? Prevention Of Heart

Attacks

PAIN

Is it good ?

or

Bad ?

SOME FACTS ABOUT CAD

• 25 -28 % of CAD die suddenly

• 55 % of all cardiac deaths occur within the 1st hour

• Among survivors around 10% die in the 1st year and 5%

thereafter every year.

A disease known is Half Cured

Heart is most important organ in the body

It is very sensitive, strong and hard

working

It contracts for more than one lakh times in

a day and pumps blood to each and every

organ in the body

A person dies if it stops for 3minutes

It is a muscular organ and supplies oxygen

to each cell in the body through blood

Right half of the Heart collects de-

oxygenated (impure) blood from all parts of

the body and pumps into the lungs for

getting oxygen and removal of carbon-

dioxide and other metabolic waste .Then the

pure blood from lungs enters left side of the

heart.

For pumping of blood to all parts of body,

Heart also needs oxygen and energy. It

gets energy and oxygen through,

“Coronary Arteries which are branches of

Aorta”.

If due to some reason, Coronary Arteries

get blocked, it results in “Heart Attack”

Usually as age advances, the blood

vessel walls get thickened and become

rigid, a condition called “Atherosclerosis”

At the same time, if cholesterol (Fat) in

the blood is increased, it causes block in

the blood flow. If this occurs in coronary

blood vessels, it results in “Heart Attack”

Indian Scenario of Heart Attacks

(Coronary artery disease)

CAD appears a decade earlier in

India, compared with developed

countries

Males are affected more than

females

Hypertension and Diabetes

accounts for about 40% of all

cases

Heavy smoking is responsible

aetiologically in a good number

of patients

Clinical Manifestations

Signs and Symptoms of CAD

Sudden death may be the first clinical

manifestation of CAD in as many as one-fourth

of the patients. In about 55% of all cardiac

deaths mortality occurs within the 1st hour

Retrosternal (center of chest) stabbing pain

Radiation of pain to left shoulder and even up to

tip of left little finger

Palpitation, fatigue, sweating all over the body

and burning sensation in the stomach

Sudden breathlessness (previously never

existed)

Toothache/ pain near the jaws

Nausea or Vomiting

Sometimes without any of the signs and

symptoms (silent infarction). It is usually seen in

Diabetics.

Risk Factors for CAD

Non-Modifiable risk factors of

CAD

Age

Sex

Family History

Genetic Factors

Personality

Modifiable Risk Factors

Cigarette Smoking

High Blood Pressure

Elevated Serum cholesterol

Diabetes mellitus

Obesity

Sedentary habits

Stress

Lack of exercise

Smoking

SOME PEOPLE COMMIT “SUICIDE” BY

“DROWNING”, BUT MANY BY “SMOKING”

Smoking is responsible for 25% of CAD deaths under

65yrs of age in men. Cigarette seems to be

particularly important in causing sudden death from

CAD in men below 50yrs of age.

The main culprits in Tobacco, which harms Heart and

blood vessels are

NICOTINE and

CARBON MONOXIDE

Nicotine stimulates the heart and increases demand

of more oxygen to heart, and thus increases heart

rate.

Carbon monoxide has 200 times more affinity towards

hemoglobin and thus reduces oxygen supply to all

tissues

Smoking increases the viscosity of blood and

enhances the chances of blood clotting inside the

vessels.

Hypertension

Hypertension damages the blood

vessel walls and accelerates

atherosclerotic process resulting in

precipitation of CAD

Studies reveal that a reduction of

BP by 2-3mm of Hg in general

populations can produce large

reduction in CVD complications

ADVANTAGES OF LIFE STYLE MODIFICATIONS

Modification Recommendation Reduction in Systolic

Blood Pressure

• Weight reduction BMI 18.5-24.9 5-20mm of Hg/10 kg

reduction

• DASH eating plan Fruits, vegetables, low fat etc. 8-14mm of Hg.

• Reduction in Na. 5-6 gms of sodium 2-8 mm of Hg.

• Physical Activity Regular aerobic physical activity 4-9 mm of Hg.

30 mts /day

• Limitation of Alcohol < 2drinks/day(30ml ethanal) 2-4 mm of Hg.

