Coronary heart disease is emerging as a major killer disease in India as the years roll by. The predictions are that 40 % of the total deaths will be due to this disease by the year 2015 in India. The magnitude of
the problem is such that whatever preventive care is to be effected, will have to be on a war footing. |
Coronary heart disease was the major killer
disease in USA in the 1970's and 1980's wherein it reached a peak. From then on there was a
descending curve for this disease. This information is vital to us because, we in India,
are experiencing the same epidemic now. The lesson from the west is to be taken seriously
for us to tackle this epidemic.
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The decreasing prevalence of this disease
in US is because of multipronged strategies that were adopted. These included a clear
understanding of the risk factors which influence this disease, public education, targeted
management of the high risk populations and applying the various treatment strategies with
a state of art.
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In the next few articles we will be sharing
with you all this information so as to bring in the qualitative change in public health.
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CORONARY RISK FACTORS :
Some factors are identified for a long time to be responsible for the development and
progression of the blocks in the blood vessels of various organs in the body. These
include :
1. Hypertension
2. Diabetes
3. Smoking
4. Hyperlipidemia (elevated lipid levels in the blood)
5. Family history of the disease.
The above factors influence the disease
directly or indirectly. It is found that control and treatment of these factors results in
less disease and lower complications.
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HYPERTENSION :
The high blood pressure is the commonest disease afflicting the heart and blood vessels.
The normal blood pressure is considered to be less than 140/80mmHG. Whenever BP continues
to be in higher range which defines hypertension, its effect falls on various parts of the
body. As a consequence of the hypertension, the cholesterol levels of the blood increase,
cholesterol gets accumulated within the walls of the blood vessels and results in the
formation of a block or blocks. It is found in various studies, that by keeping
BP
under control through medication and some other nondrug therapies, the block formation in
the blood vessels is reduced and the complications of the blocks is also reduced.
The common misconception that a higher BP
is normal for an advanced age is no longer true. Whatever may be the age, maintaining a BP
of <140/80 will reduce the complication of block formation in the blood vessels.
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DIABETES :
The propensity for the block formation is significantly increased by diabetes. Again, like
in hypertension, the cholesterol deposition in the blood vessels is greatly increased by
this disease. It is found that by keeping the blood sugar level under control,
considerable benefits could be extended. Ideal blood sugar levels below which maximal
benefit occured was a fasting blood sugar level <140mg% and postprandial blood sugar
level <180mg%.
(TO BE CONT.)
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SMOKING :
Smoking definitely confers a significant risk in the development of vascular
disease. This becomes an important risk factor especially in the young people. Persons less than 40 years of age had smoking as an important risk factor for the
development of heart attack. Smoking facilitates easy blood clotting besides many
other changes in the blood cells which increase the propensity for block formation.
Do you know that the moment a puff is taken, the blood pressure rises sharply by about 30
- 40 mmHG !!!. This in itself could be dangerous. In addition, after the last
cigarette is smoked today, smokers risk of heart attacks equals that of nonsmokers only at
the end of 2 years !!!. Many a time physicians are faced with question that many do
smoke, but not all get the heart attacks and hence why don't we smoke too !!. The
answer lies in the question. Because we do not know who is going to get the problem,
and it could be you or the smoker, hence smoking should be stopped.
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HYPERLIPIDEMIA
Last decade has seen many a development in the area of lipids and their effect over
the vascular disease. It is no exaggeration to comment that the practice of
cardiology in particular and the health scene as whole is not the same after this
information is available. Cholesterol and its various sub fractions and
triglycerides have direct effect over the blood vessels. They increase the
propensity of block formation within the blood vessels, increase the tone of the vessels
so that the ease with which blood vessel should relax is effected considerably. This
produces a perpetual spasm of the blood vessels of the heart and also elsewhere.
This discovery has led to the stipulations by the American Heart Association regarding the
treatment of these abnormalities. The treatment includes not just drugs but equal
emphasis is given to the diet and exercise. In a nutshell, a low calorie, low
cholesterol diet is strongly advised. Regular aerobic exercise for a minimum period
of 50 min for at least 5 days a week is advised. Continued research resulted in the
development of new drugs, which are extremely effective in controlling the high lipid
content of the blood.
It was also realized that the lipid abnormalities affecting the
Indian subcontinent were slightly different from our western counterparts. We have
predominantly high triglycerides in contrast to the high levels of cholesterol in the
western hemisphere. In fact, the combination of high triglycerides, truncal obesity,
diabetes, insulin resistance defines a unique population amongst our midst who are at a
high risk of developing the vascular disease. The implications of this are clear in
that it is not simply enough if you get your cholesterol checked up. If you do so
you would miss out the more important abnormality in your system which might aggravate the
problem. So the next time your physician orders a cholesterol test on you, make sure
you get a lipid profile done.
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FAMILY HISTORY OF DISEASE
It should come as no surprise to you that the heart diseases also could be
inherited. If a male aged less than 55 years and a female aged less than 65 years
had a heart attack, their offspring are at a higher risk of developing the same problem
even when they do not have other risk factors. Problem of genetics !!!
Any
person who has such a family history should have proper preventive check for the
development of premature vascular disease.
Apart from the above risk factors, just being born as a male
confers the risk of developing the vascular disease. Any person more than 40 years
of age also is predisposed. These two would explain the innocent "wonder"
in the general public as to why these diseases develop even when one has very
"healthy" habits. In addition, some new & novel risk factors were
discovered of late. Briefly, they are Lipoprotien (a), Homocystein etc.
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IMPORTANT NOTE
:
This site presents material for your information and education. We can
assume no liability for inaccuracies, errors or omissions. Above all material on this site
should not take the place of the care you receive from your personal family physician. It
is simply designed to help in the understanding of the prevention of coronary heart
diseases and not as a diagnostic or therapeutic aid. You should seek prompt medical care
for any specific health issue. Please feel free to download material for personal and
non-commercial use. Neither is Dr. C. V. Rao nor Vizagcityonline.com in any way
responsible for any complications / problems that may arise.
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