Healing Heart Disease Naturally

🌟Welcome to Your Journey of Ultimate Wellness! 🌈💖
Thank you for choosing our ebook/magazine! 📘✨To enhance your health and beauty
experience, we've curated some phenomenal products that promise to elevate your
well-being. 🌺🌟
Skincare Saviors:
Hydrossential - Unique Beauty Serum: 💦One Simple Way To Maintain A Flawless
Skin. Link: https://mas.so/hydrossential
Sun-Kissed Confidence:
Totally Bangin' Tan by Turbo Babe: ☀️Go From “Pale Princess” to “Golden Goddess”
with this Anti-Aging Sunless Tanning. Link: https://mas.so/bangin
Hairraisingly Healthy:
FoliPrime - The Natural Egyptian Hair Balm: 💆‍♀️Supports Hair Health. Link:
https://mas.so/foliprime
Men's Wellness Wonders:
Endo Pump - Male Enhancement MONSTER: 💪U.S. Scientists Discover Secret For
Stamina & Virility At Any Age. Link: https://mas.so/endopump
African “Sex Monkeys” Unveil How To Reverse Erectile Dysfunction So You Can Have
A Rock Hard Erection Again And Last At Least 30 Minute In Bed! (Note: Due to the
potentially offensive language, I recommend considering revising this title and
description.) Link: https://mas.so/edprotocol
Conquer Health Concerns:
MenoRescue: 🧘‍♀️Support healthy hormone levels with MenoRescue™. Formulated
using the latest Ivy League research. Link: https://mas.so/menorescue
GlucoFence - Blood Sugar Support: 🛡️#1 Most Hated By Big Pharma , Rogue Doctor
Fixes Type 2 Diabetes. Link: https://mas.so/glucofence
Bonus Goodies:
NEW '23: Archangel Health Prayers for 400 Diseases, Weight Loss... Link:
https://mas.so/archangels
Natural Therapy With Killer VSL & Captivating Hook That Converts Like Crazy For
Both Health & PD Niches! Powerful Therapy Based On Acupuncture. New Non-
Invasive Alternative. To Electro-Acupuncture, Producing Astounding Results… Self-
Application Is Easy, Rapid Response. Link: https://mas.so/naturaltherapy
Every Morning This Ancient Amazonian “Drip Method” Is Being Used To Support
Healthy Weight Loss. Link: https://mas.so/ignite
The "Hidden Survival Muscle" In Your Body Missed By Modern Physicians That Keep
Millions Of Men And Women Defeated By Pain, Frustrated With Belly Fat, And
Struggling To Feel Energized Every Day… Link: https://mas.so/hipflexors
Meditation - "InnaPeace Meditation Program" : The InnaPeace Program for Anxiety
Sufferers, Discover why thousands are flocking to what experts are calling “the most
advanced self-development method known to human kind”. Link:
https://mas.so/innapeace
Don't miss out on these amazing products! Click the links above and start your journey
to a healthier, happier you!
Don't let shortened links with mas.so send shivers down your spine! 🥶It's just a friendly
URL shrinker, like a superhero packing superpowers into a tiny suit. 💪👀Fear not, visit
https://mas.so and see what mas.so is. ✨Then, click with confidence and discover your
favorite products! 🗺️Trust needs to be built on the first click. Thanks!💎

Published by:
F-2/16, Ansari road, Daryaganj, New Delhi-110002
23240026, 23240027 • Fax: 011-23240028
Email: info@vspublishers.com
Branch : Hyderabad
5-1-707/1, Brij Bhawan (Beside Central Bank of India Lane)
Bank Street, Koti Hyderabad - 500 095
040-24737290
E-mail: vspublishershyd@gmail.com
© Copyright: Dr Dayal Mirchandani
ISBN: 978-93-81384-60-2
Edition: April 2011
The Copyright of this book, as well as all matter contained herein (including illustrations)
rests with the Publishers. No person shall copy the name of the book, its title design, matter
and illustrations in any form and in any language, totally or partially or in any distorted
form. Anybody doing so shall face legal action and will be responsible for damages.

Acknowledgement
Many people have helped and influenced me. I would like to
acknowledge my teacher, Dr AP Patkar, who encouraged me to
explore off the beaten path. Dr VD Laghate, the master physician at
the Jagjivan Ram Hospital, Mumbai – he is my model of the ideal
doctor. My son Nishant was five when I wrote the first draft of this
book and his company made this a pleasurable experience.

Contents
1. Introduction
2. Understanding Heart Disease
3. Understanding Risk Factors
4. Behavioural Risk Factors
5. Changing Coronary Prone Behaviour
6. Stress and Heart Disease
7. Diet and Your Heart
8. Exercise and Your Heart
9. Smoking and Your Heart
10. Using Your Mind to Heal Your Heart
11. Putting It All Together

1
Introduction
Shyam Aggarwal, a 45-year-old businessman, woke upone morning
with a constricting feeling in the chest. After a while, as the pain
subsided, he passed it off as a bout of indigestion and went to work as
usual. A few hours later his secretary found him collapsed over a cup
of coffee, with a cigarette burning a hole through the papers on his
desk.
Shyam was moved to a hospital where an ECG revealed a heart
attack. A few weeks later a thoroughly shaken Shyam was back at
work. He could not believe that he had a heart attack and was totally
confused as to what he should do about it. His doctors advised him to
have a bypass operation immediately or otherwise he could have
another attack any moment.
Rather than being railroaded into surgery he called in a senior
cardiologist for a second opinion who told him that as for now,
medication would be enough. Later, if he required it, an angioplasty
would be enough. He decided to wait and learn more about heart
disease by reading on the subject and talking to a doctor friend, who
told him about the possibility of reversing his heart disease using a
programme of diet, exercise and lifestyle changes. He gave him an
article describing the Ornish programme. His cardiologist burst into
laughter when Shyam broached the subject of reversing his heart
disease with a programme of diet and exercise and said it was a waste
of time.
Shyam’s doctor friend encouraged him to try the programme he
had nothing to lose and at worse it would decrease the chances of
another attack. Shyam went to work on a programme similar to the
one in this book. A few months later he went back to see the

cardiologist who had initially recommended the bypass surgery. His
cardiologist could not believe the changes in Shyam’s thallium stress
test, which showed a reversal of the earlier abnormalities, and
admitted that there was no need for any intervention at present.
Three years on Shyam is back to playing tennis and swims for an hour
daily.
Ramesh, a 42-year-old teacher, started feeling breathless whenever
he walked a short distance. He ignored this until he also started
getting chest pain. A former basketball player, he could not believe
that there could be anything wrong. His doctor made a diagnosis of
angina pectoris and prescribed medication and asked him to have an
angiography to determine the severity of blockages in the arteries of
his heart. Ramesh was mortally afraid of medical procedures and said
that he would rather leave his life in God’s hand and refused to have
an angiography when he heard that there was small chance of serious
complications.
Ramesh consulted Dr Nishant, a holistic physician trained in this
approach, who had earlier helped him to give up smoking using
hypnosis. Dr Nishant had observed that Ramesh was ambitious,
power hungry and would get angry at the slightest provocation,
simmering for days on end. Dr Nishant educated him of the link
between personality and heart disease, starting him on the Pritikin
diet and deep hypnotherapy to modify his personality.
Within two weeks, Ramesh noticed that his chest pain had nearly
vanished and that he could walk longer distances without discomfort.
Within two months Ramesh was able to walk three miles at a brisk
pace. A year later his exercise stress test was nearly normal and his
physician allowed him to start playing basketball again. Six years
later Ramesh is happy and content with no apparent evidence of heart
disease.
REVERSING HEART DISEASE
Till a few years ago, it was believed that once you had heart disease it
was not possible to reverse it. However recent studies pioneered by

Dr Dean Ornish indicate that it is possible to reverse coronary artery
disease by a combination of diet, personality and lifestyle changes.
Using sophisticated imaging techniques, he has shown beyond doubt
that it is possible to physically reverse the blockages in the coronary
arteries. This is not in just isolated cases but over 90% of the patients
who stick to his programme demonstrate these changes, saving
patients from the risk, trauma and cost of surgery while reducing the
risk of a future heart attack to a greater degree than conventional
medical treatment.
However, the Ornish programme is not for everyone as it is difficult
to follow and requires one to make major changes in diet and
lifestyle. It is time consuming requiring about two hours a day for
meditation and exercise. In addition, patients need to attend four
hour group meetings twice a week and eat a fat free diet. Many
patients find it difficult to stay with the programme unless they are
part of a group. But the dramatic advantage of this programme is that
over a period of time the arteries continue to open up, compared to
angioplasty or surgery, where the arteries tend to narrow again over
the time.
The Ornish programme is designed to be administered by a team of
highly skilled doctors, dieticians and psychotherapists. Unfortunately,
there are very few people in India with the skills needed for this
purpose and there are many unqualified people practising
psychotherapy and healing which is not a regulated profession like
medicine. In addition, the Ornish programme is not well adapted as a
self-help programme, especially the stress management and
personality modification component.
The programme outlined in this book has been designed to enable
one to make the necessary healthy lifestyle changes oneself. It is also
easier to fit into one’s daily life and will enable you to regain your
health and well-being. This is not a substitute for medical treatment.
It is designed to supplement your doctor’s treatment to help improve
the quality of your life and reduce the chances of a recurrence.
Always remember that it is necessary for you to follow this

programme in conjunction with a medical doctor. If in doubt please
follow your physician’s advice and get a second opinion from a
qualified cardiologist.
Changing the quality of your life is the most important aim of this
programme. When people discover that they have heart disease, they
often get anxious, depressed and in many cases restrict their life. They
stop going out and become preoccupied with their health. Some feel
that they are living with a time bomb in their chest and become
afraid of enjoying life. This programme will help change this and
bring more joy and flexibility into your life.
Mind-body healing is one of the new advances in the behavioural
sciences. Using psychological techniques, it is possible to positively
influence or even cure many physical disorders. There is plenty of
research going on in this field and new techniques are being
developed every day. This field is gaining acceptance from the
orthodox medical practitioners as well as practitioners of alternative
medicine.
Cancer is one of the first diseases where the mind-body approach
has become popular. Dr O. Carl Simonton, a radiation oncologist, is
one of the pioneers in this field. In the 1970s he developed a
programme of therapeutic Mental Imagery and psychological change
for patients with incurable cancer. Patients in his programme lived
twice as long as patients who only received conventional medical
treatment. More than the prolongation of life was the improvement in
the quality of life that his patients reported. A few of the patients
declared to be incurable had a complete regression in their tumours
and are alive and well many years after.
Over the years, many more effective and advanced mind-body
healing techniques have been developed. The pioneering work of Dr
David Cheek M.D utilises hypnotherapy to treat gynaecological and
physical disorders. Mind-body healing is now being used in the
treatment of a variety of chronic ailments such as irritable bowel
syndrome, allergies, ulcers, ulcerative colitis, rheumatoid arthritis,
chronic pain and skin disorders. Patients with psychosomatic diseases

are now routinely being offered mind-body healing at some of the
better medical centres across the globe.

