Heart disease is one of the commonest causes of death, disability and hours at work lost in most communities. The incidence is increasing steadily and according to prevalence studies reported for Jammu and Kashmir in population above the age of 30 in cities of Jammu and Srinagar 10% have coronary heart disease. The figures from rural areas though lower, are also showing an increasing trend (around 5 per cent). These figures are according to the data from Center of chronic disease control published in 2004.
This is an alarming data. It is thus very important to understand the risk factors which are responsible for the problem. INTERHEART, a very important international study, reported in 2000 that nine risk factors could explain the causation of heart attacks in 90 per cent instances. Thirty percent patients included in this study were from south Asian countries.
The risk factors were divided in 2 categories:
Adverse Risk factors
• Current smoking
• High blood pressure
• High levels of bad cholesterol (elevated ApoB/ApoA1 ratio)
• Diabetes mellitus
• Abdominal obesity
• Psycho-social stress
Protective Risk factors
• Daily consumption of fruits and vegetables
• Regular exercise
• Alcohol intake in moderation
Globally, all 9 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.
The strongest risk predictor globally was the apoB/apoA1 ratio (a more reliable marker of cholesterol risk), followed by current smoking (associated with a 4-fold and 3-fold increased risk of heart attack respectively). The risk associated with lipids and smoking was particularly marked in the young (Below 55 years in age in men and below 65 years in women) versus the old.

FACTS TO BE REMEMBERED TO REDUCE RISK OF HEART ATTACKS AND RELATED PROBLEMS
Current smoking
Smoking over 20 cigarettes or bidis per day increase the risk of heart attack by 5 times, 10 to 19 cigarettes or bidis increases the risk by 3 times and smoking less than 5 cigarettes or bidis per day increases the risk by 1.5 times.
Smoking one cigarette shortens life by 11 minutes and people exposed to second hand smoke have 90 per cent excessive rate of heat attacks.
Quitting smoking at any age nullifies this risk in 3 years. It is never too late to give up. Reducing smoking to minimum also helps.

What is normal Blood Pressure?
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”.

Some myths about Blood Pressure
• Blood pressure increases with age and is a normal phenomenon: The normal BP of a 60 year old is 160 and at 80 years it is 180 (Age + 100). This is not true. Normal BP at all ages should be below 120/80 mms.
• Low Blood Pressure is a disease: People with BP lower than 100 to 110 mms systolic in good health often seek medical attention.
Individuals with pressures on the lower side without any disease are blessed with the possibility of a long and healthy life. They should not waste their resources on taking tonics and BP increasing measures.
Indications for taking BP-Lowering Drugs
Ideal Blood pressure at all ages should be below 120/80. In general, medicines are recommended when BP is more than 140/85 mms Hg. In some situations, medicines are recommended even at levels of 130/80 mms Hg. These situations are:
• Patients with diabetes
• Patients with kidney disease and high blood urea and creatinine
• Patients with pre-existing heart disease or stroke.
Non Drug Methods reduce BP by 10 to 15 mms Hg: These measures are
• Regular exercise.
• Salt intake of not more than 4 to 5 grams per day.
• Fresh fruits and leafy vegetables (4 to 5 servings/day)
• Avoidance of alcohol or drinking in moderation.
• Losing weight.
These measures should be adopted by everybody with high BP. The dosage of drugs and number of medicines can be brought down by these lifestyle methods. All healthy individuals should adopt these non drug measures, so their pressures remain below 120/80 mms Hg. Before starting drugs, make sure that you minimise consumption of following agents: Pain killers, Nasal drops, cough syrups, anti-depressant and mood elevating drugs.

High Level Of Blood cholesterol:
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. 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. Decreasing LDL cholesterol and increasing HDL cholesterol reduces this heightened risk. A one mg increase in HDL cholesterol is associated with 6 per cent reduction in dying from a heart attack.
Methods to increase HDL cholesterol and reducing 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).
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 long term. If you are a diabetic your chance of having a heart attack in the next 7 years is 10 times more than a non diabetic everything remaining the same.
All diabetics over 65 years of age 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 a meticulous sugar control under medical supervision. This minimizes this heightened risk.

Myths about vitamins and Heart attacks
Consumption of vitamins and anti-oxidants in form of tablets and syrups has no role in preventing heart attacks. Vitamin supplements in the form of B6 , B12, Folic acid, Vitamin C, Vitamin E , beta carotene and anti-oxidant tablets all have been shown to have no cardiac protective effect in large trials with sufficient power to detect the difference between these compounds and placebo. Vitamin D has recently shown to be useful in some situations but not to prevent heart attacks.
It is very important to understand the only tablets which are useful in preventing events in high-risk population are Aspirin, Statins (simvastatin, atorvastatin etc) and ACE inhibitors/ ARB’s (ramipril, perindopril , telmesartan etc).

Psycho-social stress
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 heart. Stress management programmes comprising breathing exercises, stretching exercises, yoga, meditation and massage have been found to be useful in alleviating stress.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.
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
This, coupled with eating a heart-healthy diet rich in fruits and vegetables, low in salt content is a very good adjunct.
Prevention of heart disease is very much feasible and needs motivation and long term dedication. It should start from early ages. The schools and colleges are ideal places to impart this education. The measures to be taken are simple: Healthy life style and general hygienic measures, eating heart healthy food, regular exercise and avoiding smoking is the key.
Prof Upendra Kaul is Executive Director and Dean Cardiology Escorts Heart Institute and Research Center, and Fortis Hospital Vasant Kunj, New DELHI

Lastupdate on : Wed, 17 Aug 2011 21:30:00 Makkah time
Lastupdate on : Wed, 17 Aug 2011 18:30:00 GMT
Lastupdate on : Thu, 18 Aug 2011 00:00:00 IST