanshi 16:14
So our pharma company is looking at adopting digital and taking it to the market or is it the doctors demanding or is it the patient's themselves? Looking around and checking on Amazon and seeing okay, what is the latest divice? Let me try, like how does it work?

Sidharth Srinivasan 16:29
I think it's a happy coincidence that all of these three things are happening together. Pharma companies have been looking at digital for a long time. Firstly, when it comes to supply chain, because pharma companies have some of the most complex supply chain and therefore I think they've always managed that, like we were discussing, I think the entire COVID Wave has increased the acceptance significantly on both the patient and doctor side. And that's where we are seeing whether it's pharma companies, whether it's venture funded startups, a lot of folks attempting to do what would have been unthinkable, say two or three years back, which is can we take over a part of your entire treatment routine? Or can we add to the current standard of care?

Kiran Somwanshi 17:12
Yes, a bunch of health tech startups such as Tricog health, cardiac design, labs, monitra, health care, Jeevtronics, and Sun Fox are using technology to provide easy to use and affordable diagnostic and self monitoring devices in India. This makes me wonder Siddharth how digitalization makes healthcare affordable.

Sidharth Srinivasan 17:33
I think affordability will always be a theme in a country like India. So I think pharma companies have have done that consistently in terms of pain medication mode, affordable. Fundamentally, the job of digital is to democratize any sector, in this case, healthcare in a country like India, where we have all of perhaps 70,000 interventional cardiologists, for a country of 1.4 million people, but almost 300 million people have the risk of heart disease. It's extremely important that digital play the role of of enhancing or amplifying the reach of each specialist, and with young people with women specially being at risk, I firmly believe that technology will play a huge role in making it easier for people to sort of check in on themselves to take care of themselves and know how they're doing at any point.

Kiran Somwanshi 18:23
Right. So coming to Sourabh, you know, just wanted to understand like, anyway, having a heart problem itself is a is a pain. How expensive is it to kind of take care of your heart disease.

Sourabh Agrawal 18:36
Preventive is economical, always.

Kiran Somwanshi 18:41
Eat less food, eat less fatty stuff.

Sourabh Agrawal 18:42
So for that you don't need anything, you just have to follow the classical advice, either what your grandparents have been telling us for many years, or how we've seen our forefathers growing. Second is if you develop a risk factor, then take care of that well in time So if you have high blood pressure, which is diagnosed on time, if you have high cholesterol, which is diagnosed in time, and then you take care of that, well, it is fairly economical, expensive if that leads to a heart attack, or a heart failure, because that's when you get into a hospital, and hospitalization overall cost of treatment cost of stay loss of Days of work, mental trauma, all of it is a humongous cost. And that's where, you know, and when you ask Sidharth about Will it be cost effective and affordable? I think digital will play a huge role. Because when you are able to manage your disease Well, early, then you don't land up into a situation of hospitalization. Again, Re rehospitalization cost is way too high. It runs in lakhs, while the cost of treatment through pills along with that some of the new age digital therapeutics, platforms and services which are available. It significantly reduces the overall cost of a typical blood thinner will start from 70, paise, to not more than a 1015 rupee a tablet per day. That's it. That's the cost. So if you have to take in a month, if you're on a single drug, it will be 30 rupees, if you're not double drug monthly will be not more than 250 rupees. So that's the way cost of treatment is in India. Similarly, for blood cholesterol reduction, those products are also in the range of eight rupees to 12 rupees to 15 rupees a tablet per day, which is making it extremely cost effective.

Kiran Somwanshi 20:32
So, two things I want to know, kind of both on digital and non digital as well, Sourabh to you first, you know, how do you see the patient adherence of medication, especially a chronic one, like for normal acute one, we know that people just put up a pill and they're fine, and they forget about it. When chronic they can't really forget, but they still forget, how do you see that? How do you see the adoption rates?

Sourabh Agrawal 20:55
unfortunately, Kiran, I think we were poor discipline when it comes to health. And so it goes for chronic disease. So while everyone understand that these are lifestyle disease, and at best you can do is manage, so you have to manage your lifestyle, and you have to take the prescribed medicine timely, so that the disease does not progress. Unfortunately, despite of a lot of effort by pharmaceutical companies, public health initiatives and so on the adherence rate in India still poor and it is not cost which leads to this it is more behaviour, which is creating a barrier here. So, typically, if I look at heart disease patient, you know, if if somebody suffers a heart attack, you will be surprised to know that even people who suffer from heart attack for six months to nine months, so many of them stopped medicines, or dropped the medicine which are prescribed that

Sidharth Srinivasan 21:49
I think the nine month figure is 65%. So 31 in every three people actually giving up medication, because they feel fine.

