Heart talk
India's young and productive workforce is at risk of heart disease due to rising stress levels, increasing work hours and changing lifestyles
Dr Harinder Singh Bedi
An estimated 17.3 million people die globally of cardiovascular disease every year. As many as 80 per cent of the deaths occur in low and middle-income countries.


Poor diet, stress, obesity, lack of physical activity, smoking, diabetes and high blood pressure are major risk factors for CVD

Have a (healthy) heart
Dr Arun Kochar
Since 2000, the last Sunday of September is celebrated across the globe as "World Heart Day." This year the theme is about adopting an approach for the effective prevention and control of cardiovascular disease (CVD) with a special focus on women and children. By 2030, it is estimated that annually and globally the number of deaths would be the population of the size of Australia.

Heart talk
India's young and productive workforce is at risk of heart disease due to rising stress levels, increasing work hours and changing lifestyles
Dr Harinder Singh Bedi

An estimated 17.3 million people die globally of cardiovascular disease every year. As many as 80 per cent of the deaths occur in low and middle-income countries.

Causes of CVD

Many risk factors contribute to the development of cardiovascular disease (CVD). Some people are born with conditions that predispose them to heart disease and stroke, but others who develop CVD do so because of a combination of factors such as poor diet, stress, obesity, lack of physical activity, smoking, diabetes and high blood pressure. The more risk factors you expose yourself to, the higher the chance of developing cardiovascular disease.

Many of these risk factors cause problems because these lead to atherosclerosis (narrowing and thickening of arteries). This narrowing and thickening is due to the deposition of fatty material, cholesterol and other substances in the walls of blood vessels. The deposits are known as plaque. The rupture of a plaque can lead to stroke or a heart attack.

Cholesterol

Cholesterol is a waxy, fat-like substance used by the body to build cell walls and for several essential hormones. Liver produces cholesterol. The body absorbs it from the animal fats one eats. Cholesterol is carried through the blood by particles called lipoproteins. There are two types: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). The former carries the cholesterol around the body in the blood and the latter transports cholesterol out of the blood into the liver.

When cholesterol is too high, or the LDL and HDL are out of balance (dyslipidaemia), the cholesterol can clog the arteries affecting the flow of the blood.

High blood pressure and heart disease

Blood moving through the arteries pushes against the arterial walls; this force is measured as blood pressure. High blood pressure (hypertension) occurs when very small arteries (arterioles) tighten. The heart has to work harder to pump blood through the smaller space and the pressure inside the vessels grows. The constant excess pressure on the artery walls weakens these making them more susceptible to atherosclerosis.

Diagnosis

There are a number of ways to diagnose coronary heart disease. For a definitive diagnosis more than one test is required. The commonly used tests used are — ECG, cardiac echo, and exercise or stress test. A coronary angiogram may then be done if indicated .This test shows the degree of blockage of the heart arteries. It can be done invasively or non-invasively with a CT angiogram.

Smoking & CVD

Smoking damages the lining of blood vessels, increases fatty deposits in the arteries, increases blood clotting, adversely affects blood lipid levels and promotes coronary artery spasm. Nicotine accelerates the heart rate and raises blood pressure.

Diet doctor

Diet plays a significant role in protecting or predisposing people to heart disease. Diets high in animal fat, low in fresh vegetables and fruit, and high in alcohol have been shown to increase the risk of heart diseases. Adopting a diet low in fat and salt and having whole grains, fruits, and vegetables has a protective effect over the long term.

Estrogen protection

Estrogen does help raise the good (HDL) cholesterol. So this hormone protects women to some extent, but once menopause starts women are equally affected by heart disease as are men. However, if a woman suffers from diabetes or has raised levels of triglycerides it cancels out the positive effect of estrogen.

Hereditary problem

Heart disease can run in some families. But even if you inherit the risks factors that predispose you to heart disease, such as high blood cholesterol, high blood pressure, diabetes, or being overweight, protective measures can help you avoid developing cardiovascular disease.

CVD risk factors

Many types of cardiovascular disease (CVD) is caused by risk factors that can be controlled, treated or modified, such as high blood pressure, abnormal lipid profile, overweight/obesity, tobacco use, lack of physical activity and diabetes. However, there are also some major CVD risk factors that cannot be controlled.

Modifiable risk factors

• Hypertension (high blood pressure)
• Tobacco use
• Raised blood glucose (diabetes)
• Physical inactivity
• Unhealthy diet
• Cholesterol/lipids
• Overweight and obesity

Non-modifiable risk factors

Some risk factors that cannot be changed like age, family history and gender - men are generally at higher risk than pre-menopausal women.

