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          Prevention of Heart Disease
What is Heart Disease?
• Heart : The most hard­working muscle of
  our body – pumps 4­5 litres of blood every
  minute during rest
• Supplies nutrients and oxygen rich blood to
  all body parts, including itself
• Coronary arteries
  surrounding the heart
  keep it nourished with
  blood
What is Atherosclerosis
 what is coronary artery disease?




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




          From First                   From Third            From Fourth 
           Decade                        Decade                Decade



Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104). 
Are Other organs Affected? 
                 Affected?



Ischemic Stroke 


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




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

• Poor handling of fats and metabolic
  syndrome
   – Diabetes, obesity, high BP, Coronary artery
     disease

Environmental insults

• Urbanization

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

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

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

       Pear­shaped paunch store fat on the 
       hips and thighs, just below the surface of 
       the skin. 


Apple­shaped paunch store body fat 
around the abdomen and chest, 
surrounding internal organs 
Physical Inactivity




Every morning my brain
tells me to exercise…

 ….. and my body
 laughs at the idea
Cigarette Smoking
•    Increases blood pressure
•   Decreases HDL
•   Damages arteries and blood cells
•   Increases heart attacks
•   Cigarette smoke contains more than
    4,000 chemicals, and 200 of these
    chemicals are poisonous
Cigarette Smoking
If you think YOU are smoking the cigarette, you are mistaken…
It’s the other way round !
Alcohol Consumption
• In small amounts it is beneficial: 1­2
  drinks
• In large amounts it adds fat and
  calories & raises BP!
• 4 drinks per day. You end up with
  gastroenterologist instead of
  cardiologist
• This is a very fine line! Finer for
  women as they are at higher risk
Diabetes
• At any given cholesterol level, diabetic
  persons have a 2 or 3 x higher risk of heart
  attack or stroke
• A diabetic is more likely to die of a heart
  attack than a non­diabetic
• ~80% Diabetics die from heart disease
• Risk of sudden death from a heart attack
  for a diabetic is the same as that of
  someone who has already had a heart
  attack.
Interactions of Risk Factors
èRisk operates across a continuum ­ no clearcut line 
(Blood Pressure; Cholesterol; overweight; Smoking) 
èThe risk is multiplicative when many risk factors co­ 
  exist; risk factors often cluster together 
èMajority of events arise in individuals with modest 
 elevations of many risk factors than from marked 
 elevation of a single risk factor 
Misfortunes always come in
by a door that has been left
      open for them.

           Czechoslovakian proverb
Everyday you make choices to try to 
help protect yourself and your family. 
In fact, protecting yourself has 
become second nature—you just do 
it. 
But do you know what you can do to 
help protect yourself from this 
number 1 cause of death­ Heart 
Disease?
For my car, I want the best
        mechanic.
 But for my own body, I follow
hearsay and advice from friends,
  kitty party, local quacks….
          Just anyone
    And decide for the worst
Creative strategies do not work !
• Karva Chauth!
• Never had a test or retest
• Never been to Doctor !
  I hate them
• Never take medicines!
• My BP is normal, so stopped
  meds!
• Miracle men and Miracle
  Medicines! So many of them
• I am my own doctor! No fees
  too
Preventing Heart Disease
   Rule #1 Look before your eat
• Eat a variety of fruits and vegetables every day.
  (5 servings ­ they are naturally low in fat and
  high in vitamins and minerals and anti
  oxidants). Eat colored vegetables and fruits
• Eat a variety of grain products
• Choose nonfat or low­fat products.
• Use less fat meats­ chicken, fish and lean cuts
§ Switch to fat­free milk—toned/skimmed milk
Dietary Guidelines
• Limit your intake of foods high in
  calories and low in nutrition, including
  foods like soft drinks, candy, junk food
• Limit foods high in saturated fat, trans­
  fat and cholesterol
• Eat less than 6 gms of salt a day
• Have no more than1­2 alcoholic drink a
  day if you are a regular drinker
Limit / Avoid
• Foods rich in Cholesterol and Saturated
  fats
  – Egg Yolk
  – Fatty meat & organ meat( Liver)
  – Butter chicken / Batter fried fish !
  – Milk fat – Desi Ghee, Butter, Cheese, Malai,
    Rabri, Khurchan, Doda, Ice Cream, full
    cream milk,
  ­Hidden Fat like Bakery biscuits, Patties (!),
    Cakes, Pastries,
Cooking Oils: The mystery of
           PUFA / MUFA
• Saturated Fats : Increase Cholesterol – Avoid
  – Coconut oil, Palm oil, Vanaspati ghee
• Monounsaturated Fats (MUFA): Heart healthy
  – Olive oil, Groundnut oil, Canola oil, Mustard oil
• Polyunsaturated Fats (PUFA): Heart healthy
  – Sunflower oil, Soybean oil


