This document provides information on coronary artery disease (CAD) and strategies for prevention. It discusses that CAD is a leading cause of death and symptoms can include chest pain and shortness of breath. Risk factors include age, family history, smoking, high blood pressure, high cholesterol, diabetes, obesity, lack of exercise, and stress. Prevention strategies target population-level interventions as well as controlling risk factors for high-risk individuals and implementing secondary prevention measures. A healthy diet, physical activity, weight control, and stress management are emphasized.

2. ? Prevention Of Heart
Attacks

3. PAIN
Is it good ?
or
Bad ?

4. SOME FACTS ABOUT CAD
• 25 -28 % of CAD die suddenly
• 55 % of all cardiac deaths occur within the 1st hour
• Among survivors around 10% die in the 1st year and 5%
thereafter every year.

5. A disease known is Half Cured

7.  Heart is most important organ in the body
 It is very sensitive, strong and hard
working
 It contracts for more than one lakh times in
a day and pumps blood to each and every
organ in the body
 A person dies if it stops for 3minutes
 It is a muscular organ and supplies oxygen
to each cell in the body through blood
Right half of the Heart collects de-
oxygenated (impure) blood from all parts of
the body and pumps into the lungs for
getting oxygen and removal of carbon-
dioxide and other metabolic waste .Then the
pure blood from lungs enters left side of the
heart.

8.  For pumping of blood to all parts of body,
Heart also needs oxygen and energy. It
gets energy and oxygen through,
“Coronary Arteries which are branches of
Aorta”.
 If due to some reason, Coronary Arteries
get blocked, it results in “Heart Attack”
 Usually as age advances, the blood
vessel walls get thickened and become
rigid, a condition called “Atherosclerosis”
 At the same time, if cholesterol (Fat) in
the blood is increased, it causes block in
the blood flow. If this occurs in coronary
blood vessels, it results in “Heart Attack”

9. Indian Scenario of Heart Attacks
(Coronary artery disease)
 CAD appears a decade earlier in
India, compared with developed
countries
 Males are affected more than
females
 Hypertension and Diabetes
accounts for about 40% of all
cases
 Heavy smoking is responsible
aetiologically in a good number
of patients

10. Clinical Manifestations
Signs and Symptoms of CAD
 Sudden death may be the first clinical
manifestation of CAD in as many as one-fourth
of the patients. In about 55% of all cardiac
deaths mortality occurs within the 1st hour
 Retrosternal (center of chest) stabbing pain
 Radiation of pain to left shoulder and even up to
tip of left little finger
 Palpitation, fatigue, sweating all over the body
and burning sensation in the stomach
 Sudden breathlessness (previously never
existed)
 Toothache/ pain near the jaws
 Nausea or Vomiting
 Sometimes without any of the signs and
symptoms (silent infarction). It is usually seen in
Diabetics.

11. Risk Factors for CAD
Non-Modifiable risk factors of
CAD
 Age
 Sex
 Family History
 Genetic Factors
 Personality
Modifiable Risk Factors
 Cigarette Smoking
 High Blood Pressure
 Elevated Serum cholesterol
 Diabetes mellitus
 Obesity
 Sedentary habits
 Stress
 Lack of exercise

12. Smoking
SOME PEOPLE COMMIT “SUICIDE” BY
“DROWNING”, BUT MANY BY “SMOKING”
 Smoking is responsible for 25% of CAD deaths under
65yrs of age in men. Cigarette seems to be
particularly important in causing sudden death from
CAD in men below 50yrs of age.
 The main culprits in Tobacco, which harms Heart and
blood vessels are
NICOTINE and
CARBON MONOXIDE
 Nicotine stimulates the heart and increases demand
of more oxygen to heart, and thus increases heart
rate.
 Carbon monoxide has 200 times more affinity towards
hemoglobin and thus reduces oxygen supply to all
tissues
 Smoking increases the viscosity of blood and
enhances the chances of blood clotting inside the
vessels.

13. Hypertension
Hypertension damages the blood
vessel walls and accelerates
atherosclerotic process resulting in
precipitation of CAD
Studies reveal that a reduction of
BP by 2-3mm of Hg in general
populations can produce large
reduction in CVD complications

14. ADVANTAGES OF LIFE STYLE MODIFICATIONS
Modification Recommendation Reduction in Systolic
Blood Pressure
• Weight reduction BMI 18.5-24.9 5-20mm of Hg/10 kg
reduction
• DASH eating plan Fruits, vegetables, low fat etc. 8-14mm of Hg.
• Reduction in Na. 5-6 gms of sodium 2-8 mm of Hg.
• Physical Activity Regular aerobic physical activity 4-9 mm of Hg.
30 mts /day
• Limitation of Alcohol < 2drinks/day(30ml ethanal) 2-4 mm of Hg.

