Normally, there is a surge in the number of patients suffering from heart attack or stroke that are brought to Kashmir hospitals in winters. The incidence rate is almost twice as much in winter as in summer, and causes many more deaths in the season. Elderly people with underlying cardiovascular and diabetic conditions are prone to these attacks in winters when frigid temperatures constrict blood vessels and increase blood pressure. The blood in the elderly population group tends to be thicker and stickier with increased viscosity during extreme cold weather conditions, notably during chilla-e-kalan in the valley, which makes it easier to clot.
Even young and healthy individuals are brought to hospitals during winters with these conditions, many of them brought dead. As per doctors working at Kashmir hospitals, there are up to 53 percent more heart attacks in winter compared to summer. Research has shown that for every 2.9 degree centigrade decline in temperature, the number of strokes in the general population goes up by 11 percent, and may further go up to 30% in persons who are already at higher risk due to associated co-morbid conditions, like those with metabolic syndrome. This year, Covid-19 is an added risk factor, in Kashmir valley in particular in winters. The SARS-COV2 viral infection causes acute and severe inflammation, building up fat deposits in blood vessels which on dislodging can easily get stuck in heart and/or in brain, where they could potentially block the blood flow.
Moreover, flu in general acts as a risk factor in winter and lack of sunlight during winter leaves people Vitamin D deficient, which is associated with increased risk of dying from heart attack or stroke. People in winter as an adaptation consume more calories, building up bad fats, and consume more salty foods, which builds blood pressure. Extreme weather conditions also limit regular exercising and outdoor activities. A sedentary lifestyle may lead to increased chances of heart attacks.
This year, to everybody’s surprise, there has been a sudden surge and an unexpected increase in heart attack/stroke rates among the young population in Kashmir. Different theories are being put forth to account for this, but there is a general opinion that abrupt decrease in physical activity in the past two years, mainly due to back-to-back lockdowns imposed by the government in Kashmir, as also due to restrictions necessitated by the coronavirus pandemic, has brought everything to standstill and could be a potential contributing cause for this deadly surge in the valley. There is also no denying the fact that the abrogation of J&K’s special status, followed by the stress and anxiety due to Covid-19, has severely affected the mental and physical health of every individual in Kashmir. But there are many other risk factors involved. Following are some risk factors that can account for this increased rate of heart attack and stroke in the young population in Kashmir.
Sedentary lifestyle. High blood pressure is a major risk factor for heart disease and if not controlled, can affect the heart and other major organs of the body, including kidneys and brain. It is often called a “silent killer” because it usually has no symptoms. LDL (Low-density lipoprotein) or unhealthy blood cholesterol level build up in the walls of arteries, including those of the heart, and decrease the blood flow to vital organs. The majority of the Kashmiri population is suffering from cardiovascular problems and the sedentary lifestyle adopted in wake of frequent lockdowns in Kashmir is one reason.
Obesity. Obesity is a new problem among the young population in Kashmir due to lifestyle changes which is linked to higher bad cholesterol and triglyceride levels. This can lead to high blood pressure and diabetes, as well as heart disease. A study published towards the end of 2017 in the journal ‘Annals of Internal Medicine’ has collected evidence that long periods of sitting is a risk factor for early death.
Diabetes. Diabetes causes sugar to build up in the blood. Over time, high blood sugar damages blood vessels and the nerves controlling the heart. Adults with diabetes tend to have heart attacks at a younger age and are more likely to experience multiple heart attacks if suffering from insulin resistance and/or high blood glucose levels. High blood glucose levels that aren’t easily managed can increase the amount of plaque within the walls of the blood vessels and can hinder the blood flow to the heart. People with diabetes are also more likely to have other underlying medical conditions that raise the risk of heart diseases. Research says that the risk of death from heart disease for adults with diabetes is higher than for adults who do not have diabetes. Diabetics are twice as likely to have heart disease or stroke as someone who doesn’t have diabetes. The longer one has diabetes, the more likely he/she can suffer from heart disease. If India is the diabetic capital of world, Kashmir could be the same of India as there has been a significant increase in cases of diabetic patients in the past decade or so, that too in the young population.
Hookah/ Cigarette smoking. Chest-related ailments are most common in Kashmir due to extensive cigarette and hookah smoking. The case rate surges even more in winters in both young and elderly population groups. A big chunk of population in Kashmir suffers from ESRD and COPD as a long-term result of addiction to hookah/cigarette smoking. The chemicals in cigarette/ tobacco cause the cells that line blood vessels to become swollen and inflamed. This narrows the blood vessels and can lead to many cardiovascular conditions. Research has found that smoking damages the heart and blood vessels very quickly, but the damage is repaired soon if one quits smoking. Rapid health improvements have been seen even in those who quit after having smoked for many years. Within a year, heart attack risk has been found to drop significantly and within five years, most smokers can cut their risk of stroke to nearly that of a non-smoker. Thus, smoking has a direct relation to chest related diseases.
Stress and Depression. Studies have shown that people with depression develop heart disease at higher rates than the general population. Depression can lead to a number of changes in one’s body. Too much stress and depression for long periods can elevate blood pressure and increase chances of heart attacks. Depression raises the levels of C-reactive protein, which is a marker for inflammation, and higher than normal levels have been found to predict heart health. Over the years and in particular in the past 2-3 years, depression and stress levels have significantly increased among the majority of young population in Kashmir, due to issues of jobs, land, property and even fundamental rights of existence. The sense of insecurity due to various political and demographic changes has further increased the stress levels. This is probably the greatest contributing factor for heart attacks healthy persons who otherwise are free from ailments. Normally, the body’s response to stress is to protect itself from associated damage. But, if the stress is constant, it is harmful to the body. Studies have suggested that the high levels of cortisol released in response to long-term stress increase blood cholesterol, triglycerides, blood sugar, and blood pressure. These changes in tandem significantly increase the chances of a sudden heart attack.
Drug abuse. Drug abuse or addiction has adverse cardiovascular effects ranging from abnormal heart rate to heart attacks. Drug injections lead to cardiovascular problems such as collapsed veins and bacterial infections of the blood vessels and heart valves. Drugs such as cocaine, heroin, cannabis and various forms of amphetamine affect the central nervous system. Excessive alcohol intake is associated with increased risk of haemorrhages in blood vessels of the brain. Alcohol abuse further leads to cardiomyopathy and is also associated with increased risk of high blood pressure. In the past few years, quite a lot of adult and young population has turned to substance abuse, which could be a contributing factor in increased rate of heart attacks/ strokes in Kashmir.
Lessons to learn
We all know that heart disease is dangerous, but it can be prevented in many cases. Everyone must work to maintain a heart-healthy lifestyle, but those who are at increased risk must be extra cautious. A few routine activities can greatly help in maintaining a heart-healthy lifestyle:
In winter in Kashmir, people must avoid early morning walks.
Exercising regularly, taking a healthy diet, and maintaining a healthy weight can help a lot.
Avoid stress, smoking, and drug abuse.
Maintaining normal blood pressure, decreasing bad cholesterol levels, and keeping blood sugars in control are necessary, and for this medication can help.

—The writer is a Senior Research Fellow (DST-INSPIRE) at CSIR-Indian Institute of Integrative Medicine Jammu. [email protected]

Sheikh Umar Ahmad