No single cause behind rise in sudden cardiac deaths, says medical experts’ group report

BENGALURU: A team of experts, led by, Dr K S Ravindranath, Director of Sri Jayadeva Institute of Cardiovascular Sciences and Research, will submit a report to the government on Monday regarding the potential link between Covid vaccination and heart attacks. The team, which includes technical advisory committee members, held a virtual meeting with the department’s principal secretary today to discuss the report.

The observational study conducted at Jayadeva Hospital did not find any association between premature cardiovascular disease and a prior history of Covid-19 infection or Covid vaccination. Most studies/reports published in the rest of the world also have not found any causal association between Covid vaccination and sudden cardiovascular events. On the contrary, Covid vaccination has been shown to be protective against cardiac events in the long term, the report said.

The investigation, which examined 251 individuals, concluded that Covid vaccination is not the cause of increased heart-related problems in young people. The committee has identified 20 key points related to the issue and will provide recommendations to the government on how to address the problem, it said.

Over the past four years, India has witnessed a significant rise in reports of sudden cardiac deaths (SCD), particularly among individuals below the age of 45. The report aims to provide clarity on the issue and guide the government’s response to the growing concern of heart-related diseases among young people.

A recent investigation examined 12 individuals under 30, 60 between 31-40 of age, and 172 between 41-45 years old, comparing their health conditions before and after Covid.

The report revealed significant increases in various health issues:

Diabetes: 13.9 pc before Covid, rising to 20.5 pc after Covid.

Hypertension: 13.9 pc before Covid, increasing to 17.6 pc after Covid.

Cholesterol: 34.8 pc before Covid, jumping to 44.1pc after Covid.

Smoking: 48.8 pc before Covid, rising to 51 pc after Covid.

Family History: 11.6 pc before Covid, increasing to 14.7 pc after Covid.

Obesity: 9.3 pc before Covid, rising to 11.7 pc after Covid.

A study of 251 patients revealed an age distribution of 12 patients under 30, 66 patients between 31-40 years, and 172 patients between 41-45 years. The majority of the patients, 218, were males, while 32 were females. Notably, 49.4 per cent of the patients (124 out of 251) were from Bengaluru city, with drivers and labourers being the most common occupations represented in the study.

As per the report, 87 were diabetic, 102 were hypertensive, 35 had cholesterol disorders, 40 had a family history of heart disease, 111 were smokers, and 77 patients did not have any of the conventional risk factors.

Nineteen out of 251 patients gave a history of previous infection with the Covid-19 virus. Of the 19, seven had diabetes, seven had hypertension, two had a family history and eight had no risk factors. In all, 249 out of 251 patients gave a history of vaccination for Covid infection — 53 received only one dose, 180 received two doses, and 17 received all three doses of vaccine. Of them, 144 received vaccination with Covishield, 64 with Covaxin and 52 were unaware of which they had received.

The investigation by the expert committee constituted by the Government of Karnataka highlights the growing public health challenge posed by the rise in sudden cardiovascular events, especially among young adults, although conventional risk factors such as hypertension, diabetes, dyslipidemia and smoking remain prevalent in a majority of patients.

There is no single cause behind the observed rise in sudden cardiac deaths. Rather, it appears to be a multifactorial issue, with behavioral, genetic, and environmental risks. While in the immediate post-covid phase, there is an increase in the incidence of sudden cardiovascular events due to a pro-inflammatory state, the same cannot be held to be true in the long term.

Importantly, large-scale, prospective, multicentric studies are needed to better delineate the long-term cardiovascular effects of both Covid-19 infection and vaccination, it said.

RECOMMENDATIONS

1. Establish a cardiac surveillance program & national registry for sudden cardiac deaths among young adults.

2. Autopsy-based reporting & registry for unexplained deaths in young adults.

3. Heart disease Routine heart screening at the school level (10th standard/15 years age): A detailed clinical examination for screening out congenital heart diseases or structural abnormalities and inherited rhythm disorders.

4. Overweight/obesity, hypertension, lipid disorders, & insulin resistance.

5. Public health campaigns regarding cardiovascular diseases, their causes, risk factors, early detection, and preventive diet and lifestyle changes.

6. Promote physical activity, smoking cessation, reducing screen time, reducing sugar and salt intake, adequate sleep, and tackling stress. (six S)

7. Research funding for large-scale prospective case-control clinical studies by a nodal agency like the ICMR to conduct a multidisciplinary collaborative study to study the long-term effect of both covid 19 infection and vaccination.