HOW TO KEEP YOUR HEART HEALTHY
Double Helical provides an easy-to-follow, meticulous and comprehensive guide to help patients fight the risk factors for heart ailments
By DR MANOJ KUMAR ROHIT
There is hardly a gathering where medical profession is not being discussed with negative overtones. Not a day passes when the media does not draw attention to some event which serves to continue to multiply the trust deficit between public and medical professionals.
It is indeed disappointing to note that cardiovascular disease (CVD), especially coronary artery disease (CAD), is rising at an alarming level. Even worse, we are seeing people in the age group of 40-50 years becomingprone to heart attack.
The rising epidemic of heart disease in the Indian patients is attributed largely to lifestyle related factors such as consumption of fast food, late night eating, less physical activity and more vehicular usage to travel, work- related stress, smoking and in some cases adverse family history.
• CVD accounts for 29% of deaths in South-East Asia Region (SEAR) countries.
• Cardiovascular diseases are attributable to changing lifestyles, stress, sedentary habits and smoking
• Incidence of CAD in the young (less than 40 years age) is about 5% in the West, while this is up to 12% in Indians.
• CAD in Indians, compared to western countries, has high prevalence. It affects young population, is more severe disease and often follows a malignant course
• CAD begins early: a) Fatty streaks are common in children as young as 5 years; b) Studies examining autopsy results of Vietnam casualties (average age 19 years) showed significant CAD in majority of men.
Coronary artery disease manifestations are:
1) Heart attack (Myocardial Infarction)
2) Effort Angina also called chest pain
3) In the elderly and diabetic, it may manifest as silent heart attack or as heart failure or as sudden death. There is advanced warning of angina or chest pain in 1/3rd patients only and half of the sudden deaths occur undiagnosed.
Risk Factors for CAD:
Non-modifiable: Genetics/ family history, sex, age. Blood vessels narrow and become less elastic as age increases. Men of 45-65 group are at higher risk. Same is the case with post-menopausal or over 55 years women. As for family history, parents, brothers and sisters are our most important genetic reference points. CAD occurring before age 55 (male) or 65 (female) may indicate an elevated genetic risk.
Modifiable: Obesity, sedentary life, blood lipids, diet, hypertension, smoking, diabetes, tension & stress.
Factors you can control:
SMOKING
HIGH BLOOD PRESSURE
BLOOD LIPIDS
OBESITY
DIABETES
PHYSICAL INACTIVITY
PSYCHOSOCIAL FACTORS.
SMOKING
India accounts for ~ 7% of the global tobacco production and 6.1% of its total utilization. Awareness of risks associated with tobacco use needs to be increased.
Smoking is a major risk factor for:
1) CAD development
2) 1st heart attack occurrence
3) 2nd heart attack occurrence
4) Cardiac arrest/sudden death
5) Bypass graft blockages
Effects of smoking on the cardiovascular system:
1) Increases blood pressure& heart rate
2) Decreases oxygen entry into blood stream
3) Decreases haemoglobin
4) Increases blood clotting
5) Increases bad cholesterol total cholesterol, LDL-C
6) Decreases good cholesterol: HDL-C
7) Increases heart arrhythmias and
8) Damages arterial wall damage.
Smoking increases CAD risk by two times and stroke (paralysis attack risk by five times.
Each cigarette smoked equates to a loss of seven minutes of life – Americans lose 5 million years of potential life annually to smoking!
QUIT SMOKING: The most unfortunate thing about this world is that good habits are easier to give up than the bad ones. Will power, counselling, and nicotine chewing gum will help you give up smoking.
HPERTENSION
Hypertension: High blood pressure is defined as resting systolic > 140 mm/Hg and/or diastolic > 90 mm/Hg. Incidence increases with:
1 Family history
2 High salt intake
3 Stress
4 Obesity
5 Kidney ailments
6 Smoking
Hypertension becomes more prevalent with age, over 50% older than 60 have hypertension, more common in men. Hypertension is often called a “silent killer.” Most people do not know they have it, 90% of causes are of unknown origin; uncorrected, HT can lead to heart failure, heart attack, stroke, and kidney failure. Exercise is often the best way to lower mild hypertension.
Suggestions for keeping blood pressure low:
1) Achieve and maintain ideal weight
2) Restrict salt intake and salty foods-Avoide xtra salt intake if you have hypertension
3) Limit alcohol intake not more than two pegs, also avoid too much of snacks with alcohol
4) Do regular exercise
5) Take prescribed BP medicine regularly
6) Get adequate calcium and potassium-increase fruit intake
7) Avoid excessive stress. Do Yoga or meditation
DIABETES
High blood glucose levels increase degeneration seen in vessels prevalence: India has already been declared as the country with the largest number of diabetics in the world. With ~ 32 million diabetic people, India is now ahead of China and USA which are in second and third place respectively
Most diabetics are Type II, adult onset. Physical inactivity and obesity are the two largest risk factors for Type II diabetes. Most often caused by insulin receptor insensitivity (brought on by huge fluctuations in blood sugar). Most Type II diabetics can control blood glucose with diet and exercise and can often live completely free of insulin therapy.