15. Blood Cholesterol
 Elevated blood lipids (Cholesterol & Triglycerides) are the
major risk factors for CAD
 Animal fats (Meat, Milk Products, Egg etc.) except fish,
contain saturated fatty acids which contain low density lipids
will increase the thickness of blood vessel walls resulting in
Hypertension and Coronary Artery Disease.
 Vegetable oils(except palm oil & coconut oil) contain poly
unsaturated fatty acids, have more „high density lipids‟
which protect the heart. The HDL fat acts as a „scavenger‟
in removing the LDL attached inside the blood vessel walls.
 In typical Indian diet, which is cereal based, about 20gms of
fat is obtained as „invisible fat‟. Therefore a daily in take of
20gms or 4 tea spoons of visible fat is sufficient. The ratio of
saturated to PUFA should be roughly 0.8-1.0

16. Poly unsaturated fatty acids (PUFA)
 Usage of oils which are rich in „Linoleic,and Linolenic
fatty acids‟ like saffola, Sunflower, Soya Bean,
Ground nut etc. will prevent occurrence of CAD.
 The deficiency of PUFA enhances mechanism of
blood clotting inside the blood vessel, which results in
CAD/ Paralysis (CVA).
 FISH is good for HEART. It is an abundant source of
long chain n-3 PUFA, which reduces the blood levels
of cholesterol and triglycerides and also decrease
fibrinogen levels, inhibit platelet activity and clotting
process.
 Mustard and Soya oils are two common vegetable
oils which contain alpha-linolenic acid. Use of any one
oil along with other oils will be beneficial.
 The n-3 PUFA is also good for brain & joints and have
anti-cancer properties.

17. Blood Lipids (mg/100ml of plasma)
Type of
cholesterol
Desirable
Border
line High
High Risk
Total
Cholesterol
<200 200-240 >240
LDL <130 130-160 >160
HDL >50** - <35
Triglycerides <150 150-500** >500
* In Indians CAD occurs even at
cholesterol levels around 180mg/100ml
of plasma
** Arbitrary Values
Cholesterol : HDL should be less than 3.5

18. Obesity
 The higher the body weight the greater is the risk
of CAD
 For every extra KG of fat, one tends to produce
20mg more cholesterol per day.
 Higher abdominal fat (Fat around waist) is known
to be a greater risk factor than accumulation of fat
around hips.
 It is hence necessary to maintain ideal body
weight.
 The simple formula to know the ideal body weight
in KGs is height in centimeters minus 100.
 The tendency for obesity seems to be inherited
and over eating. Also it is clearly an important
cause with low physical activity.

19. Diabetes Mellitus
 The risk of CAD is 2-3 times
higher in patients with Diabetes
 CAD is responsible in 30-50%
of deaths in Diabetes over the
age of 40yrs
 In Diabetes the blood lipids are
increased and these contribute
to premature or accelerated
process of „Atherosclerosis‟.

20. Genetic Factors
 A family history of CAD is
known to increase risk of
premature death.
 Probably the genetic
factors are most important
determinants of an
individual‟s “Total
Cholesterol and HDL
levels”.

21. Sedentary life style
 With increasing
industrialization,
modernization and
mechanization, sedentary
habits have become a part
and parcel of our life styles.
 Sedentary habits decrease
the energy expenditure and
therefore contribute to over
weight and rise in blood
lipids

22. Lack of Physical Exercise
 Incidence of HTN is more in those who
lack physical exercise.
 Regular physical exercise increases
the concentration of HDL and
decreases the body weight, blood
glucose, blood lipids and blood
pressure.
 Walking briskly for 45 minutes a day
can bring down the risk of HTN.

23. Hormones
The „Estrogen‟ hormone in the
female is probably the most
important hormone which protects
the female from getting CAD up to
menopause. (After menopause, the
hormone levels of estrogen fall, and
chances of getting CAD will be same
as male).

24. Alcohol
 High alcohol intake defined as 75gms or more per
day is an independent risk factor for CAD
 Alcohol stimulates heart,and increase blood pressure
transiently, and may precipitate CAD if other risk
factors are also there.
 Alcohol also stimulates „FAT‟ metabolism, increases
obesity and results in Arteriosclerosis , Hypertension
and CAD
 The evidence that moderate alcohol intake leads to a
reduction in the risk of CAD is “UNSUBSTANTIATED”
 Though alcohol in small amounts (Large glass of
beer, 35ml of whisky, 70ml of wine) increase HDL, it
doesn‟t increase the protective fraction, the HDL2 of
HDL
 Alcohol weakens heart muscle resulting in
Cardiomyopathy.

