Most of us will die due to some cardiac event. Cardiovascular disease is the number 1 cause of death in India, with 24.8% dying due to it. Of late, we have seen healthy, fit, hard working individuals getting heart disease. Sourav Ganguly felt uneasy in the gym before his "mild cardiac arrest"! Many die due to their inactions and thoughtlessness. Hope this blog alerts you.
After Remo D'Souza it was the turn of Sourav Ganguly. Dean Jones died of a heart attack earlier. It surprises us that sports people who are so active can have a heart attack. A heart attack can be looked upon as an accident. We can follow all the traffic rules and be very careful, but still we can meet with an accident!
Dr Deepak Krishnamurthy @DrDeepakKrishn1, Senior Interventional Cardiologist at Sakra World Hospital, Bangalore tweeted:
A heart attack is that. An accident whose likelihood of happening is determined by several factors. More the number of factors higher the probability! #probability #heartattackrisk
The reasons for falling prey to cardiovascular events he tweeted were:
"1 Family history/genetics
2 Stress
3 Sleep disorder
4 Conventional risk factors - Diabetes, HTN, dyslipidaemia
5 Some specific factors like Lipoprotein(a)
6 Food habits "
"Basically apart from being physically active/eating healthy/maintain ideal body wt and not grow a tummy, one needs to be endowed with good genes, sleep well/manage stress better/regularly get oneself checked for risk factors/estimation of CVD risk. Still risk is not zero!"
"In cases where there is a strong family history there is a role for more aggressively monitoring/managing risk factors and a CT coronary imaging when advised by a Cardiologist."
In the interesting discussion which followed, Thinking Hat provided link to this article:
In the Cover Story in the Cardiology Magazine:
South Asians and Cardiovascular Disease: The Hidden Threat
May 17, 2019
we learn:
"People of South Asian descent, including those from India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan and the Maldives, have a higher risk of ASCVD – fourfold higher than the general population. Moreover, they develop heart disease up to a decade earlier (often before the fifth decade of life)."
This is because we have a lot of visceral fat in the abdominal area, the liver and around the heart. We have a tendency towards for impaired glucose tolerance resulting in higher rates of type 2 diabetes (T2D).
Because of these reasons, WHO recommends using 23 kg/m2 and 27.5 kg/m2 for overweight and obesity. We already had a tough time meeting the world BMI measurements, now we have South Asian figures, which makes it even tougher!
South Asians in America have an even tougher time as their diet is a mix of traditional and American junk food.
The article concludes:
"Dietary habits have a large impact on the incidence of ASCVD. The integration of the typical South Asian diet with the Western diet has been cataclysmic. The South Asian diet focuses on carbohydrates (rice, lentils, chapatis, naan) and saturated fats (ghee, butter) with a conspicuous absence of focus on lean meats. This merged with a Western diet of dairy products, fried snacks, pizzas and potatoes has proven disastrous and has only added to the inherent predisposition to insulin resistance many South Asians are facing."
How heart attacks happen
In an article on Blood pressure on the heart.org site, you can read:
"The excess strain and resulting damage from high blood pressure (HBP or hypertension) causes the coronary arteries serving the heart to slowly become narrowed from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis.
As arteries harden with plaque, blood clots become more likely to form. When an artery becomes blocked due to an accumulation of plaque or a blood clot, the flow of blood through the heart muscle is interrupted, starving the muscle of oxygen and nutrients. The damage or death of part of the heart muscle that occurs as a result is called a heart attack (myocardial infarction)."
Blood tests to prevent cardiac issues
Blood pressure monitoring is very important. Blood pressure monitors are not that expensive. Buy one, specially if you have a senior person at home. One in eight among us suffers from high blood pressure.
Blood Sugar -- Fasting and Post-prandial
You never knew all those gulab jamuns/rosgollas/cakes could damage your blood vessels, right? Stop sugar now! Else, it may be too late! Diabetes is one of the top 10 causes of death in India.
I think practically all of us should do this test at least once a year.
But remember this test indicates your blood sugar level, say in the past 24 hours. You can do a test to indicate your average blood sugar in the past few months. HbA1c or glycated
hemoglobin.
HbA1c
Glycated hemoglobin or hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months.
Lipid Profile
Cholesterol is the main culprit which blocks your arteries. So most of us need to check our cholesterol. This blood test is not very expensive. It tells you your:
Total cholesterol
LDL cholesterol - bad
HDL cholesterol - good
Triglycerides
Non-HDL cholesterol
All these need to be in check. You need to increase your HDL to a decent level.
