Tuesday, 27 May 2014

The basic mechanism for the development of heart disease or coronary artery disease is development of atheroma (fatty deposits) in arteries supplying the heart that is coronary arteries. These atheromas or plaques gradually reduce the internal diameter of arteries, and leads to obstruction. The question is why this plaque or atheroma starts accumulating in coronary arteries? This is because of genetic make up, internal lipid milieu and lifestyles of individuals. There are many risk factors, which accelerate the process of atheroma formation and lead to coronary artery disease. These risk factors are quite simply personal characteristics or features which make us more likely to suffer a cardiovascular accident some day.

The major risk factors are smoking, high blood pressure, high cholesterol, obesity and family history of premature heart disease. The minor risk factors can be high stress jobs, type-A personalities and sedentary lifestyles. Out of these some are modifiable risk factors, correction of those reduces the frequency of cardiovascular accidents. The risks, which can be modified by us alone, are smoking and sedentary lifestyle, modification of these risk factors significantly reduces the risk of heart disease.

Smoking: Cigarette consumption remains the single most important and modifiable risk factor for the development of heart disease. The risk of smoking is increasing in adolescents, young adults and women. A person who consumes 20 or more cigarettes daily is at 2-3 times higher risk for heart attack as compared to a non-smoker. Even the company of smoker is very harmful. It has been proven that passive smoking is as dangerous as active smoking. We should protect our selves and children from passive smoke.

Hypertension: Hypertension means increased blood pressure, is very aptly called a silent killer. One does not feel anything wrong and during a routine check up, it is diagnosed. It is quite simply the pressure of the blood in the main arteries of our body. This pressure allows the blood to flow from main arteries to the smallest vessels in all the organs of body. The blood pressure of an individual is quite variable. It may vary from one moment to next; it is usually lower at night and rises during exertion and emotion.

High blood pressure is major risk factor for heart disease. It is a preventable and treatable cause of heart disease and should be aggressively treated to target levels to prevent heart attacks. High blood pressure also increases the chances of stroke and heart failure.

Diabetes: The risk of heart disease is so great in diabetes that it is called coronary artery disease equivalent. It is just the prolonged excess of sugar in the blood that after certain time damages the arteries and nerves and causes various disease spectrums of diabetes. One may be diabetic without realizing it, that is why it is important to get the blood sugars checked regularly even in non-diabetic individuals.
                Patients with diabetes have 2-8 folds higher risk of heart disease and heart attacks as compared to age matched non-diabetic individuals. Heart disease is responsible for three fourth of deaths in diabetics. The main keys for the prevention of diabetes are physical exercise and weight reduction.

Obesity: The excessive fat in the body leads to obesity and causes significant health impairment. The obesity is simply measured by body mass index (BMI), which is weight in kilograms by square of height in meters. The normal values are 18-25, if it is more than 25 it is overweight and if more man 30 it is obesity. The Indians have typically central obesity, which means fat distribution is mainly around waist and it is called apple-shaped obesity. The risk if heart disease is more with apple shaped obesity as compared to pear shaped obesity, where fat is more around thigh and buttocks. The obesity is a health hazard and 31 % of urban Indians are either overweight or obese. The obesity or weight gain is controlled by lifestyle changes mainly in forms of diet modifications, physical activity and behavioral modifications.

Dyslipidemia: High cholesterols are another enemy for our heart. The bad cholesterols are increased due to dietary habits or genetic makeup. They start accumulating in arteries and progress to coronary artery disease. The more important thing is that average values may not be necessarily normal, which means it is not always number which matter, the quality of cholesterol matters more.

                There are some other risk factors for which we cannot do much like age, sex, and family history. These things cannot be changed, but development of heart disease can be halted by various life style modifications. The most important being healthy diets, regular exercise and no smoking. Regular health checkups and control of blood pressure and blood sugars are the need of hour to prevent heart attacks.

Preventing heart attack:

1.Improve cholesterol: People with at least 2 risk factors or a disease equivalent like diabetes should aim for LDL levels of less than 100 mg/dl.

2.BP control: People in normal health should aim for 130/80 or less. Patients with certain health problems, such as diabetes and kidney disease should aim lower.

3.Exercise, normal individuals should engage in at least moderate physical activity for a minimum of 30 minutes on most if not all days of week.

4.  Healthy Diet-Diet should contain healthy balance of fruits, vegetables, grains, fish, nuts, legumes, poultry and low fat diary items. One should avoid saturated fats and trans- fatty acids.

5. Quit smoking and avoid second hand smoke.

6.Maintain ideal body weight and aim for BMI of 18.5 to 24.9.

7. Aspirin: People whose risk for heart disease within 10 years is 10% risk or more (evaluation can be done by your doctor from Framingham charts) should take low dose aspirin every day, unless they have medical reasons to avoid it.

8.Control diabetes: People with diabetes should aim for fasting glucose of less than 100 mg/dl and HbA1C less than 7%.

Dr TP Singh
Chief Consultant Cardiologist,
SGHS Hospital, Mohali
Mobile No : 09872421946


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