On the occasion of World Heart Day (September 29), Dr. Joji Mathews addresses four common concerns raised during clinical consults.
In adult cardiology, the most common conditions seen are blockages involving arteries of the heart (coronary artery disease), hypertension and hypertensive heart disease, lipid disorders, heart pumping dysfunction (heart failure) due to various reasons, disease of heart valves, and disorders of heart rhythms.
To complete the list, the less common are heart diseases that are there from birth and are detected or followed through into adulthood (adult congenital heart disease), diseases of heart muscles (cardiomyopathies) and disease involving the covering of the heart (pericardial disease).
The most common cardiac conditions
Role of genetics and lifestyle in the commonly seen cardiac ailments
The reasons behind cardiac diseases are broadly categorised as non-modifiable (e.g., age, sex, family history of heart disease/genetics, race) and modifiable risk factors (e.g., hypertension, diabetes, hyperlipidemia, physical inactivity, obesity, poor diet, sub-optimal sleep, stress, smoking).
The non-modifiable factors have a major share in the prognosis of heart disease relative to the modifiable risk factors. However, with the control of modifiable risks, there is a substantial reduction in cardiovascular disease events.
Both environment and behaviour modification by adopting a healthy lifestyle can change how a DNA sequence is read. The modifications are seen to turn on or off the genes. An over simplified implication of this would mean that just because a gene is inherited, the disease does not have to manifest. This science is called epigenetics. Its understanding is still at nascent stages. Both genetics and lifestyle determine manifestation of disease.
Cardiovascular disease in the young and apparently physically healthy
Various reasons can be considered for the increased prevalence of cardiovascular disease at a younger age. The foremost of it is a poor lifestyle – namely poor diet resulting in insulin resistance and metabolic syndrome, physical inactivity, poor sleep, stress and harmful substance use.
The markers of good health as many presume (e.g., good physique, optimal blood pressure, blood glucose levels and lipid panel) will be altered only at later stages of the disease that is under progress. This is because the body has an immense buffer system and can tolerate poor lifestyle for a long time till the balance tips against one’s favour.
On introspection, compared to the earlier generation, the food we eat are modified, loaded with pesticides, is fast and processed. In addition, there is poor discipline in food portioning, time of eating, physical activity, time spent sleeping, and a loss of social support that came while staying together in a large family. Consequently, the cumulative effect of the above factors results in a pro-inflammatory and pro-clot prone internal environment in the body. Over a course of time, there is a transformation into disease states. Therefore, the present era and the current choice of living has its bearing in precipitating disease in advance.
Outcome of optimal lifestyle and treatment compliance
Awareness of our physiology and sticking to what the body is designed for is the key to prevent progression to diseases. Once the disease is in progress, the recovery is subject to the extent of the damage that has occurred.
A bird’s eye view of a physiologically tolerated lifestyle includes: a) A diet from natural foods that is balanced in nutrition and optimal in calories calculated for the ideal body weight for height. These foods should be preferably taken in feeding windows that prevents development of insulin resistance (intermittent fasting). Stay clear from sugar and processed foods. b) An exercise programme that includes at least 30 minutes of moderate intensity activities (a pace where you can talk but cannot sing without getting short of breath); Strength training of all major muscle groups done two days a week at least as two sets of 10 repetitions; Stretch exercises across all major joints for 15 second with four repetitions; Balance exercise as in yoga or Tai-chi. c) Seven hours of sleep a day preferably at one stretch. DNA repair and toxin flushing occurs during sleep. Do not compromise on this physiological requirement of the body. d) Stress management should be done by focusing on positive inputs and keeping company with people who influence you in a positive way. Stress is subject to how any situation is processed. Be objective when deciding on gains and trade offs of the available solutions for any situation. Do not hesitate to seek help when required rather than getting mentally worked up. e) Stay clear from smoking and other recreative substance abuse that accelerates body into disease states.
Target optimal blood pressure readings <130/80mmHg, an HbA1c <5.6, Lipid levels as per the risk profile determined by expert doctors.
There is no doubt that practising a heathy lifestyle and being compliant with treatment to achieve the targets will prevent progress if not reverse from disease to health. However, despite awareness, it is noted that a large proportion of preventable cardiovascular events still happen due to poor willingness to make changes.
**Dr. Joji Mathews MD (Internal Medicine), DNB (Cardiology), Dip. IBLM is a cardiology specialist at Aster Medical Center, C Ring Road branch