• Omega­3­Fatty acids Fish oil : Heart Healthy

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




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

• Smell and taste improve within days

• Within three months of quitting, the
  smokers' cough disappears in most people
Rule # 3 Stop Smoking NOW!
Benefits much beyond Heart Disease

                          Cardiovascular 
       Tobacco 
                          Cancers 
           Diet 
                          Diabetes 

                          Chronic Respiratory Diseases 
Physical Activity 
                          Osteoporosis 

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

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

• Get the levels tested routinely and keep them
  under control
• The only thing worse than finding out that
  you have one of these conditions is…….NOT
  finding out that you have it!! 
Benefits of reducing
            cholesterol 
            cholesterol

     10% reduction of blood
   cholesterol produces 20­30%
      decline in CHD deaths

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


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

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Preventing Heart Disease

  • 1. m or u F ng ni ar Le Prevention of Heart Disease
  • 2. What is Heart Disease? • Heart : The most hard­working muscle of our body – pumps 4­5 litres of blood every minute during rest • Supplies nutrients and oxygen rich blood to all body parts, including itself • Coronary arteries surrounding the heart keep it nourished with blood
  • 3. What is Atherosclerosis what is coronary artery disease? • Over time, fatty deposits called plaque build up within the artery walls. The artery becomes narrow. This is atherosclerosis • When this occurs in the coronary arteries, heart does not get sufficient blood, the condition is called coronary artery disease, or coronary heart disease
  • 4. Myth : fat deposits at old age! It starts from 2 years of Complicated  age  age Lesion/  Foam  Fatty  Intermediate  Fibrous  Rupture  Cells  Streak  Lesion  Atheroma  Plaque  From First  From Third  From Fourth  Decade  Decade  Decade Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104). 
  • 5. Are Other organs Affected?  Affected? Ischemic Stroke  Coronary Heart Disease  • Angina  • Angina  • MI (Heart Attack)  • MI (Heart Attack)  • Sudden Cardiac Death  • Sudden Cardiac Death Peripheral Vascular  Disease 
  • 6. What are the symptoms of Coronary artery disease? • No symptoms for long period • Chest pain for short period on exertion also known as Angina or minor heart attack • Myocardial Infarction or major heart attack­Severe chest pain, death of heart muscle, heart failure, irregular heart beats • Sudden Death
  • 7. How Big is the Problem ? • No. 1 killer disease worldwide – 12 Million deaths annually • During last 30 years large declines in developed countries ­rising health awareness and government programmes • Alarming increase in developing countries especially India
  • 8. Why Should I (Indian) be Worried ? • Indians More susceptible that any other ethnic group – 3.4 times more than Americans – 6 times more than Chinese – 20 times more than Japanese – Occurs at lower cholesterol • Get the disease at much younger age – 5­10 years earlier than other communities • Disease follows more severe and malignant course – 3 times higher rate of second heart attack and two times higher mortality than whites
  • 9. Why Me ? • Genetic predisposition • Poor handling of fats and metabolic syndrome – Diabetes, obesity, high BP, Coronary artery disease Environmental insults • Urbanization • Sudden change in lifestyle
  • 10. What Increases Risk? You can’t help it ! You can !! • Age: • High Cholesterol Men > 45; • Smoking Women > 55 • High Blood Pressure • Sex • Diabetes • Race • Obesity • Family History • Alcohol • Physical Inactivity
  • 11. Cholesterol ( A type of fat) • Everybody needs cholesterol, it serves a vital function in the body. • It circulates in the blood. •Too much cholesterol can deposit in the arteries in the form of plaque and block them •No symptoms till heart attack