Blood Cholesterol

Elevated blood lipids (Cholesterol & Triglycerides) are the

major risk factors for CAD

Animal fats (Meat, Milk Products, Egg etc.) except fish,

contain saturated fatty acids which contain low density lipids

will increase the thickness of blood vessel walls resulting in

Hypertension and Coronary Artery Disease.

Vegetable oils(except palm oil & coconut oil) contain poly

unsaturated fatty acids, have more „high density lipids‟

which protect the heart. The HDL fat acts as a „scavenger‟

in removing the LDL attached inside the blood vessel walls.

In typical Indian diet, which is cereal based, about 20gms of

fat is obtained as „invisible fat‟. Therefore a daily in take of

20gms or 4 tea spoons of visible fat is sufficient. The ratio of

saturated to PUFA should be roughly 0.8-1.0

Poly unsaturated fatty acids (PUFA)

Usage of oils which are rich in „Linoleic,and Linolenic

fatty acids‟ like saffola, Sunflower, Soya Bean,

Ground nut etc. will prevent occurrence of CAD.

The deficiency of PUFA enhances mechanism of

blood clotting inside the blood vessel, which results in

CAD/ Paralysis (CVA).

FISH is good for HEART. It is an abundant source of

long chain n-3 PUFA, which reduces the blood levels

of cholesterol and triglycerides and also decrease

fibrinogen levels, inhibit platelet activity and clotting

process.

Mustard and Soya oils are two common vegetable

oils which contain alpha-linolenic acid. Use of any one

oil along with other oils will be beneficial.

The n-3 PUFA is also good for brain & joints and have

anti-cancer properties.

Blood Lipids (mg/100ml of plasma)

Type of

cholesterolDesirable

Border

line HighHigh Risk

Total

Cholesterol<200 200-240 >240

LDL <130 130-160 >160

HDL >50** - <35

Triglycerides <150 150-500** >500

* In Indians CAD occurs even at

cholesterol levels around 180mg/100ml

of plasma

** Arbitrary Values

Cholesterol : HDL should be less than 3.5

Obesity

The higher the body weight the greater is the risk

of CAD

For every extra KG of fat, one tends to produce

20mg more cholesterol per day.

Higher abdominal fat (Fat around waist) is known

to be a greater risk factor than accumulation of fat

around hips.

It is hence necessary to maintain ideal body

weight.

The simple formula to know the ideal body weight

in KGs is height in centimeters minus 100.

The tendency for obesity seems to be inherited

and over eating. Also it is clearly an important

cause with low physical activity.

Diabetes Mellitus

The risk of CAD is 2-3 times

higher in patients with Diabetes

CAD is responsible in 30-50%

of deaths in Diabetes over the

age of 40yrs

In Diabetes the blood lipids are

increased and these contribute

to premature or accelerated

process of „Atherosclerosis‟.

Genetic Factors

A family history of CAD is

known to increase risk of

premature death.

Probably the genetic

factors are most important

determinants of an

individual‟s “Total

Cholesterol and HDL

levels”.

Sedentary life style

With increasing

industrialization,

modernization and

mechanization, sedentary

habits have become a part

and parcel of our life styles.

Sedentary habits decrease

the energy expenditure and

therefore contribute to over

weight and rise in blood

lipids

Lack of Physical Exercise

Incidence of HTN is more in those who

lack physical exercise.

Regular physical exercise increases

the concentration of HDL and

decreases the body weight, blood

glucose, blood lipids and blood

pressure.

Walking briskly for 45 minutes a day

can bring down the risk of HTN.

Hormones

The „Estrogen‟ hormone in the

female is probably the most

important hormone which protects

the female from getting CAD up to

menopause. (After menopause, the

hormone levels of estrogen fall, and

chances of getting CAD will be same

as male).

Alcohol

High alcohol intake defined as 75gms or more per

day is an independent risk factor for CAD

Alcohol stimulates heart,and increase blood pressure

transiently, and may precipitate CAD if other risk

factors are also there.

Alcohol also stimulates „FAT‟ metabolism, increases

obesity and results in Arteriosclerosis , Hypertension

and CAD

The evidence that moderate alcohol intake leads to a

reduction in the risk of CAD is “UNSUBSTANTIATED”

Though alcohol in small amounts (Large glass of

beer, 35ml of whisky, 70ml of wine) increase HDL, it

doesn‟t increase the protective fraction, the HDL2 of

HDL

Alcohol weakens heart muscle resulting in

Cardiomyopathy.

