Heart Matters: Ringside Overview
Heart Matters: Ringside Overview
The statistics are encouraging. As one tries to sift out genuine data from tonnes of garbage dished out of newspaper/ magazine articles blaming everything from gossip to lack of sleep for worsening coronary artery disease ( CAD) , I must admit that we have made progress. While the total all cause mortality has remained pretty much the same, mortality due to heart diseases has come down over the decades. This has been due to tireless efforts by epidemiologists , primary health educators and scientists who have been insisting on maintaining a healthy lifestyle. This essentially involves minimising the risk factors for CAD.
- This has proved to be the single most important factor for reduced incidence of CAD. Though the incidence of smoking has reduced in urban men, it is increasing in women across the world.This is probably because of increased women participation in the workforce giving them a sense of liberty and confidence. Every smoker understands that smoking is injurious- causes bad oral hygiene, lung cancers, CAD ..... the list goes on. What I have noticed is that though a large number of youngsters pick up smoking in the college years, most of them give up in 5-10 yrs once they understand the ill effects. Government policies in the form of banning smoking in public places ; sale of cigarettes to underage students and near school premises have worked.
- This is a raging epidemic and shows no stopping or slowing down. As we Indians get richer, we get fatter. There is no time for physical activity. Every patient who visits my OPD is asked whether he goes for a morning walk. The answer uniformly is that he would go regularly till 3 months back till bad weather ( too hot/ too cold/ rainy) did them in. They tell me this every 3 months , which basically means they are not walking at all !! Also I have noticed that a lot of people who claim to have represented state teams/ played competitive sports , have simply ballooned out subsequently in later life. Diabetes leads to silent heart attacks, diffuse coronary artery disease & weakening of heart muscle ( cardiomyopathy)even in the absence of CAD.
- This is a silent killer. It usually produces symptoms at new onset or when the BP goes beyond 200/100. People present with early morning headaches though more dramatic presentations like haemorrhage in the eye, visual disturbances, neurological stroke are also seen infrequently . Usually it is well tolerated and it is very difficult for people to known when the BP shoots up. Regular home monitoring ( once a week) with electronic BP apparatus is acceptable and allows for easy dose adjustments & followup. Prevailing myths that electronic BP instruments are inaccurate have no basis. They are reasonably accurate and easy to use . Early & sustained treatment with target BP < 130/80 has shown to prolong life & control end organ damage.
- With the proliferation of pathological laboratories offering biochemical health profiles at unbelievably low rates- testing for fasting lipid profile has become very common & people are being increasingly aware about lipid abnormalities. The profile shows five different parameters of which HDL is the good cholesterol & LDL with triglycerides are the bad cholesterol. Raising the good cholesterol ( HDL) using almonds, walnuts, red wine is at best an exercise in futility. Niacin at high doses is a good alternative but very poorly tolerated by Indian subjects. Lowering the bad cholesterol is much easier. LDL elevations are usually genetic & one needs to take statins lifelong. Triglycerides can be controlled with lifestyle modification, however , if the levels are >400 , then medicines help.
Family history :
- This is something that one cannot change. If there is history of MI, sudden cardiac death, CABG / PTCA , then one needs to be careful. It is advisable to meet the cardiologists to look for the above mentioned risk factors & if present prophylaxis with a tablet of baby aspirin is advisable.
- There are several other minor risk factors which have lesser relevance. Nowadays there is increasing talk of an inflammatory basis of CAD . Thus levels of Homocysteine, Hs CRP & Lp(a) also help to monitor disease
- Heart attacks happen predominantly due to plaque rupture. A plaque is a minor deposit of cholesterol in the artery causing minimal or no obstruction to blood flow. The plaque is formed at the particular site because of endothelial ( inner lining of the vessel)damage . Endothelial damage occurs due to uncontrolled diabetes, hypertension, smoking …A plaque rupture is triggered by stress- mental/ physical.
- Heart attack happens in subjects with minor CAD. Those who have critical CAD , have angina , are aware of their illness, take treatment & retrict their activities. Those with minor CAD tend to overlook their disease & interrupt the treatment. Similarly sudden death in MI happens in people with minor disease as their heart is not subjected to a low blood flow situation & gives way. In subjects with prior critical disease, the heart is conditioned to work with decreased blood flow and is able to sustain better.
- Predicting heart disease is as accurate as predicting monsoon in Delhi. The fattest of men are healthy & the thinnest , most health conscious individual has a major heart attack. All that one can do is control all the risk factors & walk 30-45 mins/ day- leave the rest to God. Do not fret & fume about diet/ nuts/herbal remedies. If you do end up living beyond 80 yrs, thank your parents- they gave you good genes!!!