“Deposition of fat in the major arteries happens at a very young age—even in school-going children,” says Devi Shetty, chairman and senior consultant cardiac surgeon, Narayana Hrudayalaya, Bangalore. “So your child’s diet is very important. If rich foods form their dietary lifestyle, they will find it very difficult to change in future, as the human tongue has a phenomenal capacity to get used to certain tastes,” he adds.
“Indians are genetically more predisposed to cholesterol deposition,” says Vivek Gupta, senior consultant interventional cardiologist, Apollo Hospital, New Delhi. “Indian women are more prone to getting multi-vessel disease (involving more than one artery), which is more dangerous—a pattern rarely seen in the West” (See box It’s Different for Women).
Illustration: Jayachandran / Mint
Sunita Maheshwari, senior consultant paediatric cardiologist, and head of department, Narayana Hrudayalaya, suggests, “Formal discussions about maintaining the heart’s health can be initiated when your child is about 9 or 10.”
Lose extra weight
“Extra weight definitely does not help your heart, joints and the whole body,” says Dr Shetty. “Obesity has its own complications. Excess weight increases the workload on the heart and it also increases blood pressure.
“Think about the human body as a machine, with your heart as a pump that circulates the blood. If you have a bigger body, your pump has to work extra hard. Less, and its efficiency and longevity increase. If an obese diabetic loses weight, his insulin and anti-diabetic requirements come down significantly,” says Dr Shetty.
The gene effect
“Causes leading to coronary artery disease are multifactorial,” says Dr Shetty. “In simple terms (without solid basis in research, but based on the profile of patients), our guess is that (with) about 50% of people, irrespective of what they do—smoke like a chimney, drink like a fish—nothing will happen to them. The only way they will die is if you shoot them down. Another 25%, irrespective of what they do or where they live, even with the most nutritious diet, without any stress—will develop a heart attack because of genetic reasons, which cannot be modified.”
“The remaining 25% are the front-sitters. If they take care of their diet, do not smoke, and lead a healthy life, they can protect themselves.
“I believe that the right way to go about it is to figure out which category a person belongs to and advise them accordingly. This is the safest way to deal with risk factors.”
Say no to aspirin
Do not take aspirin lightly. Too many of us have started popping aspirin as a preventive, which has doctors worried. “I would strongly discourage people from taking aspirin without any medical reason,” says Dr Shetty. “Aspirin is a prescription drug and should be only taken if a cardiologist, after evaluation, prescribes it.” Though a life-saving drug (see ‘Treat’ below), it is also a potentially dangerous one: it can cause bleeding from the stomach, which can sometimes be fatal. Even if it comes packaged as a red heart.
Keep stress at bay
“In response to a stressful situation, be it a traffic jam or a difficult boss, the body produces two key hormones: epinephrine (which increases the heart rate) and cortisol (which raises blood pressure),” explains Dr Gupta. “If the body constantly generates these hormones, the heart gets overworked, increasing the risk of heart attack.”
Dr Gupta remembers a 22-year-old woman patient who had to get an angioplasty done in 2005. She had four major blocks in the heart! With no family history at all, her heart disease was attributed to work stress and an imbalance in her cholesterol profile due to lifestyle issues.
Cuddle a pet
“Just being with a pet—any pet—has a soothing effect,” says New Delhi-based psychologist Ashima Puri. “Petting a dog or cat or watching a fish in a tank is, for many people, as effective a way of relaxing mind and body as any tranquilizer or meditative technique. The relaxation can even be quantified or measured as a slower heartbeat and a drop in blood pressure.”
“I might have had the worst possible day at work, coupled with a few problems at home. But when I enter my house, the warm welcome I get from my dog just calms me down instantly,” says Ishi Khosla, a Delhi-based nutritionist.