T
2
Understanding Heart Disease
he aim of this chapter is to help you understand the medical
aspects of heart disease. It is very important that you understand
your illness, because only then will you be able to take an active role
in healing yourself. It is important to know a bit about the circulatory
system to be able to understand the illness.
In medicine, new discoveries are being made all the time. Therefore
be prepared that your doctor may give you information at variance
with what is written here. For example, new research may show that
certain procedures are no longer as effective as they are made out to
be. Safer procedure may be discovered, new drug discoveries may
revolutionise the treatment of heart disease.
It is always a good idea to get a second opinion – especially if you
are confused or have any doubts. It is always a good idea to get a
second opinion before undergoing an angioplasty or bypass surgery. It
is important you choose a doctor with whom you feel comfortable.
Your doctor should be willing to discuss and explain things to you.
THE CIRCULATORY SYSTEM
The blood supplies the body with nutrients and oxygen and carries
away the waste products of metabolism to the organs of excretion.
The blood is moved to the tissues through a network of intricate
channels called blood vessels.
The heart is a pump that pumps blood along these channels
through the body. The blood from the heart is first pumped into the
aorta, the main blood vessel of the body. The aorta then divides into a
network of increasingly smaller blood vessels that go on to supply
various parts of the body. The small arteries further divide into

smaller vessels called arterioles. These arterioles then divide into
millions of thin-walled vessels called capillaries that supply blood to
tissue and cells.
Fig. 1 - Circulation of Blood
The capillaries rejoin to form veins that carry back the blood from
which the oxygen has been used, through the veins back to the right
side of the heart. From here, the deoxygenated blood is pumped into
the lungs where it is oxygenated and then sent into the left side of the
heart.
Blood is supplied to the heart muscle by the coronary arteries
which arise at the base of the aorta. There are three main coronary
arteries that break up into smaller branches, each of which supplies a
small area of the myocardium (heart muscle) with blood. The
branches of the coronary arteries break up into smaller vessels called
arterioles that finally divide into even finer vessels capillaries. It is
through the walls of these capillaries that oxygen and nutrient
substances diffuse into the heart muscle cells.
Each coronary artery supplies a particular part of the heart with

small areas of overlap. In cases of sudden block of a coronary artery,
the muscle supplied by it is damaged permanently. If the blockage
develops slowly, often the capillaries from adjoining areas grow into
the area starved of blood. This is called development of collateral
circulation and is more commonly developed in elderly people who
exercise moderately. When there is a total blockage to a coronary
artery with a well developed collateral circulation the extent of
damage to the heart muscle is minimised. Younger people usually
have fewer collaterals and are more likely to die from a first infarct
than an older person.
Fig. 2 - Coronary Arteries
CORONARY ARTERY DISEASE
While it may appear that modern medical science knows the real
cause of heart disease, actually this is not true. So much is still being
discovered so that anyone who studies the subject in any depth will
realise that what is known is the pathology (changes in structure and
functioning) but not the cause. Heart disease is a multi-factorial
illness in the sense that there are a number of factors that come
together to cause a problem.
There is little doubt that physical factors such as a high fat diet

and/or the lack of exercise are contributory factors in coronary artery
disease. One must remember that the emotional factors are equally if
not more important. There are numerous epidemiological studies of
groups of people who have a high fat diet, are sedentary and smoke
but have much lower rates of heart disease than people from other
communities with similar habits. The crucial factor that seems to
protect these people is a Type B disposition, low levels of stress and a
stable and close social network.
In most cases of coronary artery disease, it is the deposition of
cholesterol, a fatty substance in the wall of the artery that causes the
problem. The deposition of cholesterol in the arterial wall is called
atherosclerosis or arteriosclerosis. The fatty deposits in the arterial
wall are called plaque or atheroma. The fat deposits lead to a
narrowing of the lumen of the artery and a reduction in the amount
of blood that can flow through the vessel. More important the
deposits of LDL cause inflammation and swelling in the walls of the
artery and this leads to rupture of the plaque and formation of a clot
at that point. The extent of blockage is not a very good indicator of
the risk of having a heart attack in the near future as the incidence of
heart attacks is high in people with 30-40% blockages. This is because
the plaque may be soft and there may be greater inflammation, while
the plaque in an artery with 90% block is likely to be harder and less
likely to rupture if there is less inflammation. It is important you
know this as some doctors use the fact of a high percentage of
blockage to railroad people to have an angioplasty or bypass surgery
immediately.

Fig. 3 - Atherosclerotic Artery
One should also be aware of the fact that some patients who have
had a myocardial infarction do not have significant deposits of
cholesterol in the walls of their coronary arteries, their problem is
due to the artery going into spasm due to stress and psychological
factors. Hence even if an angiography does not show any significant
blockages, it is necessary to work on changing your response to stress,
personality and other risk factors.
MYOCARDIAL INFARCTION
Any blockage to a coronary artery leads to damage and death of the
muscle supplied by that artery. This is known as a myocardial
infarction. Once the artery is blocked, the heart muscle in the area
supplied by it dies within a short while due to lack of adequate
oxygen and nutrients. The heart muscle does not regenerate after it
has been damaged. Instead it is replaced by tough, fibrous, inelastic
tissue. The total amount of contractile muscle is reduced and because
of this, less blood can be pumped by the heart.
The blockage is usually due to the formation of a clot in the
coronary artery. Sometimes the plaque can rupture and then block
the artery. In certain cases an infarct is due to a spasm in the

coronary artery due to stress or an emotional reaction. An artery can
go into spasm in the absence of significant atherosclerosis but
narrowed arteries are more likely to get blocked.
If a large portion of the muscle is destroyed following the infarction
then the person may die immediately, as the heart is unable to pump
enough blood to maintain the vital functions of the body. Generally
the amount of muscle destroyed is not enough to cause death but may
cause a reduction in the blood supplied for bodily functions. This
leads to what is called cardiac failure and the other organs start
giving way as they do not get enough blood. Sometimes there is
enough reserve left to function while resting but there is no reserve
capacity to deal with the increased demands of blood by the body
during activity.
RECOGNISING A MYOCARDIAL INFARCTION
The first symptom is usually pain in the centre of the chest. This pain
is often described as squeezing or vice-like, but in some cases the pain
may be mild or even absent. The pain often radiates to the shoulder,
back, neck or down the inner side of the left arm down to the little
finger. Occasionally the pain may only arise in the epigastrium (the
pit of the stomach) or in the shoulder, jaw, neck or arm and may be
associated with sweating and/or nausea or vomiting. Occasionally
profuse sweating may be the only sign of a myocardial infarction. In
some cases, there are no symptoms: the so-called silent myocardial
infarction that is only picked up on an electrocardiogram.
DIAGNOSIS OF A MYOCARDIAL INFARCTION
Usually the symptoms are diagnostic but your doctor will always
confirm the diagnosis with an electrocardiogram (ECG). Following a
heart attack certain diagnostic changes appear on the
electrocardiogram, but in many cases it may take a few hours before
changes appear.
In addition to an ECG, your doctor will also ask for some blood
tests. Enzymes such as creatinine phosphokinase (CPK), SGPT

enzymes are released into the blood when there is muscle damage.
During an infarction, the muscle is damaged and the enzyme levels
rise but again this may take some hours. So the test may be repeated
if required.
As the confirmatory tests such as the enzyme levels and the ECG
may take some time to become positive, your doctor will usually
admit you to the ICU for observation if he suspects an infarction on
the basis of your symptoms.
The important thing during this phase is to remain calm. Panic
leads to the release of stress hormones in the blood and this raises the
heart rate and risk of arrhythmias.
TREATMENT OF A MYOCARDIAL INFARCTION
In the intensive care unit you will be connected to a monitor that
records your heart rate and ECG that allows any abnormal rhythms of
the heart to be detected immediately so that you can be given
medicines to rectify them.
If you reach the hospital an hour or so after the onset of symptoms,
clot busting drugs may be able to dissolve the clots completely and
prevent muscle damage. An angioplasty at this stage is another option
that may prevent muscle damage.
After a few days in the ICU, if there are no complications, your
doctor will move you to an ordinary room in the hospital and then
later discharge you. Post discharge it is important to continue your
medication as prescribed by your doctor.
Usually you will be advised to walk around the house for about ten
days and then over the next four to six weeks, gradually build to
about a kilometre of slow walking. Always follow your cardiologist’s
advice about exercise.
After six weeks if you want to restart vigorous exercise, you should
have an exercise stress test. This will help determine your exercise
tolerance.
ANGINA PECTORIS

