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Heart attacks are responsible for 25 per cent of deaths in India. By 2020, 50 per cent of people with heart disease all over the world will be Indians. Unlike in the developed countries where older people are affected, in India the young — many in their early thirties — are cut down by heart attacks. Women were traditionally considered protected by their hormones till menopause but today, the number of “attacks” in premenopausal women is steadily rising.
Women tend to have atypical pain with heart attacks. Any symptom is unfortunately taken less seriously than in men. They are also less likely to reach an appropriate hospital in time. This makes them more prone to die during the first attack.
Even when women reach for treatment, their ECG and angiogram may not show typical blocks. Their blood vessels are also smaller in size. Earlier, the results of cardiac intervention in women did not do as much good as in men. Now, this problem has been rectified. The instruments and stents are smaller in size and the outcome has improved.
Certain visible body changes are associated with an increased risk of developing heart disease. In almost 50 per cent there are small yellowish white lumps called xanthelesmata around the eye or the elbow. The earlobe may have a vertical crease on one or both sides.
Obesity is a definite risk factor. The body stature is different in Indians so even relatively thin individuals have a “tummy”, indicating a high waist hip ratio. To determine the waist to hip ratio, use a measuring tape to measure the circumference of your hips at the widest part of your buttocks and your waist at the smaller circumference, usually just above the belly button. Then divide your waist measurement by your hip measurement. Abdominal obesity exists when the waist-hip ratio is above 0.95 for males and above 0.80 for females.
The ideal BMI (body mass index) is not 25 (the value internationally) in Indians but 23. The BMI is calculated by measuring the height in metre squared and dividing it by weight in kg. Ideal body weight is, therefore, height in meter squared multiplied by 23.
Many Indians carry the “thrifty gene”, a small change in chromosome 3q 27. This helped store fat during seasons of plenty and use it during times of famine. We do not have to face famine situations now —thanks to better availability of food, government distribution and storage facilities — but the gene still works to conserve calories. This predisposes the affected individual to obesity, insulin resistance, diabetes and heart disease.
Abnormal lipids with elevated cholesterol, triglycerides and altered ratios in lipoproteins cause deposition of fat plaques in the blood vessels. These may obstruct the blood vessels in the heart, brain or even in the limbs. The blood supply is compromised and heart attacks and strokes are the result. This tendency can also be inherited.
The interplay between inherited tendencies and manifestation of disease is a complex one. The expression of the unhealthy genes mentioned above can be modified by the environment (food availability and family habits) and lifestyle.
Children have to be taught from a young age to eat 4-6 helpings of fruit and vegetables instead of snacking on high calorie foods like potato chips, cream biscuits, iced cakes and aerated sweetened beverages. Oil consumption should be reduced to half a litre per person a month. Palm oil, coconut oil, butter, ghee and other saturated oils should constitute only seven per cent of the total intake. Refined flour and cereal should be substituted with whole grain products (atta instead of maida, red rice instead of white).
Eating should be a focused activity. It should not be combined with distracting activity such as reading or viewing television. This is because the satiety signals from the brain are interfered with. More food will be eaten than required.
Eating out is also fraught with danger. The food served may be more than required and unnecessarily oily. Since we are taught from a young age not to waste food, we tend to eat everything ordered even when we are not hungry. Smoking (active and passive) is a definite risk factor, which increases all others.
Exercise makes the heart work harder, utilising its maximum capacity. The rhythmic contractions force blood vessels open and improve blood supply. New connections are forged in compromised vessels. Walking briskly for 40 to 60 minutes a day will achieve these benefits and modify many of the detrimental effects of inherited bad genes.
“No time” for regular aerobic exercise will result in a lot of time for heart disease.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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