Here are 10 significant tips about Heart Health by Dr. Ashok Seth, Chairman, Fortis Escorts Heart Institute New Delhi.
World Heart Day is
celebrated on 29th September 2020 which brings in focus the vital
organ of our body heart. To discuss more on heart health and its several
parameters Famhealth is in an exclusive conversation with Dr. Ashok Seth, Chairman, Fortis Escorts Heart Institute
New Delhi.
When asked about the scale of Heart Diseases in India Dr. Ashok Seth says,
India has become the heart attack capital of
the world. In last 30years there’s an increase for about 300% in the rate of
heart diseases whereas it has dropped in the west by almost 50%.
In last 50 years heart diseases have grown in
young people by 100% which is almost double if we compare to west. India is a young
country with 60% of population less than 40 years of age so these numbers are
really scary because half of the country is at risk of getting a heart disease.
When asked about the reason for such
astonishing numbers about Heart Disease in India Dr. Ashok Seth says,
Lifestyle is one of the most obvious reasons
for the country to develop a heart disease. Today’s is a competitive world with
job competitiveness, educational competitiveness, meeting deadlines, stress, no
exercise and eating junk all of these lead to a unhealthy heart.
Unhealthy lifestyle issues lead to developing
of cholesterol, hypertension, diabetes and ultimately leading to blockage of
arteries and a stroke.
Pollution is another major factor that leads to
blockages of arteries, results in hypertension and youth are most vulnerable to
develop all these because they mostly remain outside for work or study.
Another leading and very obvious factor is
smoking. Youth is under stress due to one or the either reason they develop a
habit of smoking and alcoholism thus digging in their own graves i.e. pushing one
to develop a heart disease.
When asked about possible ways to avoid a heart disease Dr. Ashok Seth says,
A regular routine check-up of lipid profiles, diabetes,
and cholesterol level above the age of 25 in men is very necessary. If a person
is beyond 45 years of age then they should go for a complete check-up and
should be very cautious about their heart health.
Leading a very healthy lifestyle is very
important exercising for 45 minutes 5 times in a week reduces the risk of heart
disease by 25%.
Go for tests like blood tests, ECG, exercise
tests are recommended for a person to know about the functioning of heart which
reveal almost 10%-20% blockage of arteries in heart.
CT scan and CT angiogram are very important to
know about the heart health of a person. This test reveals almost 30%-40%
blockage of arteries in the heart which means a person is at high risk of
getting a heart disease.
Tips for Healthy Heart
Experts say trans fats are not good for heart health. Trans fats are found in deep fried food items and oily food items. This is because trans fat clogs your arteries by raising your bad cholesterol levels (LDL) and lowering your good cholesterol levels (HDL). By cutting them from your diet, you improve the blood flow throughout your body.
Dental health is a good indication of overall health, including your heart, because those who have periodontal (gum) disease often have the same risk factors for heart disease. Bacteria in the mouth involved in the development of gum disease can move into the bloodstream. These bacteria can cause inflammation of the bold vessels, which may increase your risk of heart disease and stroke.
Sleep is an essential part of keeping your heart healthy. If you don’t sleep enough, you may be at a higher risk for cardiovascular disease no matter your age or other health habits. It is suggestive to make sleep a priority. Experts recommend a good 7 to 8 hours of sleep.
Research has shown that staying seated for long periods of time is bad for your heart health no matter how much exercise you do. Experts say it’s important to move throughout the day. Some easy steps are – Park farther away from the office, take a few shorter walks throughout the day and/or use a standing work station.
Studies show that the risk of developing heart disease is about 25 to 30 percent higher for people who are exposed to secondhand smoke at home or work. According to the American Heart Association, exposure to tobacco smoke contributes to about 34,000 premature heart disease deaths. Try to maintain a distance from passive smokers.
HEART HEALTH
A healthy human heart beats about 2.5 billion times over the average lifetime. The heart is a muscular organ, which pumps blood through the blood vessels of the circulatory system. Blood supplies our organs with oxygen and nutrients, and helps in the removal of metabolic wastes.
