by Dr. Prasad MR, Cardiologist
“ACT NOW TO AVOID HEART ATTACKS IN FUTURE”
Heart attacks come like a bolt from the blue to many, causing surprise and shock to their family members and friends. Vast majority of Indians still think it is impossible to predict heart attacks. Science has progressed a lot and various predictive risk calculators, artificial intelligence and gene based predictions are available. Using effective preventive measures the incidence of heart attacks has already started to decline in developed parts of the world like America and Europe.
1. Am I at increased risk of heart attack?
Belonging to South Asian/Indian ethnicity in itself increases the risk of a heart attack. You are at further increased risk; if you smoke/chew tobacco, if you are a male older than 40 yrs or a female older than 50years of age, if you are diabetic, if you are physically inactive, if you have family history of heart attack, if you have high LDL cholesterol and low HDL cholesterol, if you are hypertensive……and so on. You have more risk if you have multiple risk factors from above list.
2. What exactly is my next 10yrs or lifetime risk of heart attack?
You can calculate your next 10yr or lifetime heart attack risk from many risk calculators freely available from the internet. Eg
• ASCVD risk calculator (www.cvriskcalculator.com)
• Reynolds risk calculator (www.reynoldsriskscore.org)
• JBS 3 risk calculator (www.jbs3risk.com)
• Framingham CVD risk calculator
One needs to undergo some of the basic blood tests to calculate the risk. Every person has to calculate his risk at least by the age of 40 years. These risks have to be recalculated once in 5years or as and when new risk factors appear.
3. Why should anyone undergo frequent health checkups?
Some of the risk factors like diabetes, high blood pressure and hyperlipidemia (high cholesterol) in their initial years don’t cause any symptoms or disturbances but continue to cause damage to various organs inside the body. Unless one undergoes periodic health checkups, he or she will not be able to detect them early and prevent their complications. For example if someone’s sugar level increases from normal range to diabetic range (FBS >126mg/dl or RBS >200mg) at the age of 45years, for initial few years he may be completely asymptomatic even with sugar levels around 200 to 300mg/dl. But there will be ongoing damage inside his body to various organs like heart, brain and kidneys because of increased sugars. In this stage, he will come to know that he is a diabetic only if he checks his blood sugar levels as he may not have any symptoms and he feels apparently normal. Similarly it is for BP, cholesterol, etc. Most of these deranged parameters do not cause any kind of symptoms in their early stages and hence are aptly called as “silent killers”.
That’s why, WHO (World Health Organization), USPSTF and various bodies recommend periodic health checkups after certain age groups. Periodic health checkups have been proved to detect many diseases in their early stages, prevent complications and prolong lifespan. It is similar to how you frequently service your vehicles to prevent their sudden, unexpected breakdown.
With traditionally available risk factors upto 75% of heart attacks can be predicted.
TIPS TO REDUCE RISK OF HEART ATTACK
1. Quit smoking and chewing tobacco completely.
Tobacco is the most common cause of heart attack in patients younger than 40yrs, and it reduces lifespan by atleast 1 decade. For smokers, quitting smoking gives more benefit than any preventive medicine presently available. Even smoking one cigarette a day significantly increases heart attack risk. A significant contribution to “feeling relaxed and good” after smoking comes from the breathing technique involved in smoking rather than tobacco. There are many effective breathing and meditation techniques, nicotine replacement therapies and drugs available to help quit smoking. Those who have attempted to quit but failed should take the help of psychiatrists and psychologists.
2. Get physically active: Forty minutes of brisk walk /day for at least five days a week reduces the risk of heart attack by 50% and diabetes by 60%. Any aerobics like jogging, cycling, swimming, etc are also beneficial. One can rotate between them to sustain interest. Start slowly and increase gradually if you haven’t exercised for months. People with chronic knee pain should exercise using other joints for at least 40minutes a day. Reduce weight if your BMI is >25kg/m2.
3. Know what is happening inside your body! Undergo a health check up on regular basis even though you are apparently healthy (must if you are a male older than 40 years or a female above 50yrs of age) to know your BP, sugar and cholesterol levels.
4. Ensure adequate control of Blood sugars, BP and cholesterol levels by frequent monitoring if you are already diagnosed with high BP and Diabetes and taking regular medicines for it.
5. Consume vegetables, fruits, sprouts and whole grains on daily basis. An adult is supposed to consume 3 servings of fruits (total of 200g), and 6-8 servings of vegetables (total of 600-800gm) every day. Eat multicolored seasonal vegetables and fruits every day. Vegetables may be eaten raw, blanched or steamed. Grow vegetables yourself in kitchen or terrace garden if possible. Clean vegetables by soaking in Vinegar or baking powder or salt water for few minutes. At least 2 servings of fish per week (1 serving is 200gm) are recommended if non-vegetarian is acceptable. Fish known to be highly beneficial are Salmon(Rawas), Tuna and Mackerel (Bangda).
6. Consume 30gm of nuts per day : Example Almonds, walnuts, groundnuts and pista. Nuts should be unsalted and unroasted.
7. Reduce transfats: Reduce deep fried and bakery products like pastries, muffins, iced cakes, doughnuts, pies, cookies, biscuits and microwave popcorn which contains transfats. Reduce saturated fats and refined (simple) carbohydrates (sweets and sugary drinks). Choose oils rich in MUFA and PUFA (Olive, Canola, groundnut, Sunflower, Safflower, Soyabean oils…). As far as possible, avoid heating oil or heat them minimally. Avoid or reduce Stir fry, panfry (Tadka or Oggarane) and deep fry in kitchen to reduce transfats. On the contrary, naturally occurring transfats found in milk and milk products are good for health.
8. If you are consuming alcohol, do so in moderation as below.
If you are an adult male weighing >60kg, either 300ml of wine or,700ml of beer or, 60ml of whiskey or Rum per day is permissible. The dose is half for men weighing less than 60kgs or woman of any weight. Provided there is no family history of addiction, colon or breast cancer. Those who cannot restrict to above limits should not drink. Accumulating to weekends or binge drinking is hazardous.
9. Monitor your stress levels, moods and emotions. Yoga and meditations may help you to; relax, have sound sleep for eight hours, de-addict from psychotropic substances and also to keep your pride and self esteem high. Take the help of psychologists/psychiatrists when you can’t handle.
10. Discuss with your doctor regarding the requirement of statin and/or low- dose(baby) aspirin to prevent future heart attacks! A doctor will decide regarding requirement based on your calculated 10-20yr risk of heart attack and other health issues.
Example 1: All diabetics above the age of 40yrs require a statin to prevent future heart attacks.
Example 2: Similarly, all diabetics above 50yrs who also have one more risk factor (like smoking or hypertension, etc) and low bleeding risk require aspirin to prevent future heart attacks.