Introduction
At the dawn of independence in India, food scarcity was a social, economic, and political problem. The vagaries of the Indian monsoon led to devastating famines and floods. Communicable diseases such as smallpox, cholera, and tuberculosis were responsible for the loss of lives. Deficiency diseases were the cause of significant morbidity and mortality.
During the past seven decades and more, the health-care scenario has changed. Smallpox and poliomyelitis have been eradicated, and cholera and tuberculosis are on the wane. Not surprisingly, a large chunk of the population which includes the middle-class, is suffering from health hazards arising out of dietary excess and a sedentary life style. India has a huge diabetic population. Smoking may be on the decline, but is still giving rise to cardiovascular and other health related problems. These are some of the factors that are responsible for a high prevalence of IHD.
IHD has got a number of important risk factors, which are discussed below.
Hypertension
Hypertension is easy to diagnose and treat. It is also easy to miss, and therefore to mismanage.
Information that is intended to create public awareness is available as FAQs in this website.
Dyslipidemias
High levels of fatty material (lipids) in the circulating blood are an important cause of IHD.
Of all the lipids, cholesterol is the most harmful. The total cholesterol can be subdivided into several distinct fractions, such as LDL(c), HDL(c), and VLDL(c). Out of these fractions, the LDL(c) is known as bad cholesterol and is important in causing IHD. The HDL(c) is known as good cholesterol and protects the subject from IHD.
High levels of bad cholesterol and low levels of good cholesterol are responsible for increased prevalence of IHD, and vice versa. It has been proved beyond doubt that lowering the levels of bad cholesterol is beneficial for the subjects inasmuch as it leads to fewer heart attacks and brain strokes, and reduces the mortality. On the other hand, all the medicines that have been tried in volunteers to elevate the good cholesterol levels have been withdrawn because of unacceptable side effects. The only effective way to increase the levels of good cholesterol is by a structured program to exercise the subject. Unsupervised exercise is not recommended because an individual may be suffering from heart disease and will not tolerate high levels of physical activity.
Triglycerides are a weaker risk factor for IHD. Treatment for elevated triglycerides is recommended only when the blood levels exceed 500 mg/dl. This is done to prevent acute pancreatitis, and not IHD.
3. Tobacco
Indians take tobacco in various forms such as cigarettes, bidis, cigars, pipes, dokta, zarda, khaini, snuff, pan parag, and gurakhu. All forms of tobacco are bad, and there are no benefits of stopping smoking and beginning to chew tobacco. The benefits of quitting tobacco are irrefutable.
4. Diabetes mellitus
DM is an important risk factor. Uncontrolled DM leads to micro-vascular disease such as renal failure, and retinal hemorrhage.
There is evidence that prophylactic administration of ramipril and atorvastatin gives some protection against IHD.
5. Clustering around Families
Several epidemiological investigations targeting the families of the index patient have found an increased prevalence of IHD. In some families, this is because of the inheritance of common genes such as those that cause hypertension, or give rise to high levels of blood cholesterol. There can be many other harmful genes. Familial clustering may also occur when many of the family members indulge in taking large amounts of butter and cheese, red meat, and cigarettes, or lead a sedentary life style.
Take Home Message:
Healthy Life style & Healthy Heart
Our citizens need to be educated about a life style that promotes health and prevents IHD.
Our food should contain moderate quantities of carbohydrates. Intake of excessive carbohydrates i the form of rice, roti/chappati, biscuits, pastry, muri, chira (poha), jam, jelly, chutney, or sweetened beverages makes the subjects susceptible to disorders such as high BP, DM, and IHD. If people continue to feel hungry after taking their meals, they can alleviate their hunger by taking salads, or boiled vegetables such as parwal, ladies’ finger, and ridge gourd.
The intake of edible oil should be limited to 5 to 6 teaspoonful over any 24 hour period. The oil should be of a variety that remains liquid at room temperature, e.g., sun flower oil and saffola oil. People belonging to certain states like to cook their food in mustard oil. Extra virgin olive oil is beneficial, but is too expensive for an average Indian household. The consumption of butter, cheese and margarine should be strongly restricted.
Protein intake should be 1 gm/kg/day for most people. This should be in the form of skimmed milk or its derivatives, lentils, and animal proteins. The use of red meat should be restricted. Fish, especially large ocean fish, are a rich source of poly-unsaturated fatty acids that are beneficial for the heart. Vegetarian subjects derive their protein requirements from lentils, soya beans, milk/milk products, and sometimes eggs. Vegetarians and non-vegetarians may take two eggs per week. It is not necessary to throw away the yolk. The eggs should be boiled, or fried in a non-stick cooking pan with the minimum amount of cooking oil.
Fresh fruits and green vegetables are a must for every healthy person’s diet.
The patient should be strongly counselled not to consume tobacco. The help of the patients’ family members is invaluable while persuading them to quit tobacco.
While it is true that a regular intake of moderate amounts of alcohol is beneficial for health, patients should not start drinking in order to build healthy hearts. This is because alcohol is habit forming and leads to health hazards and broken families. For people who are drinking, we strongly recommend their intake to 60 ml of whisky or rum /24 hours.
The aftermaths of IHD are unpleasant. Many people who have suffered from heart attacks are left with badly scarred hearts that cannot pump well. Balloon surgery and bypass surgery of the heart are a pinch in the pocket for every household. The weaker sections of our population are in a greater disadvantage because they can ill-afford these expensive forms of treatment. Therefore, we must pay greater attention to their prevention.