Heart Health
According to centre of disease control there are various health conditions which can lead to heart disease. Some major contributory factors are genetics, age, poor lifestyle, age and family history. Genetics, age and family history are the factors which cannot be controlled. However, one can adopt a good lifestyle and can choose to eat a healthy diet to prevent heart diseases.
Risk factors causing heart diseases:
Hypertension (High Blood Pressure)
High blood pressure is one of the prime risk factors for heart disease. It is a medical condition resulting due to an excessive pressure of blood in arteries and other blood vessels. Hypertension is regarded as the one of the prime causes of major heart conditions like heart attack.
High blood pressure is also referred to as “silent killer”, as most of the people do not observe the symptoms of high blood pressure. However, high blood pressure can be controlled with a right diet, medication and a healthy life style.
High Cholesterol
Cholesterol is a fat-like, waxy thin, substance which is naturally produced by liver. However, consuming foods rich in saturated fats can lead to high cholesterol levels in our blood. The excess cholesterol gets deposited in the walls of the arteries which leads to their narrowing, thereby leading to major heart diseases like atherosclerosis and heart attack.
Diabetes
Diabetes mellitus another major risk factor of heart disease. The body needs sugar for providing energy and in normal circumstances pancreas produces enough insulin for the sugar to get utilized. However, in diabetes either no insulin or less insulin is produced by the body leading to sugar accumulation in the blood.
Major Heart Diseases
Angina
Angina is also known as chest pain or discomfort caused when the heart muscle is devoid of enough oxygen-rich blood. Angina patients may experience heaviness or tightness in the chest which can even radiate to arms, neck, jaw, back or stomach. Angina is an alarming condition of a major heart disease and should not be ignored.
Management of Angina
Treatment for angina not only reduces the symptoms but also minimizes the risk for heart attack and death.
Treatment options include:
Modifications in the lifestyle such as quitting smoking, managing weight, eating right, keeping stress at bay, and controlling diabetes
Taking medications like calcium channel blockers, satins (as prescribed by doctor)
Treatment like stenting, coronary artery bypass (depending what doctor opts for)
Cardiac rehabilitation post cardiac procedure which aims for physical fitness, minimize cardiac symptoms, and improves the overall health, and lowers the risk for heart problems in the future
Aortic Stenosis
Aortic stenosis is one of the most prevalent and most severe valve diseases of the heart which occurs due to obstruction of blood flow across the aortic valve. Affected patients may suffer from complications like chest pain, fainting, and heart failure which might lead to shortness of breath. This condition could be genetic or age related.
Management of Aortic Stenosis
Treatment for aortic stenosis depends on symptoms and the extent of the disease.
Mild disease may not require any treatment; however, a regular ECG is done by the doctor to forecast any complication. In severe cases the treatment includes:
Replacing the aortic valve: Aortic valve replacement is the only effective treatment for severe aortic stenosis.
Medications: There is no specific medication for this condition, however blood pressure is controlled to prevent further complications.
Atherosclerosis
Atherosclerosis is a disease in which plaque builds up inside the arteries, which eventually causes blockage and limiting the flow of oxygen-rich blood to your organs. It is one of the prime causes of heart attacks, strokes, and peripheral vascular disease together called cardiovascular disease.
Management of Atherosclerosis
Lifestyle management-Eating a healthy diet
A healthy diet is primarily a diet rich in fruits, vegetables, whole grains, and low in refined carbohydrates, saturated, trans fats, and sodium.
Some simple ways are to switch from white to whole-grain bread, eating fruits and vegetables rather than refined food items, using olive oil instead of solid fats like butter, and reducing sugar and sugar substitutes to a greater extent.
Quit smoking– According to the Mayo Clinic- for heavy smoker, quitting is the single most effective way to stop atherosclerosis from getting worse and reduce risk of complications
Maintain healthy weight– obese individuals are more prone to heart disease. Hence, a person should try to maintain a healthy weight.
Manage Stress– Keep the body relaxed; try deep breathing, meditation, and yoga to keep stress at bay. .
Medications and Surgery– Doctor may prescribe medication like cholesterol medication, anti-platelet medication, and calcium channel blockers. Surgery includes angioplasty, endarterectomy and bypass grafting
Atrial Fibrillation
Atrial fibrillation (also referred to as AFib or AF) is the most common type of abnormal heart rhythm (arrhythmia) which can cause complications like blood clots, stroke, heart failure and other heart-related complications.