“Work consciously towards toning down the stress in your life,” says Dr Gupta. How? “The perfect alternative method for boosting the heart’s health is to lead a simple spiritual life,” says Dr Shetty. “This is what our scriptures have also taught us: to eat healthy food and believe in god with the faith that he will protect us in every event of our life. This simple strategy will reduce tension and make life worthwhile.”
IT’S DIFFERENT FOR WOMEN
Men risk their hearts; women are smarter
The stereotype of a cardiac patient has always been a middle-aged workaholic, a hard-drinking, chain- smoking, red meat- craving male. And that caricature was as vividly drawn in medical textbooks as in the popular media. Researchers and doctors simply didn’t know any better or think to look further.
As a result of that early (admittedly inadvertent) gender stereotyping, the problem is that most modern women seem to be making the same mistakes that men did—faulty habits that are playing havoc with their body composition and upping their heart risk quotient.
“Women are about 10 years older than men (on average) when they get their first indications of heart trouble. But they lose this 10-year advantage if they smoke, have diabetes or get premature menopause (oestrogen provides heart protection),” says Dr Gupta.
More women die of a broken heart
In the past, doctors didn’t know that heart disease was a major cause of death in women—let alone the leading one. Worse, the mortality rate is higher for women. Translation into lay terms: A woman with heart disease is more likely to die of it than a man. “When women have a heart attack, the amount of heart muscle destroyed is likely to be larger and they are more liable to go into shock and heart failure,” warns Dr Gupta, adding that “mortality rate for women after a heart attack is 44% as compared to 27% in men.”
Women’s blood vessels are smaller and kinkier (“tortuous”, the medical texts call it), and are more difficult to repair. More of the arteries get tied in knots, too, at a time. This means that the surgeon is less likely to be able to sort you out if you need to go under the knife.
GENDER BENDER: A HEART ATTACK IN A WOMAN…
…may not include the “classic symptoms” experienced by men. Which means they could go undetected, undiagnosed and untreated too long...because they are too easily dismissed. Look out for:
• Chest, stomach or abdominal pain that does not necessarily feel acute or crushing
• Nausea or dizziness
• Shortness of breath
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Is your heart ticking just fine? To check that there are no problems, read our article on predictive tests for heart disease.
What are the must-have tests if you care about your heart? Recommendations from Vivek Gupta, senior consultant interventional cardiologist, Apollo Hospital, New Delhi:
• CT angiogram (computed tomography angiography): A non-invasive, 10-minute scan for plaque developing in blood vessels that supply blood to your heart. It is important that you get this test before you experience any symptoms.
• C-reactive protein test: Get it along with your lipid profile to seek out possible inflammation in your body which puts you at a higher risk of suffering a heart attack .
• Treadmill test and 2D echocardiogram: If you’re 40-plus, take these every two years. (Also see ‘SURF’) Kavita Devgan
Take this to heart: Drink up your tomatoes, though preferably not in a Bloody Mary! First, Finnish researchers reported that tomato juice reduces LDL cholesterol (the bad one). Then scientists at the University of Newcastle, Australia, found a daily dose of tomato juice reduces the risk of heart disease in people with Type 2 diabetes by lowering the “stickiness” of the platelets. Now a new review of studies from Vanderbilt University School of Medicine, US, reports that raising your potassium intake while cutting sodium is second only to losing weight as a means to control blood pressure. One glass of tomato juice has 470mg potassium. Kavita Devgan
These not-so-typical signs of heart trouble say, “Get help fast!”
• Pressure, fullness, squeezing or pain in the centre of the chest for more than a few minutes or which quickly fades in and out.
• Pain radiating through the shoulders, neck, arms or jaw.
• Light-headedness, sweating, nausea or shortness of breath.
• If you at all suspect a heart attack, man or woman, old or young, immediately chew a full-strength (325mg) aspirin and a Clopidogrel (300m) and get to the hospital at once, says cardiologist Vivek Gupta (also see ‘TEST’); on the way, place a sorbitrate tablet (510mg) under your tongue, he adds. Kavita Devgan