Matters of the Heart!
As a fellow Rotarian, Dr. Aashish Contractor needs no introduction. We are all aware (rather we ought to know!) that he heads the Rehab and Sports Medicine Dept. at Sir H N Reliance Foundation Hospital, and that he is the Vice-Chairman of the International Council of Cardiovascular Prevention and Rehabilitation, as well as the Certification Director of the American College of Sports Medicine in India. However, what we didn’t know was his pragmatic approach towards reducing incidence of heart ailments, and the lucid manner in which he dealt with the subject, which made last Tuesday’s talk a compelling and informative one.
“Heart disease is the leading cause of death worldwide, and even in India. As per WHO, India has the highest prevalence of heart diseases, and is the #1 killer not just for men, but also for women. In fact, heart diseases kill women more then all cancers put together. It’s something we need to be worried about. Statistically speaking, one out of three people, will die of a heart disease, and that’s across the country!”
“Also with the so-called modern diseases that affect us today, India is facing, what is known as a double whammy. While on one hand, we still have people dying of infectious diseases such as Tuberculosis, Cholera and Diarrhea that are easily preventable; on the other, we are also getting affected by chronic diseases like cardiovascular diseases, cancer, diabetes, etc.”
“So what do we do about it? I would like to explain four important aspects of heart health, i.e., how the heart works, what is a heart attack, what are the risk factors that can cause it, and what are some of the changes that can be made to prevent it from happening. When we talk about prevention, it works in two ways: 1) Preventing the disease from happening, which is known as primary prevention, and 2) If by chance, you’ve already suffered, then to prevent it from happening the second time. That is known as secondary prevention. And what you need to do for both, is actually is similar.”
“Did you know, a heart beats 2.5-3 billion times through out an average life span, and for that it requires its own blood supply. So while the heart supplies blood to the entire body (in fact it could be called your muscular pump), it requires blood supply for its own functioning, which comes from arteries known as Coronary Arteries. These Coronary Arteries, three of which are most important, are the right coronary artery, left circumflex, and the left anterior descending. These supply blood to the heart muscles and they run on the surface of your heart. And when you have a blockage, it doesn’t happen in the heart, but inside the arteries, which supply blood to your heart.”
“So when does a heart attack take place? We are all born with pristine clear arteries. Over time blockages build up and get to a point where they start obstructing the blood supply. And when that happens, at some point, the growth of the plaque or the blockages, break in (sort of like an erupting volcano) and that leads to a heart attack.”
“So often we hear people saying that they had an Angiography and found blockages in two or three arteries, one a 60% and other a 70%. So there are chances that a 70% blockage can break and cause a heart attack, while a 90% may not! Therefore, the key is to prevent that plague from rupturing, and if you manage to do that then you have essentially reversed the heart disease.”
“How do you know? What are the warning signs? You may have heard of the word Angina, or pain in the left side of the chest and going down to your left arm. Now that’s a very classic textbook definition. Unfortunately, that happens in only 20% of the cases. Therefore, a simple way of describing it is that, any discomfort from your navel to your nose that includes your jaws, shoulders or back, especially if it’s related to exertion, which means if you walk or run it increases, and if you sit or lie down it becomes less. If that’s the nature of pain, then it can very well be related to the heart unless proven otherwise. There will be times, when you may mistake it as gas, however, it is better to get yourself checked. If it’s gas you might have wasted couple of hours and some money, but if it is heart related, then you would have saved your life.”
“Speaking of risk factors, they can be any factor, which when present increases the chances of a disease taking place. So, what are the risk factors causing the heart diseases? What causes a heart attack? Let’s run through them one by one:
1) Age – As you age, your chances of all the chronic diseases goes up. Typically if you want to define the cut off, it is 45 for men and 55 for women (As per the Inter Heart Study, Indians tend to have heart diseases a decade younger than in western countries).
2) Family history – If anyone from your family suffers from heart diseases, your risk goes up. It certainly does not mean that you will suffer or have to suffer, it just means your risk goes up.
3) Cigarettes smoking and tobacco – In all aspects of lifestyle modification, we talk about moderation. However, this is one area where moderation doesn’t work, you just have to stop! It’s like asking me should I jump from 10th floor of the building or the 5th? Either way you are going to suffer.
4) Hypertension or High Blood Pressure – We all have blood pressure, without it we cannot live. So ideally, your blood pressure should be less then 120/80. If it’s more than 140/90 we call it High Blood Pressure. And the in-between zone, i.e., 120-140 is your borderline zone.
5) High Cholesterol – When you do a Lipid profile, remember, your total cholesterol should ideally be less then 200, your Triglycerides (which is the fat in your blood) should be less then 150, LDL (is the bad cholesterol) should be less than 100, and HDL (which is the good Cholesterol) should ideally be more then 40.
6) Diabetes – Ideally, your sugar level should be less than 100 in a fasting state and up to 120 post a meal. Anything above 126 is diabetes. Check it at least on two occasions, once-in-awhile if your sugar is high, its OK, so don’t panic.
7) Obesity – For measuring obesity we look at Body Mass Index or BMI, i.e., your weight in kilograms, divided by your height in meters square. Ideally, it should be less then 25. A simple way is to measure your waistline. For men, it should be less then 35 and for women should be less then 31. This is because, the fat around the stomach is much more dangerous than the fat around the thighs and the hips.
8) Sedentary lifestyle – Not exercising regularly can also increase your risk to heart diseases. See Chart for the ‘Traditional Exercise Prescription’.
9) Stress – The problem with stress is that there is no measure to understand how stressed you are. Stress is a part of everyone’s life. But when it becomes excessive and turns into distress, that’s when it’s a problem.
“So how do we prevent it? The answer is very simple. To prevent it we need to take care of causative factors. Take a look at the Benefits of Regular Exercising Chart on Pg2. So this is one drug which can do all this and it’s not very expensive, all you need is a pair of shoes. In fact, nowadays the trend is towards bare foot running, so all you need is a pair of legs. So my question is what’s your excuse!”
“Also previously, we used to think that our brain cells are fixed in our early years of our life. However, recent studies have shown that we can still develop new neurons even past 40, 50, or even 60, in an area of the brain called the Hypothalamus. And with regular exercise, we can actually prevent diseases like Alzheimer’s.”
“Finally, what should we eat? There are all sorts of diets being advocated, and honestly, they all work as long as you follow them. The thing with most is that we like to pick and choose from different diets and eventually end up having everything. So the simple rule of thumb is to follow the traditional Indian diet, which is very healthy. Keep junk and processed foods to a minimum. Complex carbohydrates are good, but excessive sugar or fat can be under control. And lastly keep your stress to a minimum.”
“Here’s a quote by Hippocrates which sums up my recommendation, ’Eating alone will not keep a man well, he must also exercise, for food and exercise work together to produce health’.”