Know your heart

— Dr Nirmal Kanti Bhattacharjee
Most of us tend to take good health and good heart for granted, not realising that the cardiovascular diseases like heart attack and stroke are the two most dreadful diseases of our times. They cause about 17.5 million deaths each year, almost as many deaths as HIV/AIDS, tuberculosis, malaria and diabetes plus all forms of cancer and chronic respiratory diseases combined together. Yet both these diseases are preventable to a large extent by timely and appropriate action. Prevention is always better than the cure and heart diseases are the most fitting maladies to prove that age-old adage.

When we talk about prevention, the first thing that comes to mind is what and how to prevent. The cardiovascular diseases are the results of an interaction between the vessel lining and various constituents of blood causing thickening and hardening of arteries with plaque formation. The plaques are fat (lipid) laden deposits that clog the arteries producing ischaemia, and often burst with formation of blood clots and complete stoppage of blood flow. That is what causes heart attacks and strokes. The process starts early in life, may be in the childhood or adolescence, and progresses insidiously over the years before producing any symptom or sign of the disease. Those who develop symptoms are lucky ones because they can at least have the benefit of treatment, though the presence of symptoms indicates that the process has progressed too far. But in many patients, the disease may remain completely silent; and events like sudden death may be the first and last symptom! It would be prudent to think of prevention, not when someone is having a problem but before the problem starts bothering you. Nip in the bud; it may be called in common terms.

Here comes the question of risk factors. The arterial damage and plaque formation may come as a part of ‘wear and tear’ with aging, though it cannot be taken as an invariable accompaniment of getting old; many elderly persons can have clean coronaries even at a ripe old age. However there are certain factors that predispose to or accelerate the process leading to heart attack or stroke even at an early age, and these are called the risk factors. While few of them like age, sex and family history (heredity) are non-modifiable, it is possible to modify or control many other risk factors. These include conditions like high blood pressure, diabetes, obesity and lipid disorders – ‘the gang of four’ - and a bad lifestyle that predisposes to these metabolic abnormalities. Hypertension currently affects more than a billion people worldwide and it is predicted that by 2025, nearly one in three adults over the age of 25 will have high blood pressure. Diabetes is also on the rise, especially in the Indian sub-continent, and by 2010 there will be 221 million people in the world with diabetes, and more than two-third of them will die from heart disease and stroke. Lipid abnormalities like rise in bad cholesterol and fall in good cholesterol adversely affect the arterial health. Obesity especially of the abdominal type is the fourth member in this gang and plays the central role in clustering of hypertension, diabetes and lipid disorders in an individual. The rate at which obesity is increasing even in younger generation, it is no surprise that we are heading for a major epidemic of cardio-vascular diseases. All these metabolic conditions are again related to our lifestyle – high calorie fat rich diet, lack of fruits and vegetables, fast (‘junk’) foods, smoking and tobacco use, physical inactivity, psychosocial tension and others - the changing pattern of present day living pervading almost every strata of the society and every region of the country.

Keeping this in mind, the theme for World Heart Day this year has been taken as ‘Know your risk!’ and act for a healthy heart. While it focuses on the importance of regular preventive heath check without waiting for symptoms to develop, it also puts a responsibility on the health care professionals to take every opportunity to look for cardio-vascular risk factors even in asymptomatic persons, including children. In fact, no age should be exempted from that scrutiny. Hypertension termed as a ‘silent killer’ is of special importance; it is so easy to measure and so simple to treat that it would be nothing but callousness and negligence not to check the blood pressure whenever any opportunity comes. Knowing body weight, body mass index (BMI) and waist size can warn someone to the risk of having hypertension, diabetes or lipid disorders and will also be a tool for adequate follow-up. The biochemical factors and lifestyle parameters can be added up to get the total risk score and then appropriate measures may be taken to reduce the risk burden.

What are those measures? Almost all the risk factors for heart disease, leaving aside heredity, are rooted in our lifestyle – our diet, activities, habits and thoughts. Therefore it is necessary to make lifestyle modifications to eliminate the bad factors and inculcate those, which have a positive effect on our heart and health. Taking a balanced and prudent diet with less amount of saturated fat and cholesterol but more of vegetables, fruits, fibres and antioxidants, stopping smoking and tobacco, going for regular exercise even as simple as walking; controlling stress through yoga and meditation and developing a positive attitude in life are essential components of heart care. These can be supplemented by the use of drugs to control the hypertension, diabetes and the lipid abnormalities whenever required. It has been said that if one can make it to age 50 with optimal, very achievable, risk-factor levels, it essentially abolishes the remaining lifetime risk of developing cardiovascular disease and chances for living a longer, healthier life are substantially improved. That is what we are all striving to do and so should start thinking of how to achieve that. The important point in prevention is to know the risk and act – the sooner, the better. For it is never too early to start caring for the heart, nor too late to try to keep it healthy.
(Published on the occasion of World Heart Day) source: assam tribune editorial 28.09.08