25. Personality
 Type „A‟ persons‟ behaviour is
associated with competitive
drive, restlessness, hostility and
a sense of urgency or
impatience and are more prone
for CAD.
 Type „B‟ persons are easy
going, less anxious, contented,
calm and philosophical in nature
and are less prone for CAD

26. Stress
 It is well established that ambitious and
aggressive personalities are more prone for
CAD
 Stress can be physical, social or emotional.
Stress causes heart to beat faster, the blood
pressure to go up, the muscles to become
tense and the arteries to go into spasms. All
these occur through release of a substance
called “Adrenaline”
Practice Yoga
Yoga, the age-old Indian practice of mind and
body control can play prominent role in the
reduction of stress and indirectly prevents
CAD. Yogic practices are ancient in India
systematized by Pathanjali in 300 BC

27. Oral Contraceptive pills
Women using „Oral contraceptive pills‟
have higher blood pressure and the
risk of CAD seems to be increased
and compounded by cigarette
smoking

28. Dietary Fiber
The cholesterol lowering effect of
certain types of dietary fiber is firmly
established, which in turn is useful
in the prevention of CAD. The daily
requirement of dietary fiber is 30-
40gm/day.

29. Anti-Oxidants and Micronutrients
 CAD is currently thought to be a result of
oxidative stress also i.e., the generation of
excess of free radicals and peroxide in
the tissues. Oxidized blood lipids are
more “Atherogenic‟ than un-oxidized
lipids.
 Anti-oxidants and Micro-nutrients such as
Vit C, Beta-Carotene, Vit-A, Vit-E and
Selenium can remove peroxides and free
radicals and there by reduce the oxidative
stress in tissues.
 Yellow and orange vegetables and fruits,
green leafy vegetables, egg, milk, liver,
kidney, fresh fruits, vegetable oils, cereals
etc. are the main sources of Anti-Oxidant

30. Onion & Garlic
 In scientific studies large doses of
onion & garlic are noted to be
beneficial causing a decrease in
blood lipids and glucose and an
increase in clot dissolution
(Fibrinolytic).
 The garlic and onions that are
regularly included in Indians diets
may also have beneficial effect.
 One may as well eat garlic as part of
daily diet rather than resort to garlic
capsules.

31. Salt (Sodium Chloride)
 Excess salt is bad for the heart.
 Indians are in the habit of
consuming 10-15 gm of salt/day
in the form of added salt.
 Probably 3gms of salt/day is both
safe and adequate for healthy
adults.
 Reduction in salt in turn will
reduce blood pressure and
prevent CAD.

32. Water
Some scientific evidence suggests
that heart diseases are more
common in areas with soft water than
where the water is hard. Minerals
such as calcium & magnesium and
trace metals like chromium and
vanadium present in hard water
appear to be protective to heart.

33. What to do in case of a heart attack.
 If you suspect that you are having “Heart
Attack“ Call for help at once.
 Lie down comfortably & loosen tight clothing
 Chew an “Aspirin” tablet immediately. ( It can
help prevent blood clot in your arteries.
Chewing lets it act faster).
 Inform your doctor.
 Get some one to drive you to the hospital
quickly or call an ambulance.
 If you have the “Risk Factors like HTN, DM,
Smoking etc, always keep “tab aspirin & tab
Sorbitrate” handy.

34. How to prevent Heart Attack
 Stop smoking immediately.
 Stop Alcohol, gutka, jarda etc.
 Maintain an ideal body, weight.
 Exercise of at least 30min per day.
 Reduce animal fats in your diet.
 Restrict added “Salt” in your diet to only 5gms.
 Control your stress. Yoga and meditation are good.
 See that BP and DM are under control.

35. Strategy of Prevention of CAD
 Population strategy
 High risk strategy
 Secondary prevention

36. Eat for a healthy heart. Don‟t eat your heart.
Conquer heart diseases through healthy life style
It is not work, but worry that kills
Practice yoga and meditation for better health
A little salt is divine .Too much is harmful
Eat to live, Don‟t live to eat.

37. Good Planning
If you are planning for a Year sow rice.
If you are planning for a decade plant trees.
If you are planning for a life time “EDUCATE PEOPLE”

38. No one knows you better than yourself
No one can eat for you
No one can lose weight for you
No one can think for you
No one can stop bad habits for you
No one can develop good habits for you
No one can take medication for you
No one but YOU can change yourself
SELF HELP

39. Framingham’s 10 yr Risk Score Calculation For CAD