In this condition one or more coronary arteries are partially blocked
due to the fatty deposits (atheroma) within the wall of the artery. The
atheroma restricts the amount of blood that can flow through the
lumen of the artery. The diseased arteries are narrowed and hardened
and cannot expand to allow more blood to flow to the heart muscle
during exercise or times of increased oxygen demand. This leads to
the heart muscle being starved of oxygen and nutrients and causes the
pain during exertion. The pain is caused when the heart muscle’s
demand for extra oxygen during exertion is not met. The anginal pain
is a protective signal that warns the person that he has done enough
and needs to rest.
Patients with angina pectoris are at a greater risk of having a
myocardial infarction or developing irregular (potentially fatal) heart
rhythms called arrhythmias. Because of this, it is important that you
take anginal pains seriously. Angina is a warning that your heart is
not getting enough blood and that the heart muscle has not suffered
irreversible damage as in an infarction.
SYMPTOMS OF ANGINA
Chest pain that is brought on by exertion such as walking or running
and relieved by rest is the commonest symptom of angina pectoris.
The pain may extend into the neck, shoulder or the left arm and is
usually described as a heaviness or crushing sensation. The pain of
angina may be associated with feeling that the heart is beating very
fast (palpitations) or breathlessness. In some cases, the pain may
continue for hours and could indicate an imminent myocardial
infarction.
DIAGNOSIS OF ANGINA
The typical history of pain or exertion relieved by rest along with the
ECG is often diagnostic. The ECG may show certain changes
indicative of reduced oxygen supply to the heart called ischemia. In
many cases of angina the resting ECG may be normal but an exercise
stress test detects and confirms that the person has angina pectoris.
This can then be confirmed by a C.T angiogram if your doctor thinks

it is necessary.
If you have angina and start this programme soon, it is possible to
reverse the blockage and prevent future infarction. Moreover it can
prevent the need for bypass surgery or an angioplasty.
Remember that even a small decrease in the amount of blockage
can lead to a substantial increase in the amount of blood flowing to
the heart muscle. A 5% reduction in the amount of blockage, from
75% to 70%, allows a 100% increase in the amount of blood flowing
through the artery and can lead to complete relief from symptoms.
One can thus get a substantial amount of pain relief in a short period
of time if one follows the programme.
One should not get frightened if an artery has a high percentage
blockage because the plaque is likely to be harder and stable,
therefore less likely to rupture in the near future, giving one enough
time to start on a programme of diet and exercise. People with
blockages as high as 90% have done well on the Ornish programme.
ARRHYTHMIAS
The heartbeat is co-ordinated by electrical impulses that are
generated and transmitted across the heart by a specialised system of
tissue. In the event that there is a reduction in the blood flow or
damage to these tissues the heart starts beating irregularly, or may
even stop.
This irregular heartbeat is known as an arrhythmia. There are
various types of arrhythmias but what one must understand is that
these arrhythmias can lead to a great reduction in the flow of blood
and in some cases can even lead to death. Nicotine and caffeine can
make arrhythmias worse or induce them in susceptible persons.
Emotion and stress can precipitate arrhythmias in vulnerable
individuals. There are many cases of people dying suddenly in
response to emotional stress and the most likely cause of sudden
death in these circumstances is a type of arrhythmia called
ventricular tachycardia. Your doctor may detect an arrhythmia while
examining your pulse or it may show up on an ECG.

MEDICAL TREATMENT
The first line of medical treatment for coronary heart disease is
medication that dilates the coronary arteries (such as the Nitrates)
thereby increasing the supply of oxygen to the heart. In addition
other drugs reduce the oxygen consumption of the heart by slowing it
down or reducing the resistance against which the heart beats and
anti-arrhythmic medication, if required. It is important that blood
pressure and diabetes be controlled aggressively.
In addition most patients with coronary artery will receive anti-
clotting medication to prevent new clots forming. Small doses of
Aspirin are commonly used for this purpose.
It is a good idea to read about the medication you take, become
aware of how they work and of their benefits and side effects. There
is a wealth of updated information available on the internet.
CHOLESTEROL LOWERING DRUGS
The introduction in the 1990s of the Statins, a group of cholesterol
lowering drugs, has significantly lowered the disability and death
rates in patients with coronary artery disease.
The statins rapidly and effectively reduce cholesterol levels, shrink
the plaque and reduce inflammation in the arterial wall. Today it
would be unusual for a cardiologist not to recommend these drugs for
someone with CAD even if the person does not have elevated levels of
cholesterol.
The Simvastatin Survival study by Dr Terje Pedersen, Head of the
Coronary Care Unit at Aker University Hospital, Norway was one of
the earliest studies using statins on 4444 men and women. He found a
30% reduction in heart attacks and 42% reduction in death rates and
a 37% reduction in the need for invasive procedures such as
angioplasty and bypass surgery.
While on cholesterol lowering medication you will be required to
have frequent blood tests; you will need to have regular serum lipid
levels regularly to determine that these medicines are working and
tests to make sure that they are not causing any liver or muscle

damage.
Many experts including Dr Ornish recommend that before getting
onto cholesterol medication it is worth attempting to reduce
cholesterol levels through dietary means. The Ornish, McDougal and
Pritikin programmes have all been found to be effective and utilise a
very low cholesterol and fat diet, with less than 10% of calories from
fats (unlike most cardiologists who allow 20-30% of calories from
fats).
They offer an option for people unwilling or unable to go on a fat
free diet. Aggressive cholesterol lowering plus exercise and stress
release and personality modification provides significant benefits.
CORONARY BYPASS SURGERY
Surgical procedures are becoming increasingly popular for treating
patients with heart disease. In this procedure the blockage is bypassed
by a graft from the veins of the legs, thus increasing the blood flow to
the heart muscle. This is a major operation with mortality rates of 1-
2%. In addition, high percentages (5-20%) of patients develop other
complications such as infection. One of the major problems with a
bypass operation is the fact that the graft closes down in a fairly high
percentage of cases, up to 50%, in the first five years. To overcome
this, surgeons have started using arterial grafts utilising the internal
mammary arteries in the chest, they have a lower failure rate.
While CABG does improve quality of life, many studies have shown
that there is not much difference in the death rates between patients
who have undergone bypass surgery and those receiving conventional
medical treatment. These studies revealed that only patients with the
advanced CAD i.e. more than 90% blockage of the left coronary
artery, or of three or more vessels with significant blockage with
moderate or severe left ventricular dysfunction had improved survival
for some years. One must balance this against the fact that some
patients die as a consequence of the operation and many suffer non-
fatal complications.

ANGIOPLASTY
This is a less invasive and cheaper procedure than bypass surgery.
The cardiologist inserts a thin catheter into an artery in the arm or
groin and then guides it into the coronary artery, the area that is
blocked. A small tube with a balloon at the end is inserted through
the catheter. This tube is then inflated and as it expands it opens out
the blockage by compressing the plaque and expanding the artery.
There is a small risk of death and a small percentage of patients will
have an infarction or ruptured artery during the procedure. A team of
surgeons are usually standing by so that, in event of complications,
emergency coronary artery surgery can be performed.
The major problem with an angioplasty is that in approximately
30% cases the arteries close down again within a few months
necessitating bypass surgery. To overcome this problem various
techniques have been developed, such as inserting a small metallic
spring (stent) into the artery after the angioplasty to keep the artery
open. They reduce the risk of immediate closure to less than 10%.
Some years ago very expensive medicated stents have been
introduced that have a special coating, which reduces the chances of
immediate re-occlusion to less than 5% after an angioplasty. However
in 2007 warnings were issued about the safety of these medicated
stents and the jury is still out on them.
SURGERY AND ANGIOPLASTY VS LIFESTYLE CHANGES At the
time of this edition (2007) there is still controversy about whether
surgery or angioplasty alters the long term prognosis of patients with
coronary artery disease. What it does, is to improve the quality of life
and exercise tolerance. It is likely that in certain sub-groups of
patients these procedures will prolong life, especially in those not
willing or able to make lifestyle changes. But even here some patients
who otherwise would have survived will die or suffer debilitating
complications due to the intervention.
On the other hand, a programme of personality and lifestyle
changes will prevent the progress of the disease and the clogging up
(restenosis) of the arteries that plague these procedures.

Studies have shown that patients who have a Bypass or Angioplasty
adopt a healthier lifestyle and diet, more so patients who have had
surgery. Many researchers believe that this may explain the short
term survival advantages of people with high risk CAD. If the patient
does nothing to change his lifestyle and diet, bypass surgery may not
prolong life very much.
Dr Ornish found that his programme did not prevent the 30%
restenosis rate in the first few months after an angioplasty. Therefore
it is preferable to attempt an intensive programme of diet and
lifestyle changes before any traumatic procedure that may damage
the endothelium and normal anatomy of the arteries. This is
especially true if your doctor feels that it would be safe to wait for
some time before having the operation or invasive procedures.
It may be possible to avoid surgery if one starts follows this
programme seriously at an early stage as soon as one discovers that
one has heart disease.
PREVENTION
The prevention and screening for heart disease that starts in
childhood. There is no doubt that a programme of inculcation of a
healthy mental attitude, appropriate diet, exercise and non-smoking
prevents the discomfort and suffering caused by coronary artery
disease. One should also have regular screening for cholesterol, once
in childhood and once every five years after the age of 20. After the
age of 40 it is wise to have a full medical examination yearly.

S
3
Understanding Risk Factors
tatistics show that heart disease is one of the leading causes of
death, across the globe. In India many more people are developing
severe Coronary Artery Disease (CAD) at an earlier age than ever
before. This increase in incidence has been attributed to changes in
lifestyle, smoking and the stresses of modern life interacting with a
genetic vulnerability.
Studies from UK, US and Indonesia indicate that people of Indian
origin are developing heart disease at a rate higher than the locals. In
UK and USA we have a 40-50% higher rate of heart disease than the
local population. In the age group under 40 the incidence of heart
disease is 4-6 times higher. This increased incidence is especially
marked in the middle classes and has been attributed to a genetic
vulnerability that manifests when the person has rich diet and higher
levels of stress.
Research also shows that adopting a western lifestyle is one of the
major causes for the increased incidence of heart disease among Asian
peoples. The Japanese, for example, have one of the lowest rates of
heart disease in the world. Once they migrate to the West and adopt
an American lifestyle their rates of heart disease increase 5 times, to
reach American rates. The Japanese who move to America and
maintain their Japanese lifestyle experience no such ill effects.
RISK FACTORS
In this section we will look at some of the risk factors that contribute
to the development of heart disease. Many of these can be modified to
either prevent heart disease or at least reduce the risk of progression
and in some cases reverse the changes in the arteries.