  • 12. Where does it come from ? 35% 35%  65%  • Two sources of cholesterol: Food & made in your body • Food sources: All foods containing animal fat and meat products 
  • 13. Good vs. BAD Cholesterol • LDL cholesterol is known as bad cholesterol. It has a tendency to increase risk of heart disease • LDL cholesterol is a major component of the plaque that clogs arteries • HDL cholesterol is known as the good cholesterol. Higher in women, increases with exercise • HDL cholesterol helps carry some of the bad cholesterol out of arteries.
  • 14. Obesity • People who are overweight (10­30 % more than their normal body weight) • Obese have 2 to 6 times the risk of developing heart disease • Normal Waist­Hip Ratio < 0.85 for women; < 0.95 for men • Pears or apples?
  • 15. Pears and Apples  Apples Apple­ shaped are at a higher risk Apple  shaped are at a higher risk  Pear­shaped paunch store fat on the  hips and thighs, just below the surface of  the skin.  Apple­shaped paunch store body fat  around the abdomen and chest,  surrounding internal organs 
  • 16. Physical Inactivity Every morning my brain tells me to exercise… ….. and my body laughs at the idea
  • 17. Cigarette Smoking • Increases blood pressure • Decreases HDL • Damages arteries and blood cells • Increases heart attacks • Cigarette smoke contains more than 4,000 chemicals, and 200 of these chemicals are poisonous
  • 18. Cigarette Smoking If you think YOU are smoking the cigarette, you are mistaken… It’s the other way round !
  • 19. Alcohol Consumption • In small amounts it is beneficial: 1­2 drinks • In large amounts it adds fat and calories & raises BP! • 4 drinks per day. You end up with gastroenterologist instead of cardiologist • This is a very fine line! Finer for women as they are at higher risk
  • 20. Diabetes • At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of heart attack or stroke • A diabetic is more likely to die of a heart attack than a non­diabetic • ~80% Diabetics die from heart disease • Risk of sudden death from a heart attack for a diabetic is the same as that of someone who has already had a heart attack.
  • 21. Interactions of Risk Factors èRisk operates across a continuum ­ no clearcut line  (Blood Pressure; Cholesterol; overweight; Smoking)  èThe risk is multiplicative when many risk factors co­  exist; risk factors often cluster together  èMajority of events arise in individuals with modest  elevations of many risk factors than from marked  elevation of a single risk factor 
  • 22. Misfortunes always come in by a door that has been left open for them. Czechoslovakian proverb
  • 24. For my car, I want the best mechanic. But for my own body, I follow hearsay and advice from friends, kitty party, local quacks…. Just anyone And decide for the worst
  • 25. Creative strategies do not work ! • Karva Chauth! • Never had a test or retest • Never been to Doctor ! I hate them • Never take medicines! • My BP is normal, so stopped meds! • Miracle men and Miracle Medicines! So many of them • I am my own doctor! No fees too
  • 26. Preventing Heart Disease Rule #1 Look before your eat • Eat a variety of fruits and vegetables every day. (5 servings ­ they are naturally low in fat and high in vitamins and minerals and anti oxidants). Eat colored vegetables and fruits • Eat a variety of grain products • Choose nonfat or low­fat products. • Use less fat meats­ chicken, fish and lean cuts § Switch to fat­free milk—toned/skimmed milk
  • 27. Dietary Guidelines • Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks, candy, junk food • Limit foods high in saturated fat, trans­ fat and cholesterol • Eat less than 6 gms of salt a day • Have no more than1­2 alcoholic drink a day if you are a regular drinker
  • 28. Limit / Avoid • Foods rich in Cholesterol and Saturated fats – Egg Yolk – Fatty meat & organ meat( Liver) – Butter chicken / Batter fried fish ! – Milk fat – Desi Ghee, Butter, Cheese, Malai, Rabri, Khurchan, Doda, Ice Cream, full cream milk, ­Hidden Fat like Bakery biscuits, Patties (!), Cakes, Pastries,
