Heart attacks happen because of narrowing and closure of blood vessels that take blood to the heart. This is also called ischemic heart disease. This is due to the deposition of cholesterol and other fats in the walls of blood vessels by a process called atherosclerosis. Ischemic heart disease (also called coronary artery disease) cripples and kills tens of thousands of people all over India every year. It has now assumed epidemic proportions. Heart diseases in our region grew by 300% in the last 30 years and are still growing by 2-3% every year. Experts project that by 2015 one million people under the age of 40 will die from this disease and 60% of heart patients in the world are likely to be in India.

Can’t we prevent heart disease and minimize morbidity and loss of life?

The answer is: yes and no.

We don’t have control over certain factors, which make us vulnerable to heart disease. There are certain factors which we can modify and minimize the risk.

Non-modifiable Risk Factors of Heart Disease

The three factors that are out of our control are:

• Age
• Gender
• Genetics and Family history

Age

Heart disease risk increases as we age. Men 45 and older and women 55 and older are at increased risk. Unfortunately, we cannot undo the ravages of age. A potion that keeps us perpetually young is yet to be discovered.

Gender

Heart disease manifests itself in women seven to 10 years later than in men. It is because natural hormones in women give some level of protection from heart disease before menopause. But after menopause, women are as vulnerable as men to heart disease. We have to accept sex and the risk associated with it as beyond our control.

Genetics and Family History

Indians are more prone for ischemic heart disease. In addition, heart disease sometimes can run in families. Family history means having a father or brother who had heart disease before 55, or a mother or sister who had heart disease before 65. Since we cannot choose our parents or siblings, we cannot wish away family history.

Even if one has uncontrollable risk factors, it doesn’t mean that one should reconcile oneself to fate or destiny and keep quiet. One can minimize risk by learning about controllable risk factors and controlling them. But most people don’t do it because they think that heart disease always happens to some one else, until it happens to them. It is also perhaps because they don’t feel or see heart disease, which is a gradual, life-long process.

Because of breathtaking advances in medicine and technology, people with heart disease are living longer and leading more productive lives. We can prevent the progression of the disease or the occurrence of clinically significant disease with modern treatments. Yet, prevention of heart disease is any day preferable to its medical and surgical management.

Modifiable Risk Factors of Heart Disease and Stroke

You should, however, appreciate that even if you do all the right things suggested here, you may not be totally immune from heart disease. But by making certain lifestyle changes, you can ward off heart disease for years or minimize its havoc.

Following are the modifiable risk factors:

• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Stress
• Physical inactivity
• Obesity
• Unhealthy diet

Stop smoking

If you smoke, quit. You can dramatically lower your heart attack risk. Tobacco smoke contains more than 4,800 chemicals, many of which damage your heart and blood vessels. It results in the narrowing of the arteries (atherosclerosis), which ultimately leads to a heart attack.

Smoking also decreases the amount of “good” (HDL) cholesterol and increases the “bad” (LDL) cholesterol circulating in the body. In addition, nicotine in cigarettes increases blood pressure and heart rate.

Smokers have more than twice the risk of having a heart attack as non-smokers. Smoking is the biggest risk factor for sudden cardiac death. Smokeless tobacco and low-tar and low-nicotine cigarettes also are risky, as is exposure to secondhand smoke. But if you quit smoking, your risk of heart disease drops dramatically within just one year.

Lower blood pressure

High blood pressure, or hypertension, is a silent killer. It causes the heart to work harder. Because of this, the heart muscle can enlarge. High blood pressure can also damage the lining of the artery walls, which encourages plaque build-up. A blood pressure level of 140 over 90 mm Hg (millimeters of mercury) or higher is considered high. A healthy blood pressure is 120/80 or less.

Poor eating habits and physical inactivity both contribute to high blood pressure. Table salt increases average levels of blood pressure in some people.

Reduce cholesterol

Cholesterol is a fat-like substance in the blood. High levels of triglycerides, another form of fat in the blood, can also indicate heart disease risk. There are two types of cholesterol in the body: LDL and HDL. LDL – or “bad” – cholesterol sticks to the inside of an artery’s walls, causing plaque to build up. HDL – or “good” – cholesterol circulates through the arteries and decreases the risk of plaque build-up. Cholesterol is found only in foods derived from animals, such as milk, cheese and meat.

To know your cholesterol levels you have to undergo a blood test after fasting for nine to 12 hours. A lipoprotein profile will reveal your total cholesterol, LDL and HDL. All these are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

• Total cholesterol less than 150 mg/dL is desirable.
• Low-density lipoprotein (LDL should be less than 100 mg/dL.
• Triglycerides should be less than 150 mg/dL
• HDL levels of 60 mg/dL or more help lower heart disease risk, and a HDL level of less than 40 mg/dL is low.

Manage diabetes

Diabetes increases the rate at which heart disease develops and progresses. People with diabetes are at very high risk for cardiovascular disease and diabetes-related death.

Diabetes is a disease in which the body does not properly produce or use insulin. Insulin is a hormone needed to convert sugar, starches, and other nutrients into energy. One in three people who have diabetes don’t know they have it. See a doctor if you have any diabetes symptoms, which include frequent urination, excessive thirst, extreme hunger, unusual weight loss, increased fatigue, irritability, and blurry vision.