We will mainly focus on the physical risk factors that can be
modified. In the next chapter we will examine the psychological and
behavioural factors that many maintain are as if not more important
in the development of heart disease. It is crucially important that you
understand the role of these risk factors well, so that you can take
preventive action by modifying them.
If you have heart disease, it is likely that you have some or all of
these risk factors. Remember that these factors have a multiplier
effect on each other. The more risk factors you have, the greater the
rate of progression of your disease.
If you have, for example, three risk factors the risk is not increased
threefold (3+3+3=9) it is more like (3×3×3=27). You must also
remember that it is these risk factors that are responsible for a
recurrent heart attack or the arteries closing up again after bypass
surgery.
One of the most important studies to determine risk factors in the
development of coronary artery disease was the Framingham study in
America. This study began in 1940s and 5000 residents of a small
town in Massachusetts were examined regularly over 40 years to
discover the factors responsible for the development of heart disease.
This has been confirmed in numerous other subsequent studies.
The Framingham study showed that cholesterol, smoking, high
blood pressure, obesity and a sedentary lifestyle were the main risk
factors. Many other subsequent studies in a number of countries have
confirmed this. Several other risk factors have since been identified
but those mentioned here are the major ones that need to be
modified.
SMOKING
Despite all the protestations of the merchants of death who run the
cigarette industry, there is no doubt that cigarette smoking is a major
preventable cause of premature death and heart disease today. For
years the tobacco industry has used all types of methods to hide this
information from consumers. Worse they continue to use unethical

marketing methods to induce the youth, especially girls, to start
smoking particularly in third world countries.
The larger the number of cigarettes smoked, the greater the risk of
developing coronary artery disease. Smokers are 3-9 times more likely
than non-smokers to develop heart disease. People who smoke have a
greater risk of developing stroke, cancer, asthma and clotting
disorders of the blood. Even the family member and children of
smokers have a greater risk of developing these diseases due to the
second hand smoke they are exposed to.
Cigarette smoke contains cancer causing tar and high levels of
carbon monoxide. The carbon monoxide binds to the haemoglobin in
the blood replacing oxygen, and this reduces the oxygen carrying
capacity of the blood. In addition cigarette smoke contains powerful
free radicals that damage the walls of the artery and hasten the
deposition of cholesterol in the walls.
The nicotine in cigarettes is a powerful and addictive stimulant.
When inhaled it leads to an outpouring of the fight and flight
catecholamine hormones and a rapid rise in blood pressure. These
hormones often trigger arrhythmias (irregular heart-beats) which in
some cases can be fatal. A cigarette smoker has a 5 times higher risk
of a second heart attack than a non-smoker.
It is very important to remember that even if you continue smoking
a cigarette a day your risk levels remain elevated. Hence if you smoke
it is vital that you stop smoking completely. For someone with a heart
problem smoking is like committing suicide slowly.
The chapter on smoking will provide you with effective techniques
to stop smoking. Remember that if you continue to smoke after
developing heart disease it is like holding a loaded gun to your head.
HIGH BLOOD PRESSURE
High blood pressure or hypertension is a common problem today. The
increasing stress of modern life has lead to large numbers of people
developing hypertension. A genetic predisposition, obesity and a high
salt intake are risk factors for hypertension.

Blood is pumped into the arteries by the heart under pressure. This
pressure is determined by the force with which the blood is pumped
with and the resistance offered by the arterial system. The resistance
is determined by the bore of the blood vessels. The smaller the bore,
the higher the resistance and the more force required to propel the
blood through it.
The smooth muscle in the arterial wall is under the control of the
sympathetic nervous system. In response to stress the sympathetic
system is stimulated and the catecholamine hormones noradrenaline
and adrenaline are released. This causes the blood vessel to contract
which leads to an increase in the blood pressure.
Normal blood pressure is about 120 by 80 mm of mercury. The first
figure is the systolic blood pressure, the level the pressure rises to
when the heart pumps blood into the arteries. The second figure is
the diastolic blood pressure or the blood pressure in the arteries when
the heart is refilling with blood from the venous system.
Raised blood pressure is one of the major causes of the thickening
of the arterial wall due to atherosclerosis. Both systolic and diastolic
hypertension are an important cause of atherosclerosis, though a
raised diastolic level is of greater significance.
Blood pressure above 140/90 mm of mercury (Hg) is considered to
be high and requires medical treatment. However recent studies
(2003) indicate that it is wise to begin intervening naturally as blood
pressure levels rise above 120/80. Remember the higher your blood
pressure the faster the progression of the disease and the greater the
damage to your arteries. Since high blood pressure by itself rarely
causes any symptoms, do not be under the mistaken impression that if
you do not have any symptoms, your blood pressure is normal.
Keeping a regular check on your blood pressure is necessary. This
can be done frequently at home if you have hypertension. Your
doctor can teach you how to take your own blood pressure at home.
Fig. 4

Raman’s case is typical. He went to see his doctor because he was
feeling stressed and could not sleep properly. His doctor found that
his blood pressure was slightly high at 150/90 mm of mercury (Hg)
and as a first step recommended that Raman cut down his intake of
salt, take things easy and get his blood pressure checked every few
days. Within a week Raman’s blood pressure had returned to normal
without medication.
Raman will now have to have his blood pressure checked
frequently. Had Raman’s blood pressure been any higher, he might
immediately have been prescribed medication. Unless your blood
pressure is very high, your doctor will probably give you advice
similar to that given to Raman.
In about 10% of cases hypertension is caused by a hormonal or
kidney disorder. In the remaining majority (90%), no physical cause
is detected and this type is called Essential Hypertension. Many
doctors believe that personality and stress are the two most important
factors in the development of Essential Hypertension. In fact the Type
A personality (described later), is one of the personality types that has
a greater risk of developing high blood pressure and heart diseases.
There is little doubt that controlling your blood pressure will
reduce chances of further progression of your heart disease. Therefore
do not neglect to have your blood pressure checked regularly.
REDUCING BLOOD PRESSURE NATURALLY
Try reducing your intake of salt as a first step. About 30% of people
are salt sensitive and a low salt diet will result in a significant fall in
blood pressure in these people. For those who are not salt sensitive, a

reduction of salt may not reduce hypertension but in any case it is a
good idea to reduce your salt intake.
High blood pressure is much more common in an overweight
person. Many overweight people find that with weight reduction,
their blood pressure returns to normal. If your doctor has started you
on medication you may find that as you lose weight you need less
medication.
Seema’s case is informative. She suffered severe hypertension,
which would not come under control. The doctor advised her to lose
weight as she was 20 kilos overweight. Afraid that something would
happen Seema started on a fairly strict diet and in two months had
lost most of her excess weight. At this time she started developing
attacks of giddiness and nearly had a serious accident while driving.
Her doctor, finding that her blood pressure had fallen to very low
levels stopped her medication completely.
In a hot country like ours, one can lose quite a lot of salt through
perspiration. Therefore you should be careful to get enough salt
particularly if your job requires you to go out in the sun a lot or if
you sweat a great deal while playing games. You may also develop
symptoms of salt depletion if your doctor has prescribed a diuretic
medication that removes salt from the body. Be careful if you develop
symptoms such as cramps or giddiness. They could indicate sodium
depletion.
Mr Das discovered that he had blood pressure of 160/110 mm of
mercury. Despite dietary and salt restriction Mr Das required large
doses of medication as his hypertension was resistant and difficult to
control. Unfortunately Mr Das developed uncomfortable side effects
to the medication, the worst of which was impotence. His doctor tried
a number of changes but could not overcome his impotence. Finally
his doctor recommended that he should try a stress management
programme using intense hypnotherapy. In a few months his blood
pressure started going down and in six months Mr Das was able to
dispense with his medication.
For most people with hypertension, modifying Type A personality

traits (described later) and deep relaxation or self hypnosis practised
regularly for a few months will cause a substantial fall in raised blood
pressure. If this is combined with exercise, weight loss and salt
restriction, it is possible in many cases to discontinue anti-
hypertensive medication or at least reduce the dose substantially.
Another technique called biofeedback has also been found to be very
useful for reducing elevated blood pressure.
SERUM LIPIDS
These are a group of fatty substances that circulate in the blood in
various forms i.e. cholesterol and triglycerides. The levels of these fats
have been found to have a significant influence on the risk of your
developing coronary artery disease. You must get them measured
regularly and know the risk they pose to you.
CHOLESTEROL
Cholesterol is a fatty substance found in the blood. It is required for
the maintenance of the integrity of nerve and other cells. The liver
manufactures enough cholesterol for the body’s requirements from
fat. Some amount of cholesterol is absorbed from food, especially
organ meats such as liver and egg yolk which are rich in cholesterol.
The more saturated fats (such as butter or ghee) one eats, the greater
the amount of cholesterol produced by the liver and the higher the
levels in the blood.
A serum cholesterol level below 200 mg per 100 ml (mg/dl) is
considered to be normal and up to 220 mg/dl as borderline (earlier
240 mg/dl). Anything above that is high. The higher the level of
cholesterol, the greater is the risk of an infarction. To be safe you
should aim for a Total Cholesterol (TC) level of 150 mg/dl or below.
Remember that about a third of patients who have a heart attack
have a blood cholesterol level between 150 to 200 mg/dl so you will
need to work on the programme even if your cholesterol is in this
range. Dr William Castelli has found that it is rare for any one with a
TC below 150 mg/dl to develop CAD, hence one should aim for this:

Fig. 5
People have genetic differences in the amount of cholesterol that
they can clear from their blood. Some people can eat a high fat, high
cholesterol diet and still have a serum cholesterol level of 150 mg/dl.
These lucky people are unlikely to develop heart disease. On the
other hand there are many people who develop high cholesterol
levels when they consume small amounts of fat or cholesterol in their
diet; they have a higher chance of developing heart disease. If you
have heart disease it is likely that you are in the latter group. You can
greatly reduce your risk levels by strictly controlling your diet.
SUBTYPES OF CHOLESTEROL
The Total Cholesterol (TC) in your blood is made up of various sub-
fractions. These are the subtypes of cholesterol: High Density
Lipoproteins (HDL cholesterol) and Low Density Lipoproteins (LDL
cholesterol) and Very Low Density Lipoproteins (VLDL).
HDL has been called the good cholesterol and the higher the levels
the better. This type of cholesterol transports of cholesterol away
from the walls of the artery to the liver. If your HDL cholesterol level
is below 35 mg/dl it is a poor sign. Ideally one should aim for levels
above 45 mg/dl. The higher the levels of HDL cholesterol, the less the
chances of your having a heart attack in the future. Moderate exercise
is the best way of raising HDL cholesterol.
Fig. 6