  • 29. Cooking Oils: The mystery of PUFA / MUFA • Saturated Fats : Increase Cholesterol – Avoid – Coconut oil, Palm oil, Vanaspati ghee • Monounsaturated Fats (MUFA): Heart healthy – Olive oil, Groundnut oil, Canola oil, Mustard oil • Polyunsaturated Fats (PUFA): Heart healthy – Sunflower oil, Soybean oil • Omega­3­Fatty acids Fish oil : Heart Healthy Rotate the oils or Mixture of oils
  • 30. Preventing Heart Disease Rule #2 Exercise • Maintain a level of physical activity that keeps you fit and matches the calories you eat • Serves several functions in preventing and treating those at high risk • Reduces incidence of obesity • Increases HDL • Lowers LDL and total cholesterol • Helps control diabetes and hypertension
  • 31. Exercise, Exercise, Exercise •Mortality is halved in retired men who walk more than two miles every day •Regular exercise can halve the risk of heart disease, particularly in men who walk briskly •Someone who is inactive has as great a risk of having heart disease as someone who smokes, has high blood pressure or has high cholesterol •Exercise significantly reduces the chances of diabetes and stroke •With regular exercise, blood pressure in those with hypertension is reduced by as much as 20mms Hg
  • 32. Exercise and Heart Disease Moderate to intense physical activity for 30­45 minutes on most days of the week is recommended
  • 33. Walking for a healthy heart • Complicated exercise machines or sweating it out in the gym not essential JUST WALK!
  • 34. Rule # 3 Stop Smoking NOW! • The risk of heart attack starts decreasing within 24 hours of quitting smoking, within 1 year of quitting, CHD risk decreases significantly, within 2 years it reaches the level of a nonsmoker • Smell and taste improve within days • Within three months of quitting, the smokers' cough disappears in most people
  • 35. Rule # 3 Stop Smoking NOW!
  • 36. Benefits much beyond Heart Disease Cardiovascular  Tobacco  Cancers  Diet  Diabetes  Chronic Respiratory Diseases  Physical Activity  Osteoporosis  Oral Health  Alcohol  Mental Health 
  • 37. Rule # 4 Know your Number! And that’’  And that s not your Mobile Number! s not your Mobile Number!  Desirable numbers • Total cholesterol < 200; • LDL < 100 • HDL > 40 • triglycerides < 200 • Get the levels tested routinely and keep them under control • The only thing worse than finding out that you have one of these conditions is…….NOT finding out that you have it!! 
  • 38. Benefits of reducing cholesterol  cholesterol 10% reduction of blood cholesterol produces 20­30% decline in CHD deaths All Adults >20 yrs must get tested­ if normal test again  after 5 years, if elevated, work towards normalizing the  levels with lifestyle modification and drugs as needed
  • 39. Controlling Blood Pressure • Adults should have their blood pressure checked at least once every two years, as there are no symptoms to tell if you have high blood pressure • Optimal levels : 120 /80 mm Hg • If high – Modify your lifestyle – Diet, Weight, Exercise, Salt restriction – Adhere to the prescribed medication without fail, to decrease chances of getting heart disease – Do not stop your medicines without consulting your doctor, even if the blood pressure becomes normal
  • 40. Controlling Blood Sugar • All adults should have their blood sugar checked regularly, as there are no early symptoms of diabetes • Normal blood sugar: • Fasting < 100; post meals <140 • If high – Modify your lifestyle – Diet, Weight, Exercise – Adhere to the prescribed medication without fail, to decrease chances of getting heart disease – Do not stop your medicines without consulting your doctor, even if the blood sugar becomes normal
  • 41. If you or someone in your family already diagnosed with heart disease • Don’t get disheartened – science has made significant progress • Just monitor risk factors much more aggressively – Eat healthy – Walk regularly – Watch your weight – Quit smoking immediately – Keep your weight under control – In addition to improving your heart – health these measures are sure to enhance your appearance !! • Adhere to you medicines & listen to your doctor
  • 42. Don’t wait for a heart attack to take an action ! Don’t wait for a second life we are not cats!