Reduce stress

Stress puts excess demand on the heart muscle. During stressful situations, the body releases adrenaline, a hormone that increases heart rate and narrows blood vessels. This in turn increases blood pressure, and the heart works even harder. People under stress may overeat, start smoking or smoke more than they otherwise would. And people with heart disease are more likely to have a heart attack during times of stress. Stress can be reduced through stress management techniques and exercise.

Be active

Regular physical activity helps prevent heart disease by increasing blood flow to your heart and strengthening your heart’s contractions so that your heart pumps more blood with less effort. Physical activity also helps you control your weight and reduce your chances of developing other conditions that may put a strain on your heart, such as high blood pressure, high cholesterol, diabetes and stress.

Get 20 to 30 minutes of moderately intense physical activity atleast 4-5 days of the week.

Shed weight

Obesity places you at risk for high cholesterol, high blood pressure and diabetes and heightens your risk of cardiovascular disease. Obesity is becoming an epidemic even in India among adults and children because of unhealthy eating and sedentary lifestyle. Regular physical activity and following a heart-healthy diet are essential to shed weight and prevent heart disease. Even small reductions in weight can be beneficial.

Your Body Mass Index (BMI), which considers your height and weight, will tell you if your weight is healthy. BMI numbers 25 and higher are associated with an increased risk of heart disease and stroke.

Waist circumference is another tool to assess abdominal fat. In general, men are considered overweight if their waist measurement is greater than 36 inches. And women, in general, are overweight if their waist measurement is greater than 32 inches.

Eat healthy

You can lower your chances of getting heart disease by choosing your foods carefully. You should eat less fat, more vegetables, fruits and whole grains and fiber and cut down on salt.

Eat less fat: Make sure that fewer than 30 percent of your daily calories come from fat and that fewer than 7 percent come from saturated fat. Nothing in your food — not even cholesterol — will raise the level of cholesterol in your bloodstream faster than saturated fat will. These fats are usually found in foods from animals, such as meat, milk, cheese, and butter. They also are found in foods with palm and coconut oils. Eat less of these foods.

In contrast, monounsaturated fats (found in nuts and in olive, canola, and peanut oils) and polyunsaturated fats (found in safflower, corn, soybean, and cottonseed oils) may actually lower harmful cholesterol. Furthermore, omega-3 fatty acids, a type of polyunsaturated fat found in nuts, flaxseed, and many types of fish, may help prevent the types of blood clots that can cause heart attacks and strokes.

Eat more fruits and vegetables: Many types of produce are rich in vitamins C, beta-carotene, and other antioxidants that may help prevent hardening of the arteries. Green leafy vegetables, peas, beans, and some fruits also contain folic acid, a nutrient that lowers the risk of heart attack or stroke Finally, many fruits and vegetables contain potassium, a mineral that both protects arteries and lowers blood pressure.

Select whole grains: Whole grains haven’t had their bran and germ removed by milling, making them good sources of fiber — the part of plant-based foods your body can’t digest — and other nutrients. Whole grains are also a source of vitamins and minerals and phytochemicals. The nutrients in whole grains play a role in regulating blood pressure and heart health.

Cut down on salt: Consume no more than 2,300 milligrams of sodium each day. That’s a little less than one teaspoon of salt a day. Eating less sodium can help lower some people’s blood pressure and reduce the risk of heart disease.

Eat fewer calories: When we eat more calories than we need, we gain weight. Being overweight can cause heart disease. When we eat fewer calories than we need, we lose weight.

Drink in moderation: A small amount of alcohol each day may lower your blood pressure and boost your good cholesterol, but too much can actually destroy portions of heart muscle, increase triglycerides and raise blood pressure. A healthy limit is two drinks a day for men and one drink a day for women.

Metabolic Syndrome

One out of every three Indian men and one out of every two Indian women have metabolic syndrome. Any person with metabolic syndrome has a 42% higher chance of getting coronary artery disease and diabetes within the next 20 years.

You have metabolic syndrome if at least 3 of the following are true:

• You are overweight or obese and you carry the weight around your middle.
• You have high blood pressure
• You have a high amount of sugar in your blood
• You have a high amount of fat in your blood
• You have low HDL cholesterol

The more of these risk factors you have, the higher your risk of heart disease. Even if your cholesterol level is normal, you still may be at risk for a heart attack or stroke.

Medications

Along with lifestyle changes, your doctor may recommend certain medications to prevent or control heart disease. One is the simple drug aspirin. Aspirin has been shown to reduce strokes in women and heart attacks in men. Drugs known as ‘Statins’ lower LDL, the bad cholesterol. These drugs prevent the onset of heart disease and the progression of heart disease if you already have it. Beta Blockers are another class of drugs that are effective in protecting people who have already had a heart attack. They are also helpful in controlling blood pressure and controlling angina, which is a symptom of chest discomfort due to a blockage in the artery.

You need not construe heart disease as a disaster. You can minimize its consequences if you follow a healthy lifestyle and take medication as prescribed by your doctor.