<p>Heart disease is one of the commonest causes of death, disability and lost hours at work in most communities. <br /><br />According to several prevalence studies carried out in our country, around 10 per cent of the population above the age of 35 years in our metros (Delhi, Jaipur, Mumbai, Chennai, Bangalore, or Thiruvananthapuram), have coronary heart disease. <br /><br />The figures from rural India, though lower, are also showing an increasing trend (around 4 per cent). <br /><br />An estimated 60 million people in India are suffering from problems related to blockages of coronary arteries. It is thus very important to understand the risk factors which are responsible for the problem. INTERHEART, an international study, reported in 2000 that nine risk factors could explain the causation of heart attacks in 90 per cent instances. Thirty per cent patients included in this study were from south Asian countries. <br /><br />The risk factors were divided into two categories: <br />*Adverse Risk Factors: Current smoking; high blood pressure; high levels of bad cholesterol (elevated ApoB/ApoA1 ratio); diabetes mellitus; abdominal obesity; psycho-social stress.<br />*Preventive Risk Factors: Daily consumption of fruits and vegetables; regular exercise; alcohol intake in moderation <br /><br />Globally, all nine risk factors were very significantly associated with heart attacks except alcohol, which had only a modest statistical significance. These risks were consistent in all regions, ethnic groups, and in men and women worldwide. <br /><br />The strongest risk predictor globally was the ApoB/ApoA1 ratio (a more reliable marker of cholesterol risk), followed by current smoking (associated with a four-fold and three-fold increased risk of heart attack respectively). The risk associated with lipids and smoking was particularly marked in the young (below 55 years in men and below 65 years in women) versus the old. <br /><br />Current smoking<br />Smoking over 20 cigarettes or bidis per day increases the risk of heart attack by five times, 10 to 19 cigarettes or bidis increases the risk by three times and smoking less than five cigarettes or bidis per day increases the risk by 1.5 times. <br /><br />Smoking one cigarette shortens the lifespan by 11 minutes and people exposed to second hand smoke have 90 per cent excessive rate of heat attacks. <br /><br />Quitting smoking at any age nullifies this risk in three years. It is never too late to give up. Reducing smoking to the minimum also helps. <br /><br />Normal blood pressure <br />Optimal BP is a pressure less than 120/80 mms Hg. Any rise in BP above 110/75 mms is associated with a linear increase in stroke and heart attack rates. This has been proven by several epidemiologic studies and life insurance statistics. An increase of 10 mms in the systolic or diastolic pressure is associated with doubling of the risk of a vascular event. Unfortunately, high BP is invariably not accompanied by symptoms and therefore its detection and management is a challenge. It has been described by some as a “silent killer”. <br /><br />High level of blood cholesterol<br />High levels of bad cholesterol and low levels of good cholesterol promote heart disease. One per cent reduction in cholesterol leads to two per cent reduction in heart attacks. <br /><br />Low levels of good cholesterol (HDL cholesterol) are associated with a higher chance of getting a heart attack. Forty per cent of south Asians have it. The levels of less than 40 mgs in men and 50 mgs in women are defined as low. <br /><br />Decreasing LDL cholesterol and increasing HDL cholesterol reduces this heightened risk. A one mg increase in HDL cholesterol is associated with six per cent reduction in dying from a heart attack.<br /><br />Methods to increase HDL cholesterol and reduce LDL cholesterol are regular exercise, weight reduction, increase in consumption of Omega 3 fatty acids (olive oil, mustard oil, almonds, walnuts, cold water fish like salmon, trout etc). <br /><br />High risk individuals with multiple risk factors and even modestly raised levels of LDL cholesterol need in addition the statin group of drugs (simvastatin, atorvastatin or rosuvastatin). These tablets should be taken under medical supervision and once required, need to be continued for a long term. If you are a diabetic your chance of having a heart attack in the next seven years is 10 times more than a non-diabetic, everything remaining the same. <br /><br />All diabetics over the age of 65 years must take 75 mgs of aspirin, atorvastatin or simvastatin in appropriate dose and measures to keep blood pressure less than 130/80 mms Hg, besides ensuring a meticulous sugar control under medical supervision. This minimises their heightened risk. <br /><br />Psycho-social stress<br />Stress is an important risk factor. It leads to increased secretion of adrenaline. Chronic stress raises the blood pressure, invites diabetes and constricts the arteries of the heart. Stress management programmes comprising breathing exercises, stretching exercises, yoga, meditation and massage have been found to be useful in alleviating stress.<br /><br /> These are approaches that aim at blunting the adrenalin response to stress. These relaxing techniques have the added advantage of being very safe. The high-risk population will benefit the most. <br /><br />Exercise is one of the most useful methods of reducing chronic stress and in addition, has the advantage of directly reducing the chance of a heart attack and controlling obesity.<br />This, coupled with eating a heart-healthy diet rich in fruits and vegetables and low in salt content is a very good adjunct. <br /><br /><em>(The writer is Executive Director and Dean Cardiology, Fortis Escorts Heart Institute, New Delhi)</em></p>
<p>Heart disease is one of the commonest causes of death, disability and lost hours at work in most communities. <br /><br />According to several prevalence studies carried out in our country, around 10 per cent of the population above the age of 35 years in our metros (Delhi, Jaipur, Mumbai, Chennai, Bangalore, or Thiruvananthapuram), have coronary heart disease. <br /><br />The figures from rural India, though lower, are also showing an increasing trend (around 4 per cent). <br /><br />An estimated 60 million people in India are suffering from problems related to blockages of coronary arteries. It is thus very important to understand the risk factors which are responsible for the problem. INTERHEART, an international study, reported in 2000 that nine risk factors could explain the causation of heart attacks in 90 per cent instances. Thirty per cent patients included in this study were from south Asian countries. <br /><br />The risk factors were divided into two categories: <br />*Adverse Risk Factors: Current smoking; high blood pressure; high levels of bad cholesterol (elevated ApoB/ApoA1 ratio); diabetes mellitus; abdominal obesity; psycho-social stress.<br />*Preventive Risk Factors: Daily consumption of fruits and vegetables; regular exercise; alcohol intake in moderation <br /><br />Globally, all nine risk factors were very significantly associated with heart attacks except alcohol, which had only a modest statistical significance. These risks were consistent in all regions, ethnic groups, and in men and women worldwide. <br /><br />The strongest risk predictor globally was the ApoB/ApoA1 ratio (a more reliable marker of cholesterol risk), followed by current smoking (associated with a four-fold and three-fold increased risk of heart attack respectively). The risk associated with lipids and smoking was particularly marked in the young (below 55 years in men and below 65 years in women) versus the old. <br /><br />Current smoking<br />Smoking over 20 cigarettes or bidis per day increases the risk of heart attack by five times, 10 to 19 cigarettes or bidis increases the risk by three times and smoking less than five cigarettes or bidis per day increases the risk by 1.5 times. <br /><br />Smoking one cigarette shortens the lifespan by 11 minutes and people exposed to second hand smoke have 90 per cent excessive rate of heat attacks. <br /><br />Quitting smoking at any age nullifies this risk in three years. It is never too late to give up. Reducing smoking to the minimum also helps. <br /><br />Normal blood pressure <br />Optimal BP is a pressure less than 120/80 mms Hg. Any rise in BP above 110/75 mms is associated with a linear increase in stroke and heart attack rates. This has been proven by several epidemiologic studies and life insurance statistics. An increase of 10 mms in the systolic or diastolic pressure is associated with doubling of the risk of a vascular event. Unfortunately, high BP is invariably not accompanied by symptoms and therefore its detection and management is a challenge. It has been described by some as a “silent killer”. <br /><br />High level of blood cholesterol<br />High levels of bad cholesterol and low levels of good cholesterol promote heart disease. One per cent reduction in cholesterol leads to two per cent reduction in heart attacks. <br /><br />Low levels of good cholesterol (HDL cholesterol) are associated with a higher chance of getting a heart attack. Forty per cent of south Asians have it. The levels of less than 40 mgs in men and 50 mgs in women are defined as low. <br /><br />Decreasing LDL cholesterol and increasing HDL cholesterol reduces this heightened risk. A one mg increase in HDL cholesterol is associated with six per cent reduction in dying from a heart attack.<br /><br />Methods to increase HDL cholesterol and reduce LDL cholesterol are regular exercise, weight reduction, increase in consumption of Omega 3 fatty acids (olive oil, mustard oil, almonds, walnuts, cold water fish like salmon, trout etc). <br /><br />High risk individuals with multiple risk factors and even modestly raised levels of LDL cholesterol need in addition the statin group of drugs (simvastatin, atorvastatin or rosuvastatin). These tablets should be taken under medical supervision and once required, need to be continued for a long term. If you are a diabetic your chance of having a heart attack in the next seven years is 10 times more than a non-diabetic, everything remaining the same. <br /><br />All diabetics over the age of 65 years must take 75 mgs of aspirin, atorvastatin or simvastatin in appropriate dose and measures to keep blood pressure less than 130/80 mms Hg, besides ensuring a meticulous sugar control under medical supervision. This minimises their heightened risk. <br /><br />Psycho-social stress<br />Stress is an important risk factor. It leads to increased secretion of adrenaline. Chronic stress raises the blood pressure, invites diabetes and constricts the arteries of the heart. Stress management programmes comprising breathing exercises, stretching exercises, yoga, meditation and massage have been found to be useful in alleviating stress.<br /><br /> These are approaches that aim at blunting the adrenalin response to stress. These relaxing techniques have the added advantage of being very safe. The high-risk population will benefit the most. <br /><br />Exercise is one of the most useful methods of reducing chronic stress and in addition, has the advantage of directly reducing the chance of a heart attack and controlling obesity.<br />This, coupled with eating a heart-healthy diet rich in fruits and vegetables and low in salt content is a very good adjunct. <br /><br /><em>(The writer is Executive Director and Dean Cardiology, Fortis Escorts Heart Institute, New Delhi)</em></p>
