Data suggest 20 deaths in 30 days is not anomaly compared to Karnataka

“The incidence in Hassan seems to be more or less the same as what is known to be the incidence across the state. Some of the deaths are unconfirmed heart attack deaths because there has been no investigation or post-mortem,” Dr K S Ravindranath, the director of Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR) in Bengaluru, said. Dr Ravindranath heads the five-member panel constituted by Chief Minister Siddaramaiah to probe the Hassan heart attacks.

Government hospitals in the Bengaluru city region have reported 2,599 deaths due to heart attacks between January to May, an average of around 520 per month.

At SJICSR, a premier government heart hospital in Bengaluru, 119 heart attack deaths were recorded from January to June this year, with 21 deaths being reported in June, according to data from its medical records department.

In the Kalaburagi district, where the SJICSR has a facility, 95 deaths were recorded between January and May, with 23 of these being reported in May alone, according to hospital data.

In most of the Hassan deaths, no post-mortem was done, and there is no clinical history, Dr Ravindranath said. “We have asked for the details on whether any ECG has been done, whether they have seen a doctor, whether the death occurred at home or in transit, whether it is documented, etc. There are many things that are not clear. Sometimes the media and television hype the deaths. We do not know if they have really confirmed the causes,” he added.

“Now we have sent a proforma to the DHO (district health officer) and officials, and they are going about collecting the data of the dead. They are gathering data on the patients, like their medical history for obesity, cholesterol, diabetes, usage of tobacco, alcohol or any recreational drugs. We have also asked for associated things like genetics, family history and use of medications for any infections, lifestyle factors and indulgence in crash diets,” he added.

The expert panel needs to conduct a verbal autopsy since the deaths occurred some time ago and has to determine from family and close relatives whether patients had complained of chest pain, for how long, and the treatment received. “We are trying to find any indirect evidence to establish the deaths were in fact caused by heart attacks,” Dr Ravindranath said.

“The incidents in Hassan look coincidental and not unusual. It needs further investigation to find the real reasons,” said K S Subramani, professor of cardiology at the SJICSR in Bengaluru.

Media reports spark furore

The heart attack deaths in Hassan came into the limelight after local television channels began claiming that the deaths spread across age groups—including some young people in their teens and early 20s—were an unusual phenomenon. The media reports sparked a furore, leading to a large number of people gathering for check-ups at hospitals in some districts.

On Monday, Siddaramaiah ordered the constitution of an expert panel of doctors to study the deaths. “In the past month alone, in just one district of Hassan, more than twenty people have died due to heart attacks. The government is taking this matter very seriously. To identify the exact cause of these series of deaths and to find solutions, a committee of experts has been formed under the leadership of Dr. Ravindranath, Director of Jayadeva Institute of Cardiovascular Sciences and Research, and they have been instructed to submit a study report within 10 days,” Siddaramaiah said on X on Monday.

The committee had already been instructed in February “to conduct a thorough study on the reasons behind sudden deaths among young people in the state, and whether the COVID vaccines could have any adverse effects”, Siddaramaiah said.

In a political jibe directed at the BJP, the Karnataka chief minister also said that “it cannot be denied that the hasty approval and distribution of the Covid vaccine to the public could also be a reason for these deaths, as several studies worldwide have recently indicated…”.

In a rebuttal on Tuesday, the Indian government stated that the matter of sudden unexplained deaths has been investigated by the Indian Council of Medical Research and All India Institute of Medical Sciences and “have conclusively established that there is no direct link between COVID 19 vaccination and the reports of sudden deaths in the country”.

Post-COVID spike in deaths among youth due to heart attacks

According to Dr Rahul Patil, interventional cardiologist and head of the Premature Heart Disease Division at the SJICSR, who is in charge of a registry for heart attack deaths at the institute, there has been a spike in deaths among young people due to heart attacks in the post-COVID period in Karnataka.

“In terms of numbers, there is a nine to 10 per cent increase in heart attacks recorded in the Premature Coronary Artery Disease register when compared to pre-COVID and post-COVID. This is, however, a natural progression that we see for the incidence of any non-communicable disease in a large population,” Dr Patil said.

“There is an increase in heart disease, but what needs to be studied is whether there is also a proportionate increase in co-morbidities. We are also seeing that around 27 to 30 per cent of the population are getting heart attacks in the absence of conventional risk factors,” he said.

“In some of the very young heart attacks we are seeing, and which are discussed in the media, what we are seeing is that there could be a different category of causes. There could be congenital heart disease, structural heart disease or congenital rhythm disorders,” he said.

“One of the solutions that we have thought of is a very basic heart screening at the high school level for Class 10 students, consisting of ECG, Echo, sugar and cholesterol tests. This could help us bring down the sudden deaths to a great extent among the very young,” Dr Patil indicated.

“We also need a national registry for sudden deaths. Like any other diseases which are called notifiable diseases, the sudden deaths have to be made notifiable where they are reported. They have to be studied as a separate entity,” he said.

According to Dr Patil, the main cause for heart attacks among the young is still smoking, with nearly 60 per cent of heart attack deaths being linked to this. “Other than smoking, there is also insulin resistance. The insulin resistance syndrome is very common in the Indian population. For this, we are coming up with something called the coronary calcium scan, which can be done for persons from 40 years of age. It is like a mammogram where you can screen silent blockages,” Dr Patil added.

“One of the main reasons for the high incidence of heart diseases in India is the fact that insulin resistance is more in the Indian population. Indians are more genetically prone to heart diseases than the Western population because we are prone to insulin resistance. There are a lot of theories for this, and one is that this population has experienced famines, and as a result, the body has developed insulin resistance as a survival mechanism,” he said.

“If you are looking at urbanisation as a factor, then the major aspect here is the reuse of cooking oil. Food from outside involves a lot of reused oil. In most nuclear families, at least one meal is from outside these days,” Dr Patil said.

What a 2023 Lancet paper on cardiovascular disease said

According to a paper published in the Lancet Southeast Asia edition in 2023 on regional health titled ‘The burgeoning cardiovascular disease epidemic in Indians –perspectives on contextual factors and potential solutions’ by Anuj Kalra, Cardiovascular Institute, Kalra Hospitals, and others, heart diseases were responsible for 26.6 per cent of total deaths in India in 2017, compared to 15.2 per cent in 1990.

“The burden due to CVD [cardiovascular disease] in India is remarkably higher than what is being experienced at a global level. For example, the age-standardized death rate for CVD in India (282 deaths/100,000 (264–293)) was higher compared with global levels (233 deaths per 100,000 (229–236)),” the paper reported.

Heart disease-linked deaths also occur at a younger average age (53 years) in India compared to other populations (58.8 years), according to studies.

“While increased biological risk among Indians can be attributed to phenotypic changes caused by early life influences, six major transitions can be considered largely responsible for the population-level changes in India—epidemiological, demographic, nutritional, environmental, social-cultural and economic,” the 2023 Lancet paper pointed out.