Personality

Type „A‟ persons‟ behaviour is

associated with competitive

drive, restlessness, hostility and

a sense of urgency or

impatience and are more prone

for CAD.

Type „B‟ persons are easy

going, less anxious, contented,

calm and philosophical in nature

and are less prone for CAD

Stress

It is well established that ambitious and

aggressive personalities are more prone for

CAD

Stress can be physical, social or emotional.

Stress causes heart to beat faster, the blood

pressure to go up, the muscles to become

tense and the arteries to go into spasms. All

these occur through release of a substance

called “Adrenaline”

Practice Yoga

Yoga, the age-old Indian practice of mind and

body control can play prominent role in the

reduction of stress and indirectly prevents

CAD. Yogic practices are ancient in India

systematized by Pathanjali in 300 BC

Oral Contraceptive pills

Women using „Oral contraceptive pills‟

have higher blood pressure and the

risk of CAD seems to be increased

and compounded by cigarette

smoking

Dietary Fiber

The cholesterol lowering effect of

certain types of dietary fiber is firmly

established, which in turn is useful

in the prevention of CAD. The daily

requirement of dietary fiber is 30-

40gm/day.

Anti-Oxidants and Micronutrients

CAD is currently thought to be a result of

oxidative stress also i.e., the generation of

excess of free radicals and peroxide in

the tissues. Oxidized blood lipids are

more “Atherogenic‟ than un-oxidized

lipids.

Anti-oxidants and Micro-nutrients such as

Vit C, Beta-Carotene, Vit-A, Vit-E and

Selenium can remove peroxides and free

radicals and there by reduce the oxidative

stress in tissues.

Yellow and orange vegetables and fruits,

green leafy vegetables, egg, milk, liver,

kidney, fresh fruits, vegetable oils, cereals

etc. are the main sources of Anti-Oxidant

and micro-nutrients....

Onion & Garlic

In scientific studies large doses of

onion & garlic are noted to be

beneficial causing a decrease in

blood lipids and glucose and an

increase in clot dissolution

(Fibrinolytic).

The garlic and onions that are

regularly included in Indians diets

may also have beneficial effect.

One may as well eat garlic as part of

daily diet rather than resort to garlic

capsules.

Salt (Sodium Chloride)

Excess salt is bad for the heart.

Indians are in the habit of

consuming 10-15 gm of salt/day

in the form of added salt.

Probably 3gms of salt/day is both

safe and adequate for healthy

adults.

Reduction in salt in turn will

reduce blood pressure and

prevent CAD.

Water

Some scientific evidence suggests

that heart diseases are more

common in areas with soft water than

where the water is hard. Minerals

such as calcium & magnesium and

trace metals like chromium and

vanadium present in hard water

appear to be protective to heart.

What to do in case of a heart attack.

If you suspect that you are having “Heart

Attack“ Call for help at once.

Lie down comfortably & loosen tight clothing

Chew an “Aspirin” tablet immediately. ( It can

help prevent blood clot in your arteries.

Chewing lets it act faster).

Inform your doctor.

Get some one to drive you to the hospital

quickly or call an ambulance.

If you have the “Risk Factors like HTN, DM,

Smoking etc, always keep “tab aspirin & tab

Sorbitrate” handy.

How to prevent Heart Attack

Stop smoking immediately.

Stop Alcohol, gutka, jarda etc.

Maintain an ideal body, weight.

Exercise of at least 30min per day.

Reduce animal fats in your diet.

Restrict added “Salt” in your diet to only 5gms.

Control your stress. Yoga and meditation are good.

See that BP and DM are under control.

Strategy of Prevention of CAD

Population strategy

High risk strategy

Secondary prevention

Eat for a healthy heart. Don‟t eat your heart.

Conquer heart diseases through healthy life style

It is not work, but worry that kills

Practice yoga and meditation for better health

A little salt is divine .Too much is harmful

Eat to live, Don‟t live to eat.

Good Planning

If you are planning for a Year sow rice.

If you are planning for a decade plant trees.

If you are planning for a life time “EDUCATE PEOPLE”

No one knows you better than yourself

No one can eat for you

No one can lose weight for you

No one can think for you

No one can stop bad habits for you

No one can develop good habits for you

No one can take medication for you

No one but YOU can change yourself

SELF HELP

Framingham’s 10 yr Risk Score Calculation For CAD