How to keep our Heart Healthy

Cardiovascular diseases have now become the leading cause of mortality in India. 25 to 30% mortality in our country is attributable to heart attacks, brain strokes and heart failure. The Global Burden of disease in India is estimated at age-standardized death rate of 272

per 100,000 population. It is higher than the global average of 235 per 100000 populations. The other peculiarities in our country are a younger age at presentation, an accelerated course of disease and high mortality. Preventive strategies are therefore the keys to reduce this alarming trend because once it manifests, most treatment strategies are at best palliative. The World Heart federation and World Health Organization every year has marked last Saturday of September as the “World Heart day”.

This year the theme of the World Heart Day is to make 3 Promises. “Eat more healthily”, “get more active” and “say no to Smoking”. These three do’s can go a long way in preventing a heart attack and keep you healthy in general.

Eat more healthily:

A Mediterranean diet has been recommended based upon several scientific studies and is associated with lowering the chances of heart attacks. In our Indian context if we have to translate it: it would mean consuming plenty of fresh fruits and vegetables (5 to 6 servings a day). Replace butter with olive oil or Canola or mustard oil. Deep frying of food and vegetables destroys their nutrients. Keep vegetables washed and cut in a cool place or a refrigerator for quick snacks. Keep fruit in a bowl in your kitchen so that you'll remember to eat it. Choose recipes that have vegetables or fruits as the main ingredient, such as vegetable stir-fry or fresh fruit mixed into salads.

Replace red meat by oily fish like salmon, trout or mackerel. White meat is preferred over red meat. However there is no absolute no to red meat. Reduce in quantity, take it less frequently and wherever possible take away the visible fat (lean meat).

Whole grains are good sources of fibre and other nutrients that play a role in regulating blood pressure and heart health. You can increase the amount of whole grains in a heart-healthy diet by making simple substitutions for refined grain products or try a new whole grain, such as whole-grain wheat, unpolished red rice and even barley.Another easy way to add whole grains to your diet is ground flaxseed (Alsi in Hindi, Punjabi and Gujarati). Flaxseeds are small brown seeds that are high in fibre and omega-3 fatty acids, which can lower your total blood cholesterol.

Lean meat, poultry and fish, low-fat dairy products, and egg whites or egg substitutes are some of the best sources of protein. But be careful to choose lower fat options, such as skim milk rather than whole milk and skinless chicken breasts rather than fried chicken patties.Legumes — beans, peas and lentils — also are good sources of protein and contain less fat and no cholesterol, making them good substitutes for meat.Substituting plant protein for animal protein — for example, a soy or bean burger for a hamburger — will reduce your fat and cholesterol intake.

Replace salt with healthier alternatives such as fresh and dried herbs, spices, black pepper, chilli and lemon. Remove the salt cellar from the table. Choose fresh foods instead of processed and canned foods. Minimize intake of Chutneys and pickles, these have very high content of salt.

Avoid alcohol but if you want to consume limit it to 20 g a day for men and 10 g a day for women. Aim at least2 alcohol free days per week.

“Get More Active”

An inactive life style, sedentary habits and lack of regular exercise are bad habits which increase the chance of getting a major cardio vascular problem like a heart attack and associated problems. In addition this life style makes you prone to get diabetes and high blood pressure in the long run.

Regular exercise is a modifiable protective risk factor which prevents heart attacks.

Aerobic exercise done regularly has many benefits and can be an important way to lead a healthy life with considerable chance of reducing major cardiac illnesses. Exercise not only helps to fight heart disease, but for sedentary people, just adding a little exercise to the daily routine reduces the risk of high blood pressure, osteoporosis, breast and colon cancer, depression, anxiety and stress. The greatest benefit from physical activity is seen in people who formerly did no activity and then start to do activities such as walking, cycling, swimming and yogic exercises.

Aerobic exercise has the most benefit for heart and circulation. Overtime it reduces heart rate, blood pressure and improves breathing. Strengthening exercises are not good for patients with weak hearts (impaired function as seen on clinical.

Persons, who have had a heart attack, get short of breath, dizzinessor chest discomfort on exercise. Also those who have uncontrolled BP need to consult a doctor before embarking on an exercise program.