Aerobic exercise is the best way of raising HDL cholesterol.
Moderate consumption of alcohol can also increase the levels of HDL
cholesterol but this is not a recommended way of trying to raise HDL
levels. Alcohol leads to weight gain and hypertension. Heavy drinking
increases the risk of alcoholism and heart disease. A small glass of red
wine daily or one small drink is acceptable on this programme but if
you can do without it, so much the better.
LDL cholesterol has been called the ‘bad’ cholesterol and is
involved in transporting cholesterol into the wall of the arteries and
causing atherosclerosis. The higher the level of LDL cholesterol in
your blood the greater the risk of your disease progressing and of
having a heart attack. LDL cholesterol can be lowered by decreasing
one’s intake of fat, especially saturated fats and trans-fatty acids and
losing weight.
Fig. 7
In recent years researchers have become aware of the fact that if
LDL is oxidised it becomes more dangerous and causes more damage
in the walls of the artery. Oil rich in poly unsaturated fatty acid such
as safflower oil, cigarette smoking and pollutants increase levels of
oxidised LDL in blood. Certain natural antioxidants in food especially
fresh fruit and vegetables reduce levels of oxidised LDL. This is

discussed in further detail in the chapter on diet.
The ratio of total cholesterol to HDL cholesterol is a better indicator
of risk than total cholesterol. You can calculate your value by
dividing your Total Cholesterol by your HDL cholesterol level. Most
healthy males have a value of below 5, a value of 7 doubles the risk.
The lower the value, the less the chance of your heart disease
progressing. Aim for a level of 3-4, the lower the better. If your Total
Cholesterol is between 150 to 200 mg/dl, a TC/HDL ratio of 3 may
offer the same protection as offered by having a TC level below 150
mg/dl.
Apart from dietary and genetic factors, emotions play an important
part in the genesis of high cholesterol levels in the blood. Scientists
have found that under stress cholesterol levels rise. Studies on
accountants before the Accounting Year End show that their
cholesterol levels often double because of the extra stress they are
under. Individuals who keep their feelings to themselves especially
when upset or angry (repressive coping) have also been found to have
higher cholesterol levels.
REDUCING CHOLESTEROL LEVELS
Diet plays the most important role in the management of a high
cholesterol level. A very low fat vegetarian diet is the most effective
way of reducing your blood cholesterol levels. Within a few weeks of
starting on a low fat, low cholesterol diet such as The Save Your
Heart, Pritikin or Ornish diet, most patients find that their cholesterol
level decreases. With this their symptoms often become less. Patients
frequently report that their exercise tolerance has increased, pain has
decreased and that they feel more energetic.
I have noticed that the cholesterol level of some obese patients only
starts going down without medication when they lose weight. Hence
if you are overweight it would be well worth your while to work at
getting rid of the extra weight.
Other ways of reducing your cholesterol levels include eating food
rich in soluble fibre such as oats, peas, lentils (dals) and fruit. A diet

rich in fibre can reduce your cholesterol levels by around 10%.
Therefore you may want to increase the amount of fibre in your diet.
Garlic can also lead to a 5-9% decrease in cholesterol levels.
A natural substance, psyllium, is rich in fibre and is very useful for
reducing the cholesterol levels in the blood. It is freely available as
Isabgol and a tablespoon or two can be taken daily. It also has the
advantage of preventing constipation. Similarly some people find that
purified guggul gum is an effective way of reducing cholesterol.
Stress management and personality modification can also help
reduce cholesterol levels. Studies on CAD patients who practise yoga
showed a significant reduction of blood cholesterol. Similarly stress
management using self-hypnosis or meditation can also help reduce
cholesterol levels elevated due to stress.
If you have elevated cholesterol you may find that after starting on
a very low fat diet, your cholesterol level does not go down to 150
mg/dl. This should not be a cause for concern if you are strictly
adhering to the diet and lifestyle programme, especially if your Total
Cholesterol is below 200 mg/dl and TC/HDL ratio is less than 4.
Some doctors may want to put you on cholesterol lowering
medication if this happens.
In his study, Dr Dean Ornish found that patients who adhered to his
programme and stayed on the diet with less than 10% of calories
from fats obtained significant reduction in the fatty deposits in the
arteries. This was even though their serum cholesterol levels
remained elevated above 150 mg/dl.
Some cardiologists now recommend that patients with a TC above
210 mg/dl (or even lower levels if people with multiple risk factors)
start on the statin group of cholesterol lowering medication. It is a
good idea to ask your doctor if you can first try lowering it with a
very low fat diet and a programme of stress management. Be aware
that quite a few doctors do not believe that individuals can stick to a
low fat diet and would rather prescribe medication to be safe. Once
medication has been started, most doctors are reluctant to stop it
unless the patient develops side effects.

If, despite adequate dietary modifications for a period of a few
months your serum cholesterol still remains elevated, your doctor
may prescribe cholesterol lowering medication. There is evidence to
indicate that cholesterol reducing medication can also help reduce the
mortality from a heart attack and in many cases cause a regression in
the atherosclerotic process.
Cholesterol lowering medication may also be necessary for a person
who is not able to or is unwilling to switch to a low fat vegetarian
diet. It may take a number of years for the cholesterol lowering
medication to cause regression in the atherosclerotic plaque.
TRIGLYCERIDES
There is another type of fatty substance in the blood called
triglycerides. High levels (above 150 mg/dl) can also increase the risk
of coronary heart disease. You should aim to keep your levels below
130 mg/dl (ideally 100 mg/dl or below if you aim to be safe and
reverse your heart condition).
Triglyceride Level (in milligrams per dl) Classification
Fig. 8
The best way to reduce the triglycerides levels is to lose weight
using a low fat vegetarian diet. If you have elevated levels it is very
important that you drastically reduce your intake of sugar and
alcohol. Replace white rice with brown rice, refined white flour
(maida) with whole wheat (atta). In addition stop smoking if you have
not already done so. Tofu and fish also help reduce triglycerides.
Triglyceride levels respond to weight loss and dietary modification in
a short time. As a last resort you may require medication. Nowadays

most cardiologists will prescribe Atorvastatin or other specific
medication for this purpose.
Sometimes when you change over to a low fat vegetarian diet
triglyceride levels may rise above your baseline level. As long as you
really stick to a low fat diet and the level is below 150 mg/dl you
need not worry about it.
Note:
The levels of serum cholesterol, triglycerides and the amount of
dietary fat recommended in this book are much lower than what most
doctors advise. This is because the aim of this programme is to
promote positive health and reverse the atherosclerotic process. Many
doctors suffer from therapeutic nihilism and do believe that people
can make lifestyle and personality changes required to achieve these
aims. They would rather prescribe medication and avoid the risk of
losing the patient by making demands that challenge them.
OBESITY
Research has shown that people who are more than 20% overweight,
have a higher risk of developing coronary artery disease than their
normal weight counterparts. This is especially true if the fat is
deposited around the belly (apple shaped). Overweight people who
accumulate their fat around their thighs (pear shaped) have a smaller
risk than apple shaped people.
The obese person also runs a higher risk of developing
hypertension, diabetes and certain types of cancer. Hence it is
worthwhile losing weight as this leads to a reduction of raised blood
pressure, cholesterol and risk of further progression of your disease.
As with exercise it is necessary that you maintain the weight loss.
Once you lose weight you must plan to keep off the excess weight
permanently. It has been found that those who keep gaining and
losing weight (yo-yo dieting) are at a greater health risk than those
who remain slightly overweight. A gradual weight loss of about half
or at the most one kilogram per week is recommended.

If you stick to the diet and exercise programme outlined in this
book you will lose weight automatically. The exercise and stress
control programme will help make it easier to adhere to your diet.
Hypnosis is one of the most effective ways of promoting weight loss
even in patients who are massively obese.
DIABETES
Diabetes is a condition where the blood sugar level in the blood is
higher than normal. If your fasting blood sugar is higher than 110
mg/dl your doctor will need to evaluate you for diabetes. Diabetics
are at a much greater risk of developing arteriosclerosis especially if
their diabetes is not well controlled.
There are two types of diabetes — The first (Type 1) due to damage
to the insulin secreting cells in the pancreas, leading to insulin
deficiency. The second (Type 2) is due to the peripheral tissues not
responding to the insulin in the blood. The second type is more
common in overweight adults and can often be reversed by weight
reduction and dietary control.
It is important that your diabetes be treated under the close
supervision of a physician specialising in this condition. Uncontrolled
diabetes can lead to the damage of your blood vessels, kidneys, eyes
and heart. One must aim for rigorous control of one’s blood sugar
levels. Many doctors have fairly relaxed standards, which makes it
easy for the patient and puts them at risk.
Should you decide to follow the lifestyle changes outlined in this
book, you must do it in conjunction with your doctor. It is likely that
your requirement of anti-diabetic medication will decrease
significantly after you start this programme. If the medication is not
adjusted you may find that your blood sugar falls to a very low level
causing hypoglycaemia. The symptoms of hypoglycaemia include
sweating, anxiety and faintness. It can also trigger off an arrhythmia.
Beta blockers prescribed for coronary artery disease or hypertension
can block the symptoms of hypoglycaemia and you may not realise
that you have hypoglycaemia, which can damage your brain.