Management of Atrial Fibrillation
The atrial fibrillation treatment depends on how long the patient has had atrial fibrillation, acuteness of symptoms and the underlying cause of atrial fibrillation. Generally, the treatment goals for atrial fibrillation are to:
Obesity is a disorder which results in an excessive accumulation of the body fat. To keep a check on obesity is not only important for cosmetic reasons, but it causes serious health issues like heart diseases and high blood pressure. If you are obese it is most likely that you may encounter various health problems.
Obesity
Obesity is a multifaceted health disorder that affects both adults and children. Being obese not only affects the overall persona of an individual but also increases the risk for many health concerns. An obese person is at a higher risk of developing health conditions like diabetes, heart disease, stroke, arthritis, breathing problems, and some cancers.
Statistics have revealed that obesity is a major factor contributing factor for metabolic syndrome and type 2 diabetes mellitus (T2DM) among Asian Indians. Various factors contribute towards making an individual obese. Some major factors which contribute towards obesity are environment, family history and genetics, metabolism or the way your body converts food and oxygen into energy, and individual’s lifestyle. Besides these factors certain medical conditions also leads to obesity. Scientists are also trying to understand that some chemicals in the environment may be playing in the growing obesity problem.
Recent guidelines have revealed that 10-15% of Indian population would fall under the obese category and would need appropriate management. Purpose of these guidelines on countrywide basis projects an alarming situation of T2DM and cardiovascular disease.
Some startling facts about obesity:
According to a recent survey conducted worldwide: India has second highest obese children in world.
Followed by China India ranks second in childhood obesity with the incidence of China with 15.3 million and India with 14.4 million.
According to National Family Health Survey in 2018 –In past one decade the number of obese people has doubled.
According to a latest publication in a medical journal-“The Lancet” –Currently there are 30 million obese Indians and by 2025, this number is expected to pass 70 million.
Did you know lack of sleep increases the chances of obesity- If you do not sleep enough you produce Ghrelin, a hormone that increases your appetite and hence adds extra pounds to your body.
India the third most obese country in the world – According to a study published in a medical Journal Lancet- India is just behind US and China in this global hazard list of top 10 countries with highest number of obese people.
Latest Survey reveals that technology addiction too is adding to obesity amongst young adults and children in India. Television, computers and video games at the cost of sports and physical activity, causing sedentary life style are prime causes of obesity among young ones.
Surprisingly but true-Globally, Obesity causes more deaths than malnutrition -Worldwide, obesity is one of the top five leading causes of death. It results in greater than 2.8 million deaths every year.
What is the need for new guidelines for obesity among Asian Indians?
New guidelines have been proposed in view of alarming situation of obesity among Indians. These guidelines have been prepared by 100 medical experts all across the country hailing from the backgrounds of internal medicine, diabetes, metabolism, endocrinology, nutrition, cardiology, exercise physiology, sports medicine, bariatric surgery and representing reputed medical institutions, hospitals, government funded research institutions. The very need for these guidelines has been enumerated below:
In view of increasing trend in frequency of obesity and related metabolic diseases, there is dire need of effective interventions in obesity
As Asian Indians manifest a higher risk of cardiovascular risk factors and T2DM at lower levels of obesity, the appropriate obesity diagnosis should be based on lower level of weight for height than in non-Asian Indian populations.
Current obesity international guidelines are not appropriate for Asian Indians. Moreover, WHO has authorized local governments and scientists to decide on the localized guidelines for the Asian Indians.
If appropriate diet, exercise, drug and surgery are employed at lower levels of obesity, nearly 15% of the adult population of India (nearly 5-7 crore people) will show improvement in obesity coupled with reduced risk of diabetes and cardiovascular disease.
How obesity is diagnosed among Indians?
Three parameters which are used to measure obesity are body mass index BMI, waist circumference WC and waist-to-hip circumference ratio (WHR). The most accepted method to define thinness and fatness is BMI, a ratio of weight in kilograms divided by height in meters squared (kg/m2).
What are the cut offs for BMI and WC in defining obesity among Asian Indians?
After a major consensus among scientists below table has been prepared to depict the obesity among Asian Indians:
Classification
BMI(kg/m2)
Principal cut-off points
Cut-off pointsfor Asians
Normal range
18.5 – 24.9
18.5 – 22.9
23.0 – 24.9
Pre-obese
25.0 – 29.9
25.0 – 27.4
27.5 – 29.9
Obese (Class I)
30.0 – 34.9
30.0 – 32.4
32.5 – 34.9
Obese (Class II)
35.0 – 39.9
35.0 – 37.4
37.5 – 39.9
Obese (class III)
≥40.0
≥40.0
Source: Adapted from WHO 2004 and recent guidlines
What does recent guidelines say about WC and WHR cut offs in defining obesity?
Research has revealed that abdominal obesity is associated with higher risk of diabetes and cardiovascular disease when compared with generalized obesity. Cardiovascular disease is associated with increased amounts of excess abdominal adipose tissue, both intra-abdominal adipose tissue (IAT) and subcutaneous adipose tissue (SCAT). In view of this a joint discussion and consensus among scientists concluded the WC cut off among Asian Indians as defined below:
Action level 1: Men: 78 cm, women: 72 cm. Any person with WC more than these levels should refrain from gaining weight and adopt healthy lifestyle to prevent the risk of any of the cardiovascular risk factor.
Action level 2: Men: 90 cm, women: 80 cm. Individuals with WC above this should seek medical help so that obesity-related risk factors could be diagnosed and handled.
What are the causes of obesity?
Obesity could be genetic, behavioral and can also result due to the hormonal changes in the body. Obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat. Some medical conditions also result in obesity such as Prader-Willi syndrome, Cushing’s syndrome, and other diseases and conditions. The main reasons for obesity are either sedentary lifestyle or eating unhealthy such as junk foods at wrong intervals.
What are the risk factors that can contribute to obesity?
Obesity usually results from a combination factors, including:
Genetics. Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercises.
Family lifestyle. Family members share common eating habits. Obesity runs mostly in families as common eating habits of eating fatty foods contribute to obesity.
Inactivity. If you are inactive throughout the day, you are more prone towards obesity. Certain diseases like arthritis also result in decreased mobility and hence inactivity
Diet. A diet rich in fats and less minerals and vitamins can result in obesity
Medical problems. In some people, obesity can be traced to a medical conditions like Prader-Willi syndrome, Cushing’s syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.
Medications. Some medicines such as antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers also make the person obese
Social and economic issues. Research has shown that weight gain can be linked to social and economic factors.
Age. As we grow in age a decreased physical activity and lower metabolic rate can result in obesity.
Sleep deprivation. Not getting enough sleep or getting too much sleep can cause changes in hormones which may lead to an increase in appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
What are the complications associated with obesity?
A number of health problems arise if you are obese. Some of the diseases which you may encounter include:
High triglycerides and low high-density lipoprotein (HDL) cholesterol
Type 2 diabetes
High blood pressure
Heart disease
Stroke
Cancer
Breathing disorders, including sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts
Gallbladder disease
Gynecological issues such as infertility and irregular periods
Erectile dysfunction and sexual health issues
Quality of life-If you are obese you are most likely to suffer from other issues, which can severely affect the quality of life. Some common problems which arise due to obesity include depression, disability, sexual problems, shame and guilt, social isolation, and poor performance at workplace
How can you prevent obesity?
You can take some below-mentioned steps to prevent obesity:
Exercise regularly. Exercises such a fast walking and swimming for 150 to 300 minutes in a week can prevent obesity
Eat healthily. Eat low-calorie, nutrient-dense foods, such as fruits, vegetables, and whole grains. Refrain from foods which are high in fat content.
Monitor your weight regularly. Keep an eye on your weight at regular intervals as it can help you to assess your weight regularly
What are the recent guidelines on physical activity?
According to joint decision among scientist below is the list of guidelines about physical activity in combating obesity and associated health concerns:
Physical inactivity should be refrained as much as possible
Pro active medical consultation is recommended for those with chronic conditions or those who are symptomatic
Inactive people must switch on to physical activity
Brisk walking (walking at an intensity wherein an individual finds speaking difficult but not impossible) should be encouraged
On an average a total of 60 minutes of physical activity like aerobic activity, work-related activity and muscle strengthening activity should be included daily
For additional and greater health benefits, adults can increase their aerobic physical activity to 300 minutes (5 hours) a week of moderate-intensity, or 150 minutes a week of vigorous-intensity aerobic physical activity
Yoga should be included; however, more research is needed to fully explore its benefits
Children should undertake at least 60 min of outdoor physical activity. Screen time (television/computers) should be less than 2 hrs a day.
What is the treatment of obesity?
The treatment of obesity includes a combination treatment from a dietitian, behavior counselor or an obesity specialist. Recent guidelines suggest identifying and treating the underlying cause of obesity, lifestyle modification, pharmacological treatment like ant-obesity drugs along with lifestyle modification, and if needed surgical treatment is advisable in treating obesity.
Scientists have concluded that anti-obesity drugs should be prescribed in combination with dietary and lifestyle changes as a part of comprehensive weight loss program. Also, drug treatment should be monitored on an ongoing basis for efficacy as well as safety. In general, anti-obesity drugs should be administered for BMI above 27 kg/m2 or a BMI above 25 kg/m2
Anti-obesity drugs which are recommended to treat obesity are sibutramine, orlistat should be used as a second line therapy. At times metformin and exenatide can be used under special clinical conditions.
What is the surgical treatment for obesity?
Over the past few years bariatric surgery has come out as an option for obesity reduction. Bariatric surgery involves an alteration in the digestive system by reducing the gastric volume or by changing the path of food bolus which can lead to malabsorption. According to current international guidelines below are the guidelines for bariatric surgery:
Current International Guidelines: BMI above 35 kg/m2, or BMI above 40 kg/m2.
For Asian Indians: BMI above 32.5 kg/m2
Various surgical options are available under the umbrella of surgery which includes:
Restrictive Procedures like Adjustable gastric banding (LAGB) & sleeve gastrectomy
Combined Procedures like Roux-en-Y Gastric or Bypass (RYGBP)
Malabsorptive Procedures like Bilio-pancreatic diversions (BPD)
Experimental Procedures like ileal interposition
Duodeno-jejunal bypass and other implantable pulse generators.
Pros and Cons are associated with above mentioned procedures; however, it is upon the physician to decide that which surgical treatment is best suited for the particular patient.
Having a positive attitude towards weight loss and employing various changes in lifestyle such as exercising and eating a well-balanced diet can help you to lose weight. Nevertheless, obesity remains a rampant problem even in developing nation like India. Appropriate interventions are required in a timely manner to combat this problem to prevent other major health concerns.
Obesity Support Groups
These inspiring stories of those who have overcome Diabetes will keep you motivated
720 g (6 oz) thick white fish fillets, skin and bones removed
Freshly ground black pepper
1 lemon thinly sliced
4 tomatoes cut into wedges
2 bay leaves
1 tbsp olive oil
3 tbsp white wine
½ cup (125ml) salt-reduced chicken stalk
1 tbsp chopped fresh parsley
Directions
Preheat the oven to 200 ℃
Spread the onion, garlic and thyme sprigs in roasting pan that will be large enough to hold all the fish fillets, with a little space in between. Place the fish on the top and season well with freshly ground black pepper
Arrange the lemon slices over the fish and scatter the tomatoes and bay leaves around the fish. Combine the olive oil, wine and stock and pour over the fish.
Bake the fish for 20 Minutes.
Note
Remember to manage your portion sizes. Recommended portion size should not exceed 2 servings/helpings. Consuming diabetes friendly recipes in inappropriate portion sizes may lead to spiking of your blood glucose levels.
Famhealth, derived from the term family health is a platform,
that strives to help the patient and the ‘family health guardian’
navigate through various issues related to the health of her family.
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Famhealth derived from the term Family Health is a healthcare venture in bringing people with common health conditions and concerns together.
Patients and their caregivers have questions that remain unanswered. We plug this information gap by aggregating; curating and disseminating evidence-based information through various media platforms.
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The large part of health conditions in India today are lifestyle led and are chronic or ‘lifelong’. While our medical fraternity does an outstanding job in treating our diseases and conditions, there is an enormous stress on our healthcare infrastructure.
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