C-reactive protein
Inflammation leads to atherosclerosis (hardening of the arteries). High levels of C-reactive protein indicate a high risk of heart attack, stoke and CVD (Cardiovascular Disease).
I have foolishly done this test, even when my doctor advised against it! Always, do the tests after consultation with a doctor.
High Sensitivity C-reactive protein
This test is more responsive and has a wider range, CRP in the range from 0.5 to 10 mg/L, so is able to indicate heart disease even in apparently healthy individuals.
Lp(a) or Lipoprotein (a)
High levels indicate an increased risk of heart disease.
Plasma ceramides
Some ceramides have been linked to plaque in the arteries and insulin resistance. If you have high levels, you are likely to face cardiovascular issues within 1-5 years.
Natriuretic peptides
Brain natriuretic peptide (BNP). High levels indicate heart damage.
Troponin T
This will help tell your doctor about your risk of having heart disease. High levels indicate higher risk.
Which Tests should I do?
Ideally, do tests only on the recommendation of a doctor. Why waste money getting some numbers on a sheet of paper?
Stress Test
I missed out the Stress Test or the Treadmill Test.
But according to Dr Devi Shetty (who needs no introduction truly) it reveals cardiac disease only if it has progressed to 70%.
In an article in Times in September 2019, Dr Shetty said: That CT Angio would be the best preventive tool in heart care.
CT Angio / Coronary Calcium Scan
CT scan is the umbrella term. CT Angiography is an X-ray of the blood vessels. The x-ray that you get is called the angiogram. CT angiogram can show narrowing (stenosis) or blockage in the coronary arteries. This happens when there is buildup of cholesterol (a medical term for a type of fat) and calcium in the arteries. Plaque is the medical term for the buildup.
CT angiography can detect heart disease right at the inception according to Dr Devi Shetty.
CT angiography in Mumbai can cost between Rs.7000-14,000 as per Dr Google.
Coronary Calcium Scan or simply Heart scan shows the doctor how much calcium plaque is there in your arteries. Calcium buildup or plaque is a good indicator of heart disease.
Niyati #StayAtHome @NiacinDoc says:
Coronary calcium CT scan is increasingly being done for patients at risk.
Should I get an ECG?
Again, your doctor or cardiologist is the best person to tell you. Your relative, friend, boss, wife may not be the best person...unless he/she is a doctor/cardiologist!
You will need to do an ECG if you have risk factors for heart disease or you have symptoms of heart disease. Risk factor such as high blood pressure, or symptoms such as palpitations or chest pain.
If you are a heart patient you would have some knowledge about ECG and 2D echo. Your wife too will have this knowledge. So you and others are likely to recommend 2D echo too or ECG.
A senior cardiologist told me on Twitter that doing preventive tests may not be useful.
Preventive Heart Care
Preventive care clinics have opened up in Maharashtra (probably all over India) to provide preventive tools and resources to prevent diabetes and heart disease. Maybe a 10 year old phenomenon. Not sure how successful they are but you will always see testimonials on FaceBook and Social Media and WhatsApp about some success stories.
TV, social media, WhatsApp, press are all full of advice on how to prevent diabetes and heart disease. Perhaps, these diseases are the Gabbar and Mongambo of our lives. And media etc are the Amitabh and Dharmendra (mercenaries?) who with the help of the gaonwallos get rid of these two monsters.
Let me provide you an excellent link on Medline (an Awesome resource) on How to Prevent Heart Disease.
Here is a summary of what they recommend:
- Control your blood pressure
- Keep your cholesterol and triglyceride levels under control
- Stay at a healthy weight
- Eat a healthy diet
- Get regular exercise
- Limit alcohol
- Don't smoke
- Manage stress
- Manage diabetes
- Make sure that you get enough sleep
Consult a doctor is one advice I would give. As a medical translator I translate medical records of Canadian Hospitals. I see so many diseases and conditions being mentioned. I see so many
medicines being mentioned. Doctors are trained. They have spent years in classes and with books. Have gained experience over the years. We should not grudge them the fees of Rs.800/1200. Imagine
a few thousand rupees in preventive care can save you a bypass, heart surgery, angioplasty! These procedure would cost you lakhs of rupees.
So take care, my friends. Have a heart! Your heart beats for you every second. It has taken care of you. Now, you take care of it.