Prevention of Heart

Disease
 What is Heart Disease?
• Heart : The most hard-working muscle of our body
– pumps 4-5 litres of blood every minute during
rest
• Supplies nutrients and oxygen rich blood to all
body parts, including itself

• Coronary arteries
surrounding the heart
keep it nourished with
blood
 What is Atherosclerosis
what is coronary artery
disease?

• Over time, fatty deposits called plaque build up within the

artery walls. The artery becomes narrow. This is
atherosclerosis
• When this occurs in the coronary arteries, heart does not get
sufficient blood, the condition is called coronary artery
disease, or coronary heart disease
 Myth : fat deposits at old age!
It starts from 2 years ofComplicated
age
Foam Fatty Intermediate Fibrous Lesion/
Cells Streak Lesion Atheroma Plaque Rupture

From First From Third From Fourth

Decade Decade Decade

Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104).

Are Other organs Affected?

Ischemic Stroke

Coronary Heart Disease

• Angina
• MI (Heart Attack)
• Sudden Cardiac Death

Peripheral Vascular
Disease
 What are the symptoms of
Coronary artery disease?
• No symptoms for long period
• Chest pain for short period on
exertion also known as Angina or
minor heart attack
• Myocardial Infarction or major heart
attack-Severe chest pain, death of
heart muscle, heart failure, irregular
heart beats
• Sudden Death
 How Big is the Problem ?
• No. 1 killer disease worldwide
– 12 Million deaths annually
• During last 30 years large declines in
developed countries -rising health
awareness and government
programmes
• Alarming increase in developing
countries especially India
Why Should I (Indian) be Worried
?
• Indians More susceptible that any other ethnic
group
– 3.4 times more than Americans
– 6 times more than Chinese
– 20 times more than Japanese
– Occurs at lower cholesterol
• Get the disease at much younger age
– 5-10 years earlier than other communities
• Disease follows more severe and malignant course
– 3 times higher rate of second heart attack and two times higher
mortality than whites
 Why Me ?
• Genetic predisposition

• Poor handling of fats and metabolic

syndrome
– Diabetes, obesity, high BP, Coronary artery
disease

Environmental insults
• Urbanization

• Sudden change in lifestyle

 What Increases Risk?
You can’t help it ! You can !!
• Age: • High Cholesterol
Men > 45;
Women > 55 • Smoking
• Sex • High Blood Pressure
• Race • Diabetes
• Family History • Obesity
• Alcohol
• Physical Inactivity
Cholesterol ( A type of fat)
• Everybody needs cholesterol, it
serves a vital function in the body.
• It circulates in the blood.
• Too much cholesterol
can deposit in the
arteries in the form of
plaque and block them
• No symptoms till heart
attack
 Where does it come from ?
65% 35%

• Two sources of
cholesterol:
Food & made in
your body
• Food sources: All
foods containing
animal fat and
meat products
 Good vs. BAD Cholesterol
Cholesterol
• LDL cholesterol is known as bad
cholesterol. It has a tendency to
increase risk of heart disease
• LDL cholesterol is a major component
of the plaque that clogs arteries
• HDL cholesterol is known as the good
cholesterol. Higher in women, increases
with exercise
• HDL cholesterol helps carry some of the
bad cholesterol out of arteries.
 Obesity
• People who are overweight (10-30 % more
than their normal body weight)
• Obese have 2 to 6 times the risk of
developing heart disease
• Normal Waist-Hip Ratio
< 0.85 for women;
< 0.95 for men

• Pears or apples?
 Pears and Apples
Apple- shaped are at a higher risk

Pear-shaped paunch store fat on the

hips and thighs, just below the surface of
the skin.

