How To Prevent Heart Attack Dr.Sapra

How to prevent HEART ATTACK? Dr Rakesh Sapra MBBS, MD, DM Consultant Cardiology ARTEMIS HEALTH INSTITUTE, GURGAON

Prevalence of CAD in India

Changing life style

CAD Risk Factors

Age (older than 55 for men, 65 for women)

Family history of premature CVD

(men under age 55 or women under age 65)

Hypertension*

Diabetes mellitus*

Dyslipidemia*

Cigarette smoking

Obesity* (BMI > 30 kg/m2)

Physical inactivity

*Components of the metabolic syndrome.

Approach to risk factor modification in prevention of CAD

Non modifiable risk factors : age, sex, race, family history of CAD

Behavioral risk factors : sedentary life style, unhealthy diet, heavy alcohol or cigarette consumption.

Physiological risk factors : hypertension, diabetes, lipid disorders, obesity, which may be a consequence of behavioral risk factors

Cholesterol abnormalities

Clinical benefits of Cholesterol Reduction

A recent meta-analysis of 38 trials demonstrated that for every 10% reduction in TC

CHD mortality decreased by 15% (P<0,001)

Total mortality decreased by 11% (P<0.001)

Decreases were similar for all treatment modalitiesd

Cholesterol reduction did not increase non-CHD mortality

High Blood Pressure

Blood Pressure Classification <80 and <120 Normal 80–89 or 120–139 Pre hypertension 90–99 or 140–159 Stage 1 Hypertension > 100 or > 160 Stage 2 Hypertension DBP mmHg SBP mmHg BP Classification

CAD Risk

Each increment of 20/10 mmHg doubles the risk of CVD across the entire BP range starting from 115/75 mmHg.

The BP relationship to risk of CAD is continuous, consistent, and independent of other risk factors.

Pre hypertension signals the need for increased education to reduce BP in order to prevent hypertension.

Benefits of Lowering BP Average Percent Reduction Stroke incidence 35–40% Myocardial infarction 20–25% Heart failure 50%

Lifestyle Modification Approximate SBP reduction (range) Modification 5–20 mmHg/10 kg wt loss Weight reduction 2–8 mmHg Dietary sodium reduction 4–9 mmHg Physical activity 2–4 mmHg Moderation of alcohol consumption

Diabetes

Smoking

Effect of cigarette smoking on CAD mortality Study Follow up Cigarette Mortality Comments (yrs.) per day ratio Hemmond (1964) 3 none 1.00 about 2-5000 1-9 1.95 men, 40-59 yrs 10-19 2.42 20-39 2.5 40+ 3.0 Pooling project 9 none 1.00 34,440 British 1-14 1.47 male physicians 15-24 1.58 25+ 1.92 Doll et al 22 none 1.00 6194 British 1-14 1.97 female physicians 15-24 2.20 25+ 2.12

Role of physical activity

Physical activity and CAD events and mortality

Multiple studies over past 35 years show a strong and consistent relation between lack of occupational and leisure time physical activity and CVD events, CVD mortality and all cause mortality.

Cardiovascular benefits of exercise