 

Heart attack warning signs Some heart attacks are sudden and intense. The "movie heart attack," is where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that show a heart attack is happening: Chest discomfort. Most heart attacks involve discomfort in the centre of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. Shortness of breath with or without chest discomfort. Other signs may include breaking out in a cold sweat, nausea or light-headedness. As with men, in women the most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. If experiencing any of these signs, which could come and go, call your emergency services/ambulance immediately. STEPS one NEEDs TO TAKE Get active. Even 30 minutes of moderate intensity activity five times per week reduces the risk of heart disease and stroke. Activities such as household chores, gardening etc. count. Set realistic goals; build up levels of activity gradually. Investigate physical activity schemes in your area like cycle or run to work schemes. Provide children with opportunities for increased physical activity. Limit watching television or playing computer games to no more than 2 hours a day. A heart-healthy diet is rich in fruits and vegetables. High intakes of saturated fats, trans-fats and salt increase risk of a heart attack or stroke. Too much salt can cause high blood pressure; Fats can clog arteries. Avoiding sweets completely. Eat fruits instead. Limit salt intake to less than five grams per day (about one teaspoon). Consider portion sizes; use smaller plates. Pack your and your child's tiffin with home-cooked healthy options. Ensure every evening meal contains at least 2 to 3 servings of vegetables per person. Avoid processed foods. Say 'no' to tobacco. Quitting smoking and avoiding second-hand smoke reduces risk of heart disease and stroke Know your numbers. Keep a regular check on your heart health. Check blood pressure, cholesterol, glucose levels, weight and body mass index (BMI) regularly. Watch your weight: Your body burns fewer calories as you age. Excess weight causes your heart to work harder and increases the risk for heart disease, high blood pressure, diabetes and high cholesterol. Exercising regularly and eating smaller portions of nutrient-rich foods may help you maintain a healthy weight. Ask the experts. If you have suffered from a heart attack or stroke, speak to your healthcare professional on the best way in which to treat and manage your risk, so that you can try and avoid a second event.

The writer is Head, Cardiovascular Endovascular & Thoracic Surgery, Christian Medical College & Hospital, Ludhiana.

Have a (healthy) heart
Dr Arun Kochar

Since 2000, the last Sunday of September is celebrated across the globe as "World Heart Day." This year the theme is about adopting an approach for the effective prevention and control of cardiovascular disease (CVD) with a special focus on women and children. By 2030, it is estimated that annually and globally the number of deaths would be the population of the size of Australia. More than 80 per cent of these 23 million deaths are preventable if we adopt a healthy lifestyle alone.

Women and children

Contrary to the popular belief, CVD is not restricted to the elderly and men. It affects women equally and is responsible for causing maximum deaths among females. About one in three women dies due to CVD. This accounts for almost one death per minute globally!

Similarly, children and teenagers in India are witnessing a fast-changing economic and social changeover. This has brought additional challenges for the younger generation. Single parent care or lack of family support systems, stressful competitive environment with drug dependence, lack of exercise with enhanced screen time and consumption of high-caloric, unhealthy junk foods are some of the problems and factors affecting them. Many of them would witness loss of a family adult due to CVD and may also be at future risk of heart disease due to unhealthy lifestyle. In India, the average age of person having a heart attack is 10 years younger than the western population.

Prevention measures

Adopting heart-healthy behaviour, eating healthy diet, being physically active and staying away from tobacco is the key to success. The course of cardiovascular disease and its global impact can be checked by encouraging and supporting heart-healthy existence from an early age. It is important to spend time in moderately intense physical activity every day. Walking, gardening and cycling etc. are extremely effective. Eating a healthy diet with less of transfats and saturated fats helps in controlling the rapidly increasing overweight population. Avoiding drugs and cigarette smoking is extremely crucial in preventing CVD. Tobacco in all forms should be shunned and social as well legitimate decrees need to be constituted for the same. Stopping smoking for 15 years reduces the heart attack risk to the same level as of someone who had never smoked.

It is not important to implement most expansive treatments or opening state-of-the-art hospitals to curb the CVD menace. The fundamental concept rests on motivating and modifying the life-style of families and societies, encouraging healthy nutrition and dissuading people from unhealthy habits such as smoking.

 

Killer Facts Heart diseases have emerged as the number one killer in both urban and rural areas of the country. About 25 per cent of deaths in the age group of 25-69 years occur because of heart diseases. In urban areas, 32.8 per cent deaths occur because of heart ailments, In India, 24.8 per cent of total deaths annually (25-69 years) occur because of CVD. Of these 26.3 per cent are men and 22.5 per cent are women. Indian women account for 15 per cent of the global burden of heart disease. Heart diseases have emerged as the number one killer for Indian women, too as it was in younger Indian men. This takes away a large productive force of the country. Simple lifestyle changes (prudent diet, exercise, yoga, control of blood pressure, stress and diabetes can dramatically reduce the incidence of heart disease.

The writer is senior interventional consultant cardiologist, Fortis Hospital, Mohali