Exercise of any kind which you like is good; it can be brisk walking, jogging, cycling or swimming. Playing games is also a good alternative. The duration should be at least 30 minutes or more with a frequency of 5 to 6 times a week. It is always recommended to give a break for at least one day for allowing the muscles to recoup.

The other important part is the intensity of exercise which is best correlated with the heart or pulse rate. The target should be to keep it at least 80 percent of the maximal predicted heart rate. Maximal Predicted heart rate can be calculated by a simple formula: THR = 80% of Maximum heart rate = 0.8 x (220 – age). For a 50 year old person it will be 136/minute. Healthy people can go and exceed it also, as long as you do not get fatigued or get any unusual discomfort. If anybody starts getting tightness of chest, severe shortness of breath, dizziness or fainting the exercise program should be interrupted and best course will be to see your doctor.

Say no to Smoking

Smoking is clearly one of the most important and totally preventable causes of heart disease. Contrary to the prevalent belief that smoking only leads to chronic bronchitis and in some instances lung cancer, it is actually the most important, cause of premature heart attacks. In a study conducted by the author over 25 years ago in Delhi, and published in the American Heart Journal (1986), it was present as a risk factor in 76% of patients below the age of 40 years who had suffered a heart attack.

Smoking is a major cause of atherosclerosis— a build-up of fatty substances in the arteries. Atherosclerosis occurs when the normal arterial lining deteriorates, the walls of the arteries thicken and deposits of fat and plaque block the flow of blood through the arteries.

A person’s risk of heart attack greatly increases with the number of cigarettes he or she smokes. There is no ‘safe’ smoking level. Smokers continue to increase their risk of heart attack the longer they smoke. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than nonsmokers.

In a study to assess the risk factors in patients with heart attacks (INTERHEART study) done in 48 countries with a significant contribution from south Asia it was observed that smoking 1 to 9 cigarettes per day increases the risk of heart attack by 1.5 times, smoking 10 to 19 cigarettes per day increases risk by 2.8 times, and smoking more than 20 cigarettes per day increases risk by 4.7 times. The risk increases several fold in women who smoke and also use oral contraceptives.

All forms of smoking are equally bad; in fact, smoother and more refined forms may be more dangerous, since there is a tendency for deeper inhalations and the toxins reach the blood in higher concentrations, leading to more damage.Every form of tobacco smoke has multiple poisons, including addictive nicotine, carbon monoxide, ‘tars’ and hydrogen cyanide. In addition, there are 4,000 other chemicals of varying toxicity, including 43 known carcinogens (chemicals which can induce cancer).

Cigarette smoke does not just affect smokers. When you smoke, the people around you are also at risk for developing health problems, especially children. Environmental tobacco smoke (also called passive smoke or second-hand smoke) affects people who are frequently sitting in vicinity of smokers. Second-hand smoke can cause chronic respiratory conditions, cancer and heart disease. There's no one way to quit that works for everyone. To quit smoking, you must be ready, emotionally and mentally. You must also want to quit smoking for yourself, and not to please your friends or family. It needs a will and determination. When you get a craving move out and do something else. Do not allow anybody to smoke in your presence. Do not start eating sugar based products like candies at the time of getting an urge, rather chew gum. Remove ash tray and lighters etc. from your home. Always remind yourself that you are a nonsmoker. Interestingly the quit rate is very high after a heart attack or a brain stroke. One should not wait for such a catastrophe to make you quit smoking.

A number of commercial drugs have been developed to help people quit smoking. One of these agents is Varneciline (Champix). It helps in reducing the pleasurable effects of smoking and reducing the craving. These drugs are expensive; approximately Rupees.10,000 per person for a course, and the success rate is about 30- 40%. But let’s face it; nothing works better than strong will power, good counseling and a genuine desire to quit.

It’s never too late to quit smoking. Remember that quitting reduces your risk to that of a non-smoker within 3 years.

Having made these promises it is for us to act on them not only on the World Heart Day but throughout the year and in years to come. It will ensure that you will a longer, disease free life and be a more productive member of the society. India needs a healthier population.

Prof Upendra Kaul, 

Awarded Padmashiri and Dr B C Roy Award

Chairman and Dean Academics and Research,

Batra Heart centre & Batra Hospital and Medical Research Centre

New Delhi - 110062