Apple-shaped paunch store body fat

around the abdomen and chest,
surrounding internal organs
 Physical Inactivity

Every morning my
brain tells me to
exercise…
….. and my body
laughs at the idea
 Cigarette Smoking
Smoking
• Increases blood pressure
• Decreases HDL
• Damages arteries and blood cells
• Increases heart attacks
• Cigarette smoke contains more than
4,000 chemicals, and 200 of these
chemicals are poisonous
 Cigarette Smoking
Smoking
If you think YOU are smoking the cigarette, you are
mistaken… It’s the other way round !
 Alcohol Consumption
Consumption
• In small amounts it is beneficial: 1-2
drinks
• In large amounts it adds fat and
calories & raises BP!
• 4 drinks per day. You end up with
gastroenterologist instead of
cardiologist
• This is a very fine line! Finer for
women as they are at higher risk
 Diabetes
• At any given cholesterol level, diabetic
persons have a 2 or 3 x higher risk of
heart attack or stroke
• A diabetic is more likely to die of a heart
attack than a non-diabetic
• ~80% Diabetics die from heart disease
• Risk of sudden death from a heart attack
for a diabetic is the same as that of
someone who has already had a heart
attack.
Interactions of Risk Factors
➨Risk operates across a continuum - no clearcut line

(Blood Pressure; Cholesterol; overweight; Smoking)

➨The risk is multiplicative when many risk factors co-

exist; risk factors often cluster together

➨Majority of events arise in individuals with modest

elevations of many risk factors than from marked

elevation of a single risk factor
 Misfortunes always come
in by a door that has been
left open for them.

Czechoslovakian proverb
Everyday you make choices to
try to help protect yourself and
your family. In fact, protecting
yourself has become second
nature—you just do it.
But do you know what you can
do to help protect yourself from
this number 1 cause of death-
Heart Disease?
For my car, I want the
best mechanic.
But for my own body, I follow
hearsay and advice from
friends, kitty party, local
quacks….
Just anyone
And decide for the worst
 Creative strategies do not
work !
• Karva Chauth!
• Never had a test or retest
• Never been to Doctor !
I hate them
• Never take medicines!
• My BP is normal, so stopped
meds!
• Miracle men and Miracle
Medicines! So many of them
• I am my own doctor! No fees
too
 Preventing
Preventing Heart
Heart Disease
Disease
Rule
Rule #1 Look before your eat
• Eat a variety of fruits and vegetables every
day. (5 servings - they are naturally low in fat
and high in vitamins and minerals and anti
oxidants). Eat colored vegetables and fruits
• Eat a variety of grain products
• Choose nonfat or low-fat products.
• Use less fat meats- chicken, fish and lean cuts
 Switch to fat-free milk—toned/skimmed milk
 Dietary Guidelines
• Limit your intake of foods high in
calories and low in nutrition, including
foods like soft drinks, candy, junk food
• Limit foods high in saturated fat, trans-
fat and cholesterol
• Eat less than 6 gms of salt a day
• Have no more than1-2 alcoholic drink
a day if you are a regular drinker
 Limit / Avoid
• Foods rich in Cholesterol and
Saturated fats
– Egg Yolk
– Fatty meat & organ meat( Liver)
– Butter chicken / Batter fried fish !
– Milk fat – Desi Ghee, Butter, Cheese,
Malai, Rabri, Khurchan, Doda, Ice Cream,
full cream milk,
– Hidden Fat like Bakery biscuits, Patties (!),
Cakes, Pastries,
 Cooking
Cooking Oils:
Oils: The
The mystery
mystery of
of
PUFA
PUFA // MUFA
MUFA
• Saturated Fats : Increase Cholesterol – Avoid
– Coconut oil, Palm oil, Vanaspati ghee
• Monounsaturated Fats (MUFA): Heart healthy
– Olive oil, Groundnut oil, Canola oil, Mustard oil
• Polyunsaturated Fats (PUFA): Heart healthy
– Sunflower oil, Soybean oil