A related condition in obese people is called hyperinsulinism,
which has also been blamed for accelerated atherosclerosis. Here the
blood sugar levels are normal but the insulin levels circulating in the
blood are higher than normal. As in Type 2 diabetes the peripheral
tissues are not sensitive to insulin. In response the pancreas releases
more insulin into the blood. This condition is common in Asians and
some cardiologists blame it for the higher incidence of heart disease
among us. If you are overweight, weight loss with a low fat diet and
with very little simple sugars often brings back the normal
responsiveness of the cells to insulin. With this the levels of
circulating insulin usually fall back to normal.
Some people especially from South Asia (India, Pakistan,
Bangladesh) suffer from a condition called metabolic syndrome or
Syndrome X. They have hyperinsulinism, high blood pressure, high
levels of triglycerides and low levels of HDL cholesterol. They have a
much higher risk of developing heart disease and of having recurrent
attacks. People with this condition need aggressive dietary and
medical treatment.
DIET
Research shows that people who have a diet rich in fat, especially
animal fat, have a higher incidence of heart disease and stroke. The
Finns and the Danes have perhaps the highest incidence of heart
disease in the world due to the large amounts of animal fat in their
diet. At the other end of the spectrum, the Japanese islanders with
their low intake of fat have the lowest incidence of heart disease.
Recent studies show that people with a high intake of Trans-fatty
Acids are at high risk. Hydrogenated oils are rich in them and used in
cakes, biscuits, certain breakfast cereals and many other processed
foods. Hence these foods should be avoided at all costs. Research
shows that people who have a high intake of polyunsaturated fatty
acids, especially the omega-6 fatty acids in their diet (present in
cooking oil), run a greater risk of having a heart attack. The chapter
on diet contains more information on this.

SEDENTARY LIFESTYLE
Dr Ralph Paffenberger studied 17,000 Harvard Alumni in the United
States, for over 20 years. He found that those who exercised
regularly, burning about 2000 extra calories per week, had a 28%
lower annual death rate than their sedentary counterparts. About
40% of this lower death rate was due to a reduction in heart disease.
Research has shown that walking as little as half an hour, 3 to 4 times
a week can provide significant protection against heart disease.
Dr Paffenberger clearly found that those who had exercised
regularly and then gave it up were at a higher risk of developing
cardiac disorders. Because of this it is important to continue
exercising regularly especially if you are an athlete or used to exercise
regularly. Also you should only plan to do as much exercise as you
know you can realistically continue doing in the future.
Homocysteine
Homocysteine is a breakdown product of the amino acid methionine,
which is one of the building blocks of proteins. High levels of
homocysteine have been linked to damage of the arteries and increase
the risk of stroke and heart attacks. Research shows that many
Indians have raised levels of this substance in their blood for genetic
reasons. This may be one of the factors responsible for the higher
incidence of heart disease in us.
Homocysteine levels may be lowered by increasing one’s daily
intake of vitamin B-complex. One must get at least 400 mcg
(micrograms) of folic acid, 2 to 4 mg (milligrams) of vitamin B6 and
4 to 6 mcg of vitamin B12. A multivitamin or vitamin B-complex
supplement should provide enough B-complex vitamins to do this.
However this may not help reduce the increased risk and there are
some concerns that even high doses of synthetic vitamin supplements
may marginally increase the risk of a stroke or heart attack.
LIPOPROTEIN A
This is one of the few risk factors that cannot be modified at present.

Another marker of a raised risk is Lipoprotein A or Lp (a), which is
also associated with a higher risk of heart disease. It prevents the
dissolution of small clots that often form in the blood. Levels above
20 are associated with a slightly increased risk but when they rise
above 30 the risk increases greatly. If you have raised levels of Lp(a)
you will need to be much more careful about controlling all the other
risk factors. Some authorities believe that for patients with a raised
Lp(a), Trans-fatty Acids that are present in hydrogenated oil and
margarine are deadly. Avoid hydrogenated oil, margarine and foods
made from these such as, cakes, biscuits, snacks and even chocolates.
Other markers of a higher risk of recurrence are apoliporotein A
and B. High levels of a substance called C-reactive protein which
indicates the presence of inflammation have also been found to
predict a higher risk of having a heart attack or recurrence.
Remember if you have unhealthy levels of these genetic markers of
high risk it would be advisable to be very aggressive in your adoption
of lifestyle and behavioural changes.

T
4
Behavioural Risk Factors
here is ample research to show that behavioural risk factors play
an important role in the development and progression of heart
disease. In fact many researchers including Dr Dean Ornish consider
them to be as or more important than the physical ones described in
the previous chapter. This is because a certain percentage of people
with high risk factors go on to have a heart attack. In addition, in
certain populations, the risk of heart attack is low for cultural reasons
as will be described later. More important, the research shows that by
modifying these behavioural patterns it is obviously possible to
reduce the risk of having a second heart attack.
PSYCHOLOGICAL HEALTH AND DISEASE
The link between psychological health and well being has been
recognised for many years but it was the pioneering research of Dr
Caroline Thomas who, in 1948 with the psychiatrist Dr Barbara Betz,
scientifically proved this. They studied a few hundred students at the
Johns Hopkins School of Medicine and classified them as: ‘Alpha’
(cautious, steady, self-reliant and non-adventurous), ‘Beta’
(spontaneous, clever and flexible), and ‘Gamma’ (brilliant, confused
and complicated). Thirty years later they found that the Gamma had
the most medical problems with 77.3% having some serious illness as
compared to 25% of Alpha and Beta. In another sample of 127
medical students they found that 13 deaths among those originally
classified as Gamma compared to none in the other groups after 30
years.
Dr George Vaillant, a famous psychiatrist at Harvard University,
studied 185 medical students in the early forties. He followed their
lives for over 40 years and found that of the 59 men with the best

mental health, only 2 became chronically ill or died before the age of
53. In a similar group with the worst mental health, 18 became
chronically ill or died. He identified the ability to respond flexibly to
change as a key trait that protected one from chronic illness and
disease.
Many other recent studies have explored the connection between
psychological disorders and heart disease. Depression, for example,
increases the risk of having a second heart attack by around 50%.
This makes it imperative to deal uncompromisingly with the
depression that many patients experience after they have had a heart
attack or bypass surgery.
LONELINESS AND SOCIAL ISOLATION
From his early hunting days man has lived in a tribe and has an
inherent need to be a part of a group. To be liked by others is a
powerful motive for most people, especially those with a strong need
for affiliation. Isolation is one of the most difficult punishments for
most people. In fact the isolation cell is used as punishment for the
most hardened criminals. People who are socially isolated are under
chronic stress. Recent research shows that people who are isolated or
feel lonely have a much higher risk of developing heart disease.
Dr Kristina Orth-Gomer at The National Institute of Psycho-Social
Health in Stockholm has found that social isolation in middle-aged
Swedish males is a risk factor comparable to smoking in the causation
of myocardial infarction.
She found that in heart patients attachment behaviour was lower.
By ‘attachment’ she means having someone very close, who one can
confide in, share feelings with, hold and comfort. High attachment
scores are protective and prevented heart disease even in the presence
of high cholesterol levels in the blood.
Dr Orth-Gomer found another dimension of social behaviour that
also predicted heart disease — this was social integration or the size
and quality of the person’s social network. The risk was multiplied in
those with low social integration, especially those who smoked, had

hypertension or diabetes.
Other researchers have found that people who are married have a
lower incidence of illness than unmarried or divorced people. Those
men who reported that their wives were supportive were far less
likely to have severe blockages of their arteries. In another study in
Cleveland married men with multiple risk factors were studied and
those who said that their wives showed them their love were much
less likely to develop angina despite high risk levels.
Even the emotional closeness one derives from a pet can have a
healing effect. Men with pets have been found to have a 4 to 6 times
lower risk of dying in the first year after a heart attack.
Studies of Japanese men who have migrated to America show that
those, who have maintained a traditional lifestyle with an emphasis
on close social connections with their friends and relations, have a
much lower incidence of heart disease than those who adopted an
isolated western lifestyle. This is after allowing corrections for
differences in cholesterol levels and dietary fat intake. What emerged
was that the stable culture with family and social ties somehow
protected the Japanese men from heart disease.
Dr Dean Ornish considers loneliness to be one of the most
important risk factors for developing heart disease and has written a
book Love and Survival on the importance of the power of connection,
community and intimacy on health. Group therapy is a core facet of
the Ornish programme and one of the major aims of his programme is
to foster a strong sense of connection with others in the group and
help people break the bonds of isolation. The healing effects of
human connection are increasingly being recognised in the treatment
of trauma and other psychological disorders. If you have heart disease
it is important that you work on becoming aware of and changing, if
you have a tendency to be isolated or feel lonely. In fact it is a good
idea to learn how to open up to others.
BREAKING OUT OF ISOLATION
For most people, fear is the root cause of isolation. Some people are

afraid of being hurt or being taken advantage of and isolate
themselves to prevent this. Such people may have many
acquaintances but do not get close to them.
Dr Alexander Lowen M.D., the founder of Bioenergetics and the
author of the book Love, Sex and Your Heart, feels that many patients
with coronary artery disease are afraid of expressing love, “The
problem that most of us face is that the defences we erected to protect
the heart have become its prison and are now unconscious&. Most
people believe that they would be fully capable of loving if only they
were loved. They confuse the longing for love with loving itself. They
sense the loving in their heart but can’t get to it, cut off as they are
from their heart by the barriers they erected to save it.”
Opening up to others and learning to trust others more, is one way
of breaking out of your isolation cell. Talking to another about your
feelings, secret hopes and dreams is a first step. More important is to
learn how to listen to another and share in that person’s joys and
disappointments. One must also be willing to create time and give of
oneself to others.
A few years ago I met a rich businessman at a party. He had
inherited substantial wealth but said that his life was empty and
lacked meaning. In a very offhand manner I asked him if he had ever
considered the ultimate high: helping others. Two years later I met
him again and he walked across the room and thanked me. I was
surprised as I could not even remember his name. He explained that
he had taken my suggestion seriously and had started doing voluntary
work with poor people on weekends and this had changed his life. He
said he had learned how to treat them as equals and had learned a lot
from them about what is really important in life. He had made many
new friends in the sector and was now considering handing over his
businesses to professional managers so as to be able to dedicate more
of his time to voluntary work.
PERSONALITY AND HEART DISEASE
The link between one’s personality and the heart has been recognised

from time immemorial. Terms like ‘warmhearted’, ‘hard-hearted’ and
‘cold-hearted’ have become a part of one’s common everyday
language. The truth of this folk wisdom has been confirmed by
research and shows that cynical, cold-hearted people are more likely
to die of heart disease.
Links have been found between a number of psychosomatic
diseases like asthma, rheumatoid arthritis, ulcerative colitis and
migraine, but nowhere is the link as clear as in the case of heart
disease. Certain personality traits, especially hostility and cynicism,
predispose one to die of heart disease. In addition, persons with these
traits have a much higher risk of developing a second heart attack
once they have developed coronary artery disease.
In the early 1970s, Dr Meyer Friedman and Dr Ray Rossman
published a book called Type A Behaviour and Your Heart. In this book
they revealed the results of a study of three thousand people in San
Francisco. They identified certain personality traits that they labelled
Type A; patients with these traits had a four times greater risk of
developing heart disease. This increased risk was over and above that
caused by other risk factors such as cholesterol, high blood-pressure
and diet. The increased risk for a Type A person is the same as that of
someone who smokes two packets of cigarettes a day. In fact, the risk
is higher (about seven times) because the Type A person is also much
more likely to smoke cigarettes and to have hypertension.
They identified another personality type which they called Type B
people, with this personality type rarely developing Coronary Artery
Disease before the age of sixty-five. In his book Treating Type A
Behaviour and Your Heart, Dr Meyer Friedman described the results of
educational classes for hundreds of patients who had already suffered
a heart attack. The results of modifying Type A behaviour was that
the risk of a second heart attack was reduced by 48% in the first and
second years and there was a 372% decrease in mortality in the third
year. This proved that it was possible to modify Type A behaviour
and that this personality trait was responsible for progression of the
disease.

