By M. P. Ravindra Nathan, MD, FACC, FACP, FRCP
In spite of all the modern advances in the diagnosis and management heart disease, more specifically Coronary Heart Disease (CHD) that includes ‘heart attacks’ that you often hear about, it still appears to be the number one killer in the U.S. accounting for over 350,000 deaths a year. There are many risk factors for heart disease and understanding of such factors is critical for the prevention of cardiovascular morbidities and mortality. And many of these risk factors are modifiable and if we can pay attention to these factors a little more closely we can prevent many heart attacks and premature deaths.
Every one of us, adults, is at high risk for heart disease and we must do everything possible to stop this killer. Coronary Artery Disease (CAD) has now become the most predictable, the most preventable and the most treatable of all chronic diseases. Individuals at high risk of developing cardiovascular disease should be identified and preventative measures should be taken. This is called risk stratification.
Research reveals that nearly 50% of all diseases are lifestyle related, particularly heart attacks and strokes. So why not follow the advice from medical professionals and make the appropriate changes in your lifestyle? Heart disease can be prevented or at the very least postponed to a ripe old age if you pay close attention to your own risks. Prevention is much cheaper too, in the long run. So it behooves us to take the first steps to reduce the burden of this serious disease in the community. Even if one had already been diagnosed with the disease, future complications can be avoided by embracing the basic principles as listed below, what is called “secondary prevention.”
Some risk factors like, family history and gender (males are at higher risk than females) are not modifiable but many others are modifiable and treatable and everyone should pay close attention to these.
Let us look at some of the factors.
Unhealthy diet: “What you eat today is what contributes to your heart health tomorrow,” I remind my patients often enough. The ‘fried, fatty, greasy, salty and sugary food’ that we consume daily is an invitation for heart disease, so reduce the meats, butter, cream, hydrogenated fats, sweets and such. Too much refined carbohydrates could lead to early development of Type 2 Diabetes Mellitus, another risk for heart disease.
High Blood Pressure (BP), is a common problem in our clinical practice. American Heart Association recommends the ideal BP should be about 130 (systolic)/ 80 diastolic. But one can expect an age related increase as one gets older. Every pharmacy has free BP measurement station and you can quickly get a reprint of your current BP. Keeping it under control includes sticking to a low salt diet, regular exercise, maintenance of normal weight and drugs as needed.
Cigarette Smoking, also other forms of tobacco abuse, is the number one preventable cause of death, contributing to heart disease, cancer and a host of other killers. This is particularly true among young people. So quit tobacco use in any form right away.
High blood cholesterol: Check your ‘lipid profile’ and pay special attention to the total cholesterol and the bad cholesterol (LDL) numbers. They need to be kept under control with low fat diet, exercise and with appropriate medications like ‘statins.’ We don’t see often heart attacks in patients with significantly low cholesterol. As a general rule total cholesterol should be below 200 and LDL less than 100 but in high risk people, LDL should be less than 70. Actually the general agreement is, “The lower your cholesterol, the better for you.”
Diabetes Mellitus is one of the commonest causes of heart disease and hence need to be under strict control. Sadly, many who have diabetes don’t even know that they have the disease and even among those with established disease good control is lacking.
Physical inactivity: The beneficial effect of physical activity through aerobic exercise is well known. The recommended duration is about 150 minutes of moderate intensity exercise per week – 30 minutes a day, 5 days a week – like brisk walking, gentle jogging, swimming, jazzercise etc. In addition to cardiac fitness, exercise improves the lung capacity and can stave off Alzheimer’s disease too. So get moving.
Excessive alcohol usage is not good for the heart. In fact, no amount of alcohol is safe; however if you must use it, then wine is safer than hard liquors and that too in limited quantities.
Obesity: Overweight and obesity have become all too common and they result from excessive body fat, which increases the risk of serious health problems like heart disease, diabetes, high blood pressure and certain cancers. Obesity primarily results from consumption of excess of calories and hence a calorie restricted diet along with regular physical activity is the primary treatment.
Stress reduction: Lately with Covid-19 pandemic, lock down, social distancing and other factors, our stress levels have been high and we just need to find ways to keep our anxiety, tension and fears down for better health.
Based on all these known risk factors, everyone should do a personal risk stratification and come up with a suitable treatment regime in consultation with their physician. The take home message is: ‘Preventive strategies do work, and at any age, they’re well worth the effort it takes to put them into action.’
