1. Keep your cholesterol low: This is achieved by choosing a heart healthy diet. plenty of seasonal fruits, salads, vegetables, nuts (almonds, walnuts, peanuts) and a healthy lifestyle. Minimizing intake of high cholesterol containing foods like red meat, pure milk and its products like butter and ghee. LDL cholesterol fraction of total cholesterol is the atherogenic part. Its value should be kept below 100 mgs and in high-risk patients less than 70mgs/dl. Patients with previous heart attack, brain stroke or disease of limb arteries should be kept < 50 mgs/dl. Regular exercise is a very good adjunct to diet.
There are several categories of patients where long- term medicines need to be given, the most often used drugs belong to the statin group (atorvastatin and rosuvastatin) These are always given under medical supervision.
2. No Smoking: Any number of cigarettes smoked brings you closer to a heart attack. More than 20 per day increases the probability by 5 times, 10-19 a day by 3 times and less than 10 per day by doubling it. It is estimated every cigarette smoked reduces your life by 4 minutes. The nicotine contained in it leads to several disturbances, like increasing heart rate, blood pressure and constricting the arteries. Besides this the carbon makes the blood more coagulable and increases the tendency of clot formation inside the diseased artery supplying blood to the heart.
3. Treat High Blood Pressure effectively: High blood pressure is a very common problem in both urban and rural areas with a prevalence of 30 to 40% in adults especially after the ages of 30 years. It needs raising awareness levels because it most often is not associated with symptoms. Preventive measures like less salt intake and consuming plenty of fruits and vegetables are very important. However, in spite of it a large population needs drug treatment often in combinations. In a study reported by our group in patients prescribed medicines by Govt health centres 54% patients had uncontrolled BP levels. This needs a combined approach by health authorities and also voluntary organisations. Ideal BP is 130/80 mms Hg or below .
4. Recognition and Controlling of diabetes: It is also a major issue with around 15% of our adult population having it. Self-testing of sugar levels by point of care devices is an important tool. Oral medications which are cost effective and easy to consume are available but under-utilised. Newer agents which improve the heart related outcomes are very sparingly used. This challenge needs to be handled at a war footing if we have to make a dent in the ever-increasing heart disease population, especially heart attacks and heart failure. Once again it needs a combined approach as for high BP. The ideal fasting blood sugar for non-diabetic should be less than 100 mgs/dl and HBA1C should be less than 6. Anybody having Fasting blood sugar more than 100 and HBA1C more than 6 should seek medical attention.
5. Obesity especially truncal obesity: It is a major issue especially in the urban population and the well to do rural milieu. Lack of exercise, consuming a rich non-vegetarian diet and in spite of being available in plenty the consumption of fruits and green vegetables is poor. The population has to be made conscious of this fact and promote exercise and sporting activities from younger ages is important. An ideal waist to hip ratio in women should be less than 0.7 and in men less than 0.85. The body mass index calculated by using weight and height in a simple formula should be less than 25 Kg/M2, 25 to 29.9 Kg/M2 is overweight and more than 30 Kg/ M2, is obese.
6. Lack of Exercise: This has already been emphasised previously. It leads to obesity, increase in diabetes and high BP. Advocating exercise for a minimum of 30 minutes at least 5 times a week is a good way of preventing a heart attack.
7. Low consumption of fruits and vegetables: It is a very common feature in the valley and whatever is taken is deep fried and cooked in very oily cooking media. This destroys its nutritive and protective values. old habits die hard and high carbohydrate intake in the form of rice and traditional breakfast bread needs to be modified. Home made roti and supplementing with sprouts and fruits is the way to go. It is recommended that everybody should have 4 to 5 servings of fruits and seasonal fruits and vegetables with nuts like almonds and walnuts every day. These are heart protective.
8. Stress: Stress at work or at home is an important risk factor. Minimising it is important. Once again easier said than done in the present-day lifestyle. However, spending one hour a day for this can be extremely useful. It can be done in the form of Yoga or Meditation or Namaz and Zikr. Other methods equally good are listening to pleasant music for an hour or watching a soothing or entertaining movie or going for a swim or a jog.
9. What about red wine intake? The recent data including a statement from WHO has put to rest the concept of “French Paradox”. Alcohols in any form and in any quantity are injurious to health.
Take Home Message: Cessation of smoking, a healthy lifestyle, healthy food, regular exercise and a periodic health check up to detect high BP, diabetes and high lipid levels and managing the abnormalities can prevent 90% of heart attacks.
Prof Upendra Kaul, Founder Director Gauri Kaul Foundation
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK
