Listen to your heart

Listen to your heart

World Heart Day

Listen to your heart

A study conducted by Dr B K Goyal, Director of the Bombay Hospital and Medical Research Centre, reveals that by 2010, India will be weighed down by a whopping 60 per cent of the world’s heart disease burden.

The fact is cardiovascular diseases are the world’s largest killers of humans, claiming 17.5 million lives a year. That is scary.

Even scarier is the fact that heart (or cardiovascular) disease, which includes high blood pressure, stroke, angina (or chest pain) and a rheumatic heart, can affect people in their late thirties.

A study conducted by Dr Goyal at the JJ Hospital, where he was attached as Professor of Cardiology, revealed that 16 per cent of the patients admitted for treatment after a heart attack were below 40 years, whereas in the Western countries this age group accounts for a mere 4 per cent.
Stress, the culprit

Indian women, warns Dr Goyal, are even more susceptible to heart attacks because of work-related stress, smoking and contraception. He cites Indian medical studies which indicate that young women in particular are prone to premature coronary disease and heart attacks. He points out that of the several key risk factors, thinner coronary arteries are found to be genetic among Indians, especially women.

A recent study in the U.S. has revealed that incidence of coronary heart disease in people of Indian origin is twice that of their American counterparts, particularly among the younger lot. The study, Dr Goyal asserts, proves that Indians are genetically more susceptible to coronary heart disease.

As a first step, Dr Goyal, advocates education, since ‘an educated patient is an empowered patient’. He points out that hypertension is a major risk factor increasingly, for more and more women with highly stressful professional and family lives. For this segment of society, striking a good work-life balance is a great challenge. Particularly vulnerable are those who are obese, or those who smoke. Indeed, the prognosis is gloomy for those suffering from high blood cholesterol levels along with high blood pressure: the risk of heart disease or stroke simply escalates.

“Stress is the silent killer,” says Dr Goyal, who has authored a book called Heart Talk.
The increased heart rate and blood pressure that arises from a stressful situation can cause an increased demand for oxygen by the heart. This need for oxygen can set off angina or chest pain. Blood clots are also more likely to form during times of stress. Clots may then block an artery narrowed by plaque and cause a heart attack. Contraceptives and birth control pills also greatly increase the risk of heart disease, as several studies have shown. Women over 35 years who take birth control pills are at a greater risk.

“Young women should know that the female sex hormone, oestrogen, protects against coronary heart disease during the reproductive years by creating a more favourable balance of blood fats and by contributing to the elasticity and health of arteries.

However, after menopause or following a hysterectomy, where the ovaries and the uterus are removed, the body is deprived of oestrogen.  The risk factor for heart disease is thus also high in such cases,” he explains.
Lifestyle changes

He cites a study of 5,000 cases of acute heart attacks, which revealed that women heart patients have very high mortality rates. It is imperative than for women to urgently protect their hearts from wear and tear and damage inflicted by high BP, diabetes, smoking, lack of exercise, and unhealthy food habits with high fat and carbohydrate intake.

 He advises every woman above the age of 30 to undergo an annual health check up so that any indication of abnormality in the preliminary findings can be further investigated.

Watch what you eat

In addition, women are exhorted to keep strict surveillance of their lipid profiles through tests to determine the risk of coronary heart disease. “A major risk factor for heart disease is high blood cholesterol. The liver produces all the cholesterol our body requires to form cell membranes and make certain hormones. Extra cholesterol enters the body through foods like meat, eggs and dairy products. The main culprit is the saturated fat in milk products like butter, as well as red meat and tropical oils,” says Dr Goyal.

Given that most women tend to ignore regular health checks — never mind keeping watch on their lipid profiles — he explains that the lipid profile typically includes total cholesterol, HDL and LDL and triglycerides. Cholesterol packaged in low density lipoprotein (LDL) is often called ‘bad’ cholesterol because too much of LDL in the blood can choke arteries. When plaque builds up in the coronary arteries that supply blood to the heart, the risk of a heart attack increases. High density lipoprotein (HDL) is known as  ‘good’ cholesterol as it helps in removing cholesterol from the blood, preventing it from piling up in the arteries. The desirable level of cholesterol in adults without heart disease is less than 200 mg/dL.  The lower your HDL level, the higher your heart disease risk. An HDL level of under 40 mg/dL indicates a major risk factor for heart disease. Adults must ensure an LDL level of below 130 mg/dL. In patients with coronary heart disease and in diabetics, the desirable level of LDL is below 100 mg/dL.

An important tool in the diagnosis of coronary heart disease is ECG. “It is important for women, especially in the younger age groups, to know about angina and its implications. Doctors must closely monitor the symptoms of patients and conduct further tests like stress test, echocardiogram or an angiogram if needed,” he says.

At least 50 per cent of patients who have no apparent symptoms of heart attack but only symptoms of angina tend to have normal ECG, says Dr Goyal, who keeps his own heart shipshape with walks, exercise and daily workouts at the gym — a regimen he recommends to all, especially women. “Smoking is undesirable; what is important is enjoying what you do, remain stress free with yoga or meditation, ensure sound sleep, and eat a healthy diet comprising plenty of fresh fruits and vegetables,” he suggests.

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