BLOOD CHOLESTROL
Lipid Screening should be done in following all:
1) Men > 40, Women > 50
2) 2 or more risk factors for CAD
3) Clinical evidence of CAD
4) PVD or Carotid disease,
5) Family history of CAD or dyslipidaemia
6) Every 2 years for asymptomatic patients > 40 years.
Modifying Blood Lipid Levels: Blood lipids are still very dependent on a person’s genetic makeup! Some people respond to diet and exercise, some require medication. Lowering elevated lipids is extremely important for minimizing CAD risk!
Factors Modifying Blood Lipid Levels:
A) Favourable effects which lower lipids level:
1) Weight loss
2) Exercise
3) High water-soluble fibre intake
4) High polyunsaturated: saturated fat ratio
5) Intake of omega-3 fatty acids (fish)
B) Unfavourable effects which increases lipids level:
1) Smoking
2) Diet high in saturated fat and cholesterol
3) Stress
4) Oral contraceptives
5) Sedentary lifestyle
Traditional Cholesterol Values are: Total Cholesterol <200, Triglycerides 150, LDL 130 and HDL should be>45
OBESITY
Your weight will depend on how much you eat and how much you utilize. Don’t kill yourself under your own weight. Calorie charts can help people decide about their requirement. Use low or non-fat dairy products, use only lean meats, fish, and skinless poultry. Increase the use of high fibrefoods.Use a variety of fresh fruits and vegetables.If you regularly eat fresh vegetables/salads, fresh fruits, low fat & cholesterol diets and less/no meat-brain, liver, egg yolk butter, ghee you are likely to have good weight.
Limit intake of all fats. Also eat less salt and salty foods. Pay attention to portion sizes like avoid extra-large Mcburger.
Which oil to use? Cooking oils with good N6/N3 ratio are good like soya bean, rapeseed oil, mustard oil, ricebran oil. Less preferred oils are: Sunflower, groundnut oil, corn oil. Donotuse DALDA orvanaspatighee. COW’S GHEE IN MODERATION IS FINE. REMEMBER TO USE ONLY HALF LITER OF OIL PER MONTH PER INDIVIDUAL. IT IS ALSO A GOOD PRACTICE TO USE DIFFERENT BRAND OIL FOR DIFFERENT MONTH. ALSO DO NOT USE the SAME OIL FOR REPEATED FRYING TRY AND USE FRESH OIL MOST OF THE TIME.
Alpha-Linolenic Acid is good for heart. Following foods are good source of Alpha-Linolenic Acid: Fish , wheat, bajra, black gram (urad), lobia, rajmah, soybeans, green leafy vegetables, Fenugreek seeds (methi), mustard seeds and in oils: Mustard, Soyabean
With recent innovation and fashion in cooking, some of the healthy foods have become unhealthy. Here are some of the examples:
1) Traditionally we used to eat Roti but it now been replacedwith Naan – Paratha – Butter Naan
2) Replaced normal boiled rice with pulao and biryani.
3) Replaced traditional idli with ghee-fried idli
4) Replaced plain dosa with masala dosa and or ghee-roasted masala dosa
5) Replaced vegetable koftas with malai kofta
6) Replaced Bhindi with Bhindi masala Fry or Do-piazza
7) Replaced Tomato Rasam with – Cream of Tomato Soup
8) Replacing Steamed Fish /Fish Tikka with Fish Fry or Fish in Lemon Butter Sauce
HAVE GOOD BREAKFAST AND LUNCH AND LIGHT AND EARLY DINNER. AVOID LATE NIGHT DINNERS. AVOID SWEETS at NIGHT. If you already had a heart attack and triglycerides are elevated it is strongly recommended that carbohydrate intake should be reduced, like avoid rice, potato, and sugar.
ALCOHOL
Alcohol when consumed in moderation is not bad. This limit is 2 or fewer standard drinks/day.
Beer: 360 c (12 ounce)
Whisky: 45 cc (1.5 ounce)
Wine: 120 cc (4 ounce). Sip slowly. Remember alcohol also has calories. Patients with elevated triglycerides should be advised to decrease or eliminate consumption and also those who had heart attack with damaged heart should not drink at all. Never drink on empty stomach. PLEASE ALSO be ADVISED THAT OILY, NON-VEGETARIAN, and PANNER DISHES SHOULD BE AVOIDED OR TAKEN IN MODERATION ALONG WITH ALCOHOL DRINKS.