Further research by other researchers has shown hostility to be the
most toxic component of the Type A risk factor. Cynicism, a tendency
to ascribe negative intentions to others, is a mental attitude that
predisposes one to react to others and to situations with hostility.
Dr Paul Falger of the S.L. University School of Medicine in the
Netherlands found that the coronary prone individual has a habitual
manner of acting alert, with an utterly competitive involvement and
an exaggerated need for personal recognition through work. He has
observed that these competitive and aggressive people often have a
habit of getting over-involved in things and are prone to
unprecedented explosions.
Gen Kapoor is an example of a Type A person. He retired early
from the army, following a heart attack and took to social work, to
help the poor. He started a small charitable organisation, which soon
expanded into a large enterprise. All the General could talk about was
his organisation and his achievements.
His colleagues noticed that he had a terrible temper. If someone
contradicted him, he would fume for days and use foul and abusive
language to criticise the person behind his back. To the external
world, he was a saintly person concerned with the welfare of the
poor. To those who worked with him, the General seemed more
concerned with his own status and publicity. He was preoccupied
with the faults of others, and had declared ‘war’ on another voluntary
organisation, which he considered corrupt.
Petty things would trigger off attacks of rage. The staff turnover in
the General’s agency was phenomenal. Everyone recognised that the
General’s hostility was creating many difficulties as some of the
trustees had resigned.
Dr Ram, a trustee of the organisation, had tried to point out to the
General the effect his hostility was having on those working with him
and on his own health. He told the General about the famous English
surgeon Dr John Hunter (1729-93), who suffered from angina and
had noticed the link between emotions and heart disease. Dr Hunter
was often said to comment, “My life is in the hand of any rascal who

chooses to annoy me.” Dr Ram lost no opportunity to remind the
General that Dr Hunter’s words were prophetic and he died after a
heated argument with members of the Board of his hospital.
None of this seemed to have any effect until Dr Ram wrote to the
General pointing out that he was destroying the culture of the
organisation and that unless he changed, the trustees would move to
have him removed from the Board. Dr Ram also sent the General a
copy of Treating Type A Behaviour and Your Heart by Dr Meyer
Friedman.
After reading the book, Gen Kapoor grudgingly accepted that he
was a classical Type A personality and that it might have ruined his
health. He decided to change and in his usual manner decided to
wage war on his Type A behaviour rather than the world at large. On
introspection, he realised that he was angry most of the time and that
his ‘hostility’ had created major problems for him at work and with
his family and friends.
It took a few months to change but people could not believe the
transformation in his behaviour. He was surprised at how things were
much better at work and at home. A few months later he gracefully
thanked Dr Ram for saving his life telling him, “For the first in my life
I know what it is to feel happy!”
THE TYPE A PERSONALITY
The irritable, executive with his cellular phone, scurrying from one
appointment to another is the archetypal Type A person. With
globalisation, the Type A personality like a virus seems to becoming
much more common. In rural cultures Type A behaviour was rarely
known.
In addition to hostility many coronary prone individuals tend to be
cynical and over-involved in themselves. They can be selfish, lack
empathy and find it difficult to see another’s point of view. Many
coronary prone people have a lack of basic trust and this makes them
suspicious of other people, sometimes to the point of paranoia.
The Type A person is also characterised by a driving sense of time

urgency, an intense struggle for status and has high levels of free
floating hostility. Such people live for the deal or the job and evaluate
everything numerically. The only important thing for them is to make
it. Everything else: family, children, friends and even ethics are often
secondary.
TYPE A TRAITS
1) Hostility
Hostility is the most harmful personality trait that predisposes one to
develop heart disease. In response to stress, the hostile person feels
irritated or very angry and in some cases this is expressed explosively.
Often the person keeps simmering and does not express this anger or
hostility directly. Many of them express it in indirect ways such as
criticism and constant fault finding.
Teja Singh, a rich businessman, who suffered from angina is a
typical example. At parties he would somehow manage to turn the
topic to various social ills such as corrupt politicians, the exploitative
school system, or the ungrateful poor. He would then get worked up
and upset, use crude language and not allow others to have their say.
If someone did not agree with him, he would get angry and have an
angina attack.
Retired because of his angina, he spent his time clipping and
collecting newspaper articles and writing letters to the editor. His
wife Tina was gregarious and well liked by her friends but she noticed
that friends had stopped inviting them over and this troubled her. A
close friend finally told her that her husband was the problem and
that his behaviour was offending others. At a loss as to what to do she
talked to her doctor who suggested that she take her husband to
consult Dr Nishant, a Behavioural Medicine Specialist, as Teja Singh’s
behaviour was dangerous for his health.
Hostility has been found to be the most harmful aspect of Type A
behaviour. Numerous studies have shown that the person who high
levels of free floating hostility is at a much higher risk of having

narrowed arteries due to atherosclerosis.
Free floating hostility is often manifested as criticism, cynicism,
passive aggressive behaviour and irritability, the use of abusive and
crude language and a harsh jarring voice. If the Type A person is
engaged in a task which is interfered with, he will often explode in a
manner totally out of proportion to the situation.
Driving is one area where the Type A person manifests his hostility
and this often leads to trouble. The Type A driver often gets angry
when anyone overtakes him. He will abuse the other driver or try to
overtake and punish the other driver by flashing his lights, or trying
to run him off the road or blocking his way.
Being made to wait is another situation to which the Type A person
reacts with irritability. Typically, if someone else is late or has missed
an appointment and made the Type A person wait he will be very
angry.
Dr Venkat, a skin specialist, had returned to India from America
after he developed angina at the age of 36. He felt that with his
American qualifications, patients would flock to him and he would
have a relaxed practice in India. At first he found that he was fairly
busy but gradually his practice dwindled. After a lot of soul searching
during therapy for his Type A behaviour, he finally accepted the
harsh reality that he was his own worst enemy. A friend from his
medical college days, told him that patients were getting upset at the
way in which he ticked them off for not following instructions or
being late and did not want to go back to see him.
He learned how this aspect of his Type A behaviour was self-
defeating and recognised that he got worked up and had chest pains
when someone was late and kept him waiting. Dr Venkat learned to
deal with the situation by developing a flexible system to suit his
patients and the local culture. In addition he started using the free
time between patients to practise an advanced form of self-hypnosis,
to heal his mind at an unconscious level.
A few months later, he was gratified to find that he was getting
calmer and could now even be amused about his earlier impatience. It

took Dr Venkat a long time to get back to his practice, but this
experience concretely helped him realise that his impatience and
hostility were unhealthy and self-destructive and this motivated him
to change.
Six months after starting his programme of Type A counselling and
dietary modification, Dr Venkat was pleasantly surprised to find that
his exercise stress test showed marked improvement, and two years
later his stress test was normal. While this did not mean that his
arteries were no longer blocked, it did show that his arteries had
opened up enough so that his heart now received enough blood for
him to be able to exercise vigorously.
The Type A person is usually very good at hiding these traits from
others and finding rational arguments to support their hostility. I
remember talking to Mr Kini, who came in ranting about his son-in-
law and how he would teach him a lesson. All his arguments were
very logically thought out, but over a very short time it became
evident that Mr Kini was typical of the Type A person.
Mr Kini was angry because his daughter had not consulted him
before she agreed to marry her sweetheart. She knew her father well
enough to realise that he would always raise objections or find
something wrong and had therefore gone ahead and consented.
Despite his wife and others warning him that his behaviour would
damage his relationship with his daughter Mr Kini kept up his tirades.
It was only when his wife told him that she would leave him to get
away from his obsessive preoccupation with ‘teaching their son-in-law
a lesson’ that he agreed to seek help. Therapy not only helped him get
over his obsession with his son-in-law but built bridges in his
relationship with both his daughter and the earlier much despised
son-in-law.
2) Cynicism and Mistrust
The Type A person is very alert to all forms of deceit and hypocrisy in
others. It often appears that he has his radar tuned into the hypocrisy
of politicians, businessmen and priests. As the Type A person is

extremely mistrustful of the intentions of others he is the first to
notice what is wrong in a situation. Such people find it difficult to
trust or be close to others.
Dr Redford Williams, of Duke University, considers cynicism and
mistrust to be the central core of Type A behaviour. He has noticed
that increasing cynicism and mistrust is associated earlier death from
heart attacks.
3) Self Involvement
Dr Larry Sherwitz of the University of California and his team noticed
that the patients who frequently used self-referent words and phrases
such as ‘I’ ‘me’ ‘mine’ in their speech had more severe heart disease.
In fact, researchers have been able to correlate the amount of
coronary blockage to the number of times the person refers to himself
in an interview. The higher the number self referent statements the
patients used, the greater the blockage and more severe the disease.
He also noticed that patients with CAD have a tendency to use
numbers rather than metaphors and analogies in their speech.
4) Struggle and Heart Disease
Patients with coronary artery disease often claim that before their
attack they felt that they were struggling all the time. Some say they
were tired of life and felt they were on a treadmill, which they could
not get off.
The reason for feeling that one is struggling constantly, is often due
to the fact that many Type A people try to fit in as many things as
possible into a short period of time. Others try to do a number of
things at the same time. This leads them to feel pressured all the time.
For instance, some Type A persons will try to read a book or
newspaper while watching television. It is not unusual to see this trait
(polyphasic behaviour) during leisure activities. For example, an
acquaintance who died at 42 from a coronary was trying to learn
German using tapes while he played golf.
The constant activity means that the person is alert all the time and