Sourabh Agrawal 21:56
Imagine you've seen it so closely. Despite of that people do not take very basic product like blood thinners, cholesterol lowering drugs, the one which leads to chest pain reduction. And they fall back only to lifestyle which again, is not more than three, four months. And almost everyone returns to do what they were back. And that's the precise reason why in India, we have this growing. And it's not just India, I mean, adherence is not a problem just in India across the globe, health is not considered to be a good expense. Unfortunately, you may be ready to spend on a good restaurant or movie or entertainment probably not as much on health. Therefore, the discipline is poor. And therefore the efforts which are required have to be much lorge. Now I will give an example that four five years back in fact, we have we were the first company to launch Anya Chatbot. Over a period of time, we are seeing the traffic has gone up multi folds, we have more than three lakh patients interacting on this platform on a on a weekly basis. In fact, recently we realized that heart disease in women is increasing. And for that awareness we have taken Maricom on board to talk about women heart disease prevention. In India, we realize woman death rate for heart disease is twice as that of men. So and the prevalence is equal to as many women as men suffers from heart disease, but the treatment rates are half and therefore the mortality is doubled. And therefore with this campaign called Shakti. Lupin has done a lot of shaping work to make sure that women cardiac disease or heart disease is talked about. And then we at least contribute towards, you know, better health for women. And Maricom is, you know, helping us spread the awareness. So a lot of those initiatives keep happening. The needle is definitely moving. But we are not completely reached where we should. There is a long journey for us.

Kiran Somwanshi 23:56
Just to Sidharth the other question earlier, when we discussed on digital, you mentioned that it helps adherence and adoption. But I'm curious, like, does it really happen where a person uses a machine and you know, the fancy of that machine? Or early days is fine. But then as no one's progress? Does that machine keep him or her engaged? And you know, that commitment the way we have with the drug with the machine? Does it also remain?

Sidharth Srinivasan 24:20
So yeah, I think machines always look fancy on day one, right? And then and novelty sort of. But I don't think it's about the machine personally. I think one of the reasons why folks lose motivation, especially in something like, like heart disease is that there isn't a single metric that is a perfect proxy for the heart really. And therefore it's very difficult for people to know how well they're doing or how badly they do. If you're trying to lose weight, but you couldn't measure yourself on the weighing scale. How long do you think you would do it? And you will just stop because you have no clue what's happening. But if I'm able to tell you that you know what, Kiran, you've lost one kilo in the Last one week, and if I'm able to do a little bit of gamification, saying that your friends have, you know, lost one and a half kilo you know, so maybe you want to accelerate it. So digital can play that role of building community of creating some sort of reward. So I think the job of digital is essentially to make that journey of improving your heart health or improving your health. As interesting as many other things. One of the companies has made 10 credit card bills, very fascinating. I really don't see why we can't do that with heart, we can do a much better job.

Kiran Somwanshi 25:37
Yes, we all can do a better job, right from the healthcare system by bringing innovation and technology at an affordable price. The government by making doctors medicines and insurance universally available, especially to rural India. And of course, you and me by keeping the risk factors at bay, eating right and living an active life. Let me share with you the parting advice that I got from Dr. Mehta. On a closing note, a message from you on this world heart day about how to prevent heart diseases. If I today, I really want to prevent I don't want to go through all this, what should I do?

Dr. Nihar Mehta 26:15
Wonderful. I'll give you five tips, okay, which will help you to prevent heart diseases, and they are all related to the letter S. Number one is salt. Keep the salt content in your food down. Because salt is directly related to blood pressure and it plays a very big role in adding stress to your heart. India is a salt favorite country, we love to eat our salt and our salty stuff. Or an average Indian diet has around 10 grams of salt And the recommendation is close to four to six grams. So we have a lot of salt in our diet, cut down on all the excess salt. Number two is the S which is the sugar to try and keep the sugar content down. And by sugar I mean the carbohydrates which will reduce the risk of your obesity being overweight, diabetes, and even your cholesterols. So the second S is the sugar. The third s is stress. Keep your stress levels down. We are all faced with stress but you should learn ways to attack and stress the fourth S is sleep make sure that you're sleeping well. It's important to sleep well and sleep for adequate hours. You know seven to eight hours a day should be important sleep for us and not sleep which we are sleeping at two o'clock and waking up late in the afternoon. It should be sleep before midnight because that is the most restful sleep. And the last s is smoking. I think smoking is a very very important preventable risk factor for heart diseases. So if you follow these five S's, you should be able to keep your heart the risk factors for heart disease down so as salt, sugar, stress, sleep and smoking.

Kiran Somwanshi 28:02
So that's it for today. You have been listening to India's Dil Ki Baat with me Kiran Somvanshi on the morning brief. A big thank you to our guests, Dr. Mehta, Siddharth and Sourabh for the amazing insights and thank you for tuning in to this podcast brought to you by the team economic times. show producers Sumit Pande sound editor Indranil Bhattacharjee, executive producers Anupriya Bahadur and Urjit Barman. We hope you liked this episode. Do share it on your social media networks. The morning brief drops every Tuesday, Thursday and Friday. The morning brief is now streaming on Amazon Prime music and jio savan apart from Spotify, Apple and Google podcasts. And of course ET's own audio platform ET play. Do tune into ETplay our latest platform for all audio content. Have a great week ahead. All clips used in this episode belong to the respective owners credits mentioned in the description.

This transcript has been automatically generated. If by any chance there is an error please send the details for a correction to: themorningbrief@timesgroup.com We will do our best to make the amendment as soon as possible. 



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