STRESS
Stress has become integral part of life. With younger generation becoming more ambitious for early name, fame and money, it has become more prominent. Everybody has ups and downs. Stress whether related to family/ relationships, work and money can become a grave problem if not coped with effectively. Social support is the key. Think of others and work for their welfare. Be honest and true in dealings. Look beyond the material façade. Suffering gives an opportunity for personal spiritual growth. Positive attitude helps. Be optimistic. Exercise regularly, learn to relax, take a break from work, talk it over to your Guru or close relatives, plan your work, be realistic, and religious.
SOLUTION TO OUR CONFLICTS AND CONFUSION LIES IN DEVELOPING A SPIRITUAL ATTITUDE TO LIFE. BABA RAMDEV BASED IN HARIDWAR TALKS ABOUT DIET, YOGA AND PRANAYAM FOR COMBATING LIFE-STYLE RELATED DISEASE INCLUDING CORONARY ARTERY DISEASE. BHRAMA KUMARIS BASED IN MOUNT ABU TALK ABOUT GOOD DIET AND MEDITATION AND THEY HAVE SPECIAL COURSE FOR HEART DISEASE PATIENTS UNDER SUPERVISION OF QUALIFIED CARDIOLOGIST. SATHGURU JAGGI VASUDEV OF ISHA FOUNDATION BASED IN COAMBATURE PROMOTES COURSES FOR STRESS FREE LIFE SUCH AS SAMBHAVI MAHAMUDRA. BANGLORE-BASED SHRI RAVISHAKAR PROMOTES SPECIAL COURSES FOR STRESS FREE LIFE.ALL OF THEM EMPHASISE HOW IMPORTANT IT IS TO INCLUDE RAW FOOD IN YOUR DIET LIKE MORE SALAD, FRUITS, AND SPROUTED FOOD.
PHYSICAL EXERCISE
PHYSICAL EXERCISE ADDS NOT ONLY YEARS TO LIFE BUT ALSO LIFE TO YEARS
Walking: Simple, easy to perform, does not need money, material or membership of a club
Other Activities: Swimming, Cycling, outdoor games
Perform exercises at least 3 times a week, for 30 minutes
Exercise guidelines: 100 % of your heart rate = 220 – your age in years. If you are 30 years that your expected target heart rate is 220-30 = 210. Achieve 70% of your peak heart rate for 30 minutes 3 days per week.
Yoga and Meditation are also alternative to exercise. It is said that suryanamaskar is a complete exercise.
Yoga is not merely a set of postures (asanas) but a complete way of life: it promotes vegetarian diet, low in cholesterol & saturated fats, rich in anti-oxidants (vegetables,fruits), regular physical exercise, stress management techniques, abstinence from smoking. Yoga has immense potential for benefit to patients with CAD.
HOW TO SURVIVE A HEART ATTACK WHEN ALONE?
DO NOT PANIC, BUT START COUGHING REPEATEDLY AND VERY VIGOROUSLY. A DEEP BREATH SHOULD BE TAKEN BEFORE EACH COUGH, THE COUGH MUST BE DEEP AND PROLONGED WHEN PRODUCING SPUTUM FROM DEEP INSIDE THE CHEST. A BREATH AND A COUGH MUST BE REPEATED ABOUT EVERY TWO SECONDS WITHOUT LET-UP UNTIL HELP ARRIVES, OR UNTIL THE HEART IS FELT TO BE BEATING NORMALLY. DEEP BREATHS GET OXYGEN INTO THE LUNGS AND COUGHING MOVEMENTS SQUEEZE THE HEART AND KEEP THE BLOOD CIRCULATING. THE SQUEEZING PRESSURE ON THE HEART ALSO HELPS IT REGAIN NORMAL RHYTHM. IN THIS WAY, HEART ATTACK VICTIMS CAN GET TO A HOSPITAL SAFELY.
TO KEEP YOUR HEART HEALTHY: LOVE YOUR HEART
A) Become physically active every day!
B) Limit alcohol, sugar and caffeine
C) Achieve and maintain an ideal weight
D) Manage your stress.
About the Author
Dr Manoj kumar Rohit Is Professor, Department Of Cardiology at the Post Graduate Institue Of Medical Education & Research-Chandigarh. He is working as faculty since October 2002. The Advanced Cardiac Centre of the institute is a 172-Bed Cardiac Hospital dedicated to the suffering mankind. Today it performs 8000 angiographies and 1500 open heart surgeries per year at affordable cost. Thanks to Smt. Sushma Swaraj, the then Union Health Minister, Dr K K Talwar was appointed as head of cardiology and director of PGIMER Chandigarh in April 2004. Dr KK Talwar worked in this capacity for 7 years. He was intrumental in, among other things, setting up cardiac centre. The author feels himself blessed to have worked with him.