cannot relax for a few minutes. This is very stressful. A patient whom
I was treating told me after a heart attack, “I feel guilty if I do not
work or keep myself busy, I feel that I am wasting time. Even when
playing with my children I feel I could be doing something more
useful. Holidays are sheer hell, I keep wondering about the office. I’ve
forgotten how to have fun.”
Exploration under hypnosis revealed that he had incorporated a
belief, as a child, that he was worthwhile only as long as he achieved
things, since his father only paid him attention when he did well at
school and was critical if he did not come first in class. He thus
needed to keep on achieving all the time to feel worthwhile.
He finally understood why his expectations always seemed to
expand and he kept finding new and more difficult goals to work
towards. It required hard work to help him unlink his self-esteem
from the need to achieve in order to give himself the internal
permission to relax and enjoy himself, without having to achieve
things all the time.
5) Status Anxiety
Many people with coronary artery disease have an exaggerated need
for status, especially through work. This makes them very
competitive, so much so that some will not even let a child win a
game while playing with them. Many patients find this constant need
for status can be quite a struggle and this adds to the stress they
experience.
Mr Surve, a senior advertising executive, discovered during a
routine medical check up that he had coronary artery disease. He had
no symptoms but his doctor warned him that he would have to cut
down on work. This upset him very much and he got severely
depressed. Mr Surve had always believed that he was special and was
chosen to rise to the top of his company. Now, like a bolt out of the
blue, this heart problem had come in the way.
Lying in bed after an angiography, he realised that he had a real
problem as he did not have any friends. Apart from a few juniors, no

one had come to see him. Even his children visited him for a few
minutes and left the hospital.
Later during family therapy, he saw how he had alienated his
children by comparing their achievements with his own at a younger
age. He realised that his constant boasting about his own
achievements had driven others away from him (an example of self-
involvement).
6) Lack of a Sense of Humour
One of the characteristic signs of a Type A person is that he lacks a
sense of humour, especially the ability to laugh at himself. The Type
A person’s humour is likely to be sarcastic and have an edge of
hostility and envy. He will often ridicule weaker people or those
unable to fight back. He may also have the unpleasant habit of
making fun of people behind their backs and using obnoxious or
vulgar language.
7) Self-Sestructive Behaviour
Dr Meyer Friedman, the author of Treating Type A Behaviour and Your
Heart, has noticed a tendency towards self-destruction. The Type A
person will often do things that will get him into trouble, such as
taking undue risks in business, cheating on his taxes or getting into
fights and quarrels.
Take the earlier mentioned case of Dr Venkat. At the early stages of
his setting up practice in India, he began to have an affair with his
secretary and would give her expensive presents and take her out to
expensive eating places. He realised in therapy, that he was bound to
be noticed by his patients and friends, and it was only a matter of
time before his wife got to know.
Hostility, cynicism and mistrust lead people to keep a distance from
others and this turns into a deep sense of alienation and loneliness.
One way to avoid these painful feelings is by filling up one’s life with
ceaseless activity. This puts the person under chronic stress which can
causes heart disease.

RECOGNISING HARMFUL TRAITS
The most harmful traits are the hostility, cynicism and self-
involvement followed by the constant struggle to achieve things and
to be in control.
Most people will find it difficult to accept that their behaviour is
responsible for their illness. If confronted by others, they usually have
some rational justification for their behaviour. For example, they
might maintain that unless one is pushy and aggressive, one will be
left behind or that others will gobble them up.
Those with coronary disease have learned to camouflage their
feelings from others. While they may be feeling murderous, to the
outside observer they appear to be totally calm. It was because of this
that Dr Meyer Friedman’s team, while studying Type A behaviour,
intentionally designed a stressful and irritating interview to bring out
the Type A traits. Patients were made to wait without an explanation
for long periods and the interviewers often asked them difficult
questions and contradicted them frequently. Most of the diagnosis of
Type A behaviour was done on the basis of non-verbal cues.
When made to wait, the Type A person would fidget restlessly and
be ready to shoot out of his chair at a moment’s notice. He usually
spoke rapidly and would often complete another’s sentences.
The intense hostility of the Type A person which is often bottled up
can frequently be noticed in a jarring laugh, a tense, hostile facial
expression and a tendency to use obscenities and critical or
derogatory terms such as idiot, rascal, teach him a lesson etc. The
Type A person often starts getting worked up when talking about past
annoying experiences. Owing to his high levels of psychological
denial, he may not be aware of these traits or may try to explain them
away. Personality questionnaires are not an effective way of
discovering these traits. The best way is to discuss them with close
friends and family.
THE TYPE A WOMAN
With rapid westernisation, coronary heart disease is becoming

increasingly prevalent among Indian women. One reason for this rise
is the fact that many more women have started smoking. In addition,
many women, especially working women, have started developing
Type A traits.
Women are better at hiding the intense sense of free floating
hostility and a need to be in control. Such a woman is likely to have a
deep underlying sense of insecurity, which is compensated for
through achievements, especially at work. Type A women who do not
work may be involved in social activities. Like coronary prone men,
the Type A woman is likely to have a lot of bottled up hostility and a
sense of impatience.
Some women with heart disease will often admit to a deep sense of
insecurity and envy of others, who appear free to get on with work or
are doing well. Many feel a sense of frustration at not being or doing
enough. The Type A woman is likely to be under tremendous and
chronic internal stress if she is unable to achieve her dreams. In his
book, Dr Friedman reports that Dr Suzanne Haynes of the
Framingham study found that Type A working women had four times
as many heart attacks as compared to Type B working women.
THE TYPE B PERSON
The Type B person is the polar opposite of the Type A person. They
have a more leisurely, relaxed and contemplative attitude towards life
and they take things in their stride. In addition, the Type B person
usually has a mature well-developed sense of humour. They can laugh
at themselves and lack the hostility or crudeness of the Type A
person’s humour.
The Type B person has a more relaxed long-term view of things. He
rarely over-commits and is able to hand over and delegate without
getting anxious about it. In contrast, the Type A person finds it
difficult to give up control and even if he delegates, it is reluctantly
and with close supervision.
Another major difference is the hostility. The fully developed Type
A person gets angry and irritated by all manner of things — even

reading the newspaper can trigger an attack of rage. In comparison,
the Type B person has a much more balanced and calm view of life.
As a mature person, he sees that the good and the bad often go
together and are both a part of life. While he may be willing to fight
injustice, he will not get overly upset to the extent that it becomes his
only preoccupation. Similarly, when talking about or recalling an
injustice, unlike the Type A person, he will have a more philosophical
view.
The Type B person is also more likely to enjoy the simple pleasures
of life — talking to friends, reading a novel or playing with their
children. When the Type B person is doing something, he is usually
fully absorbed in that experience, unlike the Type A person who is
preoccupied with many things such as planning his other activities.
Dr Venkat, a Type A person described his experience of attending a
concert after many years. He said that instead of enjoying the concert
his mind kept jumping to hospital politics. Later he found himself
getting restless as he wanted to go out and make a telephone call.
Waiting for the concert to finish became an intolerable experience. In
order to humour his wife he sat through the concert. During this
period he noticed that hostility towards his wife built up and he later
found himself criticising her for delaying him by talking with friends
outside the theatre.
EFFECTS OF TYPE A BEHAVIOUR
It is useful to recognise the effect that Type A behaviour has on all
areas of your life. The realisation that it not only harms your health
but may poison the rest of your life can be a strong motivation to
change.
1) On Work
Since the Type A person is highly competitive, he usually finds it
difficult to co-operate with his co-workers and is rarely liked by them.
They therefore are unlikely to co-operate with him in his time of
need.

The Type A person’s constant criticism and hostility induces tension
in his subordinates and this can often lead to the Type A person being
actively disliked. I have seen cases where subordinates will take any
opportunity to sabotage their boss. The Type A person’s superiors
often recognise his inability to delegate and get along with people.
Due to this, they often choose someone with better interpersonal
skills over a Type A person for promotion.
A study by Dr Meyer Friedman of leaders in business and society
showed that the percentage of leaders with Type B traits was much
higher than their percentage in the general population. Dr Friedman
also observed that he has “yet to come across a single top Type B
corporate executive who has had a heart attack before his 65th
birthday.”
2) On Family
The Type A person is usually perceived by his wife and children to be
a tyrant or bully and is often disliked by them. After their husbands
have died of coronary disease, many wives say that it is a relief. I
have also observed that children from families with one or two Type
A parents have a much higher incidence of psychiatric illness, drug
addiction and behavioural disturbances.
Mr Suri was an ageing retired politician who had been a minister.
His son was severely addicted to heroin and Suri blamed his wife for
this insisting, saying that she had not been a good mother. During
therapy he once said, “She used to keep asking me to help with his
homework and attend his school events. Did she not realise that I am
a man of action and had much more important things to do like
raising funds for the Party.” Mr Suri maintained that different rules
applied to men of action like him.
It took him a long time to understand why his wife finally left him
with her son and moved to her brother’s house. When he realised
what he had done he suffered a severe attack of depression which had
precipitated his heart attack.

3) On Health
The Type A person is much more likely to develop high blood
pressure than his Type B counterpart. He is also more likely to smoke
and suffer from smoking-related illnesses such as bronchitis and
cancer. I have found that the Type A person is much more likely than
the Type B person, to develop psychiatric disorders such as anxiety
and depression.

Healing Heart Disease Naturally

Healing Heart Disease Naturally

Recommended

Recommended

More Related Content

Similar to Healing Heart Disease Naturally

Similar to Healing Heart Disease Naturally (13)

More from Lucky Gods

More from Lucky Gods (20)

Recently uploaded

Recently uploaded (20)

Healing Heart Disease Naturally