• Omega-3-Fatty acids Fish oil : Heart Healthy

Rotate the oils or Mixture of oils

 Preventing
Preventing Heart
Heart Disease
Disease
Rule #2 Exercise
• Maintain a level of physical activity that
keeps you fit and matches the calories
you eat
• Serves several functions in preventing
and treating those at high risk
• Reduces incidence of obesity
• Increases HDL
• Lowers LDL and total cholesterol
• Helps control diabetes and hypertension
Exercise, Exercise, Exercise
•Mortality is halved in retired men who walk more
than two miles every day
•Regular exercise can halve the risk of heart
disease, particularly in men who walk briskly
•Someone who is inactive has as great a risk of
having heart disease as someone who smokes,
has high blood pressure or has high cholesterol
•Exercise significantly reduces the chances of
diabetes and stroke
•With regular exercise, blood pressure in those
with hypertension is reduced by as much as
20mms Hg
 Exercise and Heart Disease
Moderate to intense physical activity for 30-45
minutes on most days of the week is
recommended
Walking for a healthy heart
Complicated exercise machines or sweating it out in the gym not essential
•

JUST WALK!
 Rule # 3 Stop Smoking
NOW!
• The risk of heart attack starts decreasing
within 24 hours of quitting smoking, within
1 year of quitting, CHD risk decreases
significantly, within 2 years it reaches the
level of a nonsmoker

• Smell and taste improve within days

• Within three months of quitting, the

smokers' cough disappears in most people
Rule # 3 Stop Smoking
NOW!
 Benefits much beyond Heart
Disease
Tobacco Cardiovascular

Cancers
Diet
Diabetes

Chronic Respiratory Diseases

Physical Activity
Osteoporosis

Oral Health
Alcohol
Mental Health
 Rule # 4 Know your
Number!
And that’s not your Mobile Number!

Desirable numbers
• Total cholesterol < 200;
• LDL < 100
• HDL > 40
• triglycerides < 200

• Get the levels tested routinely and keep

them under control
• The only thing worse than finding out that
you have one of these conditions
is…….NOT finding out that you have it!!
 Benefits of reducing
cholesterol

10% reduction of blood

cholesterol produces 20-30%
decline in CHD deaths

All Adults >20 yrs must get tested- if normal test again
after 5 years, if elevated, work towards normalizing the
levels with lifestyle modification and drugs as needed
 Controlling Blood Pressure
• Adults should have their blood pressure
checked at least once every two years, as
there are no symptoms to tell if you have
high blood pressure
• Optimal levels : 120 /80 mm Hg
• If high
– Modify your lifestyle – Diet, Weight, Exercise,
Salt restriction
– Adhere to the prescribed medication without fail,
to decrease chances of getting heart disease –
Do not stop your medicines without consulting
your doctor, even if the blood pressure becomes
normal
 Controlling Blood Sugar
• All adults should have their blood sugar
checked regularly, as there are no early
symptoms of diabetes
• Normal blood sugar:
• Fasting < 100; post meals <140
• If high
– Modify your lifestyle – Diet, Weight, Exercise
– Adhere to the prescribed medication without fail, to
decrease chances of getting heart disease – Do not
stop your medicines without consulting your
doctor, even if the blood sugar becomes normal
 If you or someone in your family
already diagnosed with heart
disease
• Don’t get disheartened – science has made
significant progress
• Just monitor risk factors much more aggressively
– Eat healthy
– Walk regularly
– Watch your weight
– Quit smoking immediately
– Keep your weight under control
– In addition to improving your heart – health these
measures are sure to enhance your appearance !!
• Adhere to you medicines & listen to your doctor
Don’t wait for a heart attack to
take an action !

Don’t wait for a second life

we are not cats!
 Heart disease is often avoidable. Following a heart-
healthy lifestyle doesn't have to be complicated, and it
doesn't mean you need to live a life of self-deprivation.
Instead, find ways to incorporate heart-healthy habits
into your lifestyle — and you may well enjoy a healthier
life for years to come.