Article II - Fitness, How to avoid heart attack?

Fitness Videos

Every body wishes to avoid heart attack very few people try to prevent it. The most important thing is how may people know how to prevent such a disastrous disease? Before we start to discuss how to prevent a heart attack, we have to consider the circumstances and estimate the risk profile.

We have to stare all the risk factors – modifiable and non modifiable and then start from there. The gravity of situation or otherwise determines the future plan. One has to be objective and practical. First of all, look at the non modifiable risk factors which determine one’s likelihood of developing a problem, but one cannot do anything about them. It is aggressive one has to be in modifying other modifiable risk factors. Important to know them because this will determine how aggressive one has to be in modifying other modifiable risk factors. Important factors are age, sex, and family history. The older the person, the higher the risk of heart attack. The risk of developing a heart ailment below the age of thirty is very slim in males and rather rare in female. The chances of developing a problem are very high as one enters in seventh decade of life. The risk is almost similar for both sexes, a little more for females. In between there is a gradual increase in risk for both sexes, whereas the risk rises sharply for women as they become post menopausal. Those with a positive family history are more at risk. There is a lot of confusion that surrounds family history. Family history is important when a parent or a sibling suffers a heart attack at a younger age – around forty. If someone’s mother dies of a heart attack at the age of eighty that does not come under a strong risk factory.

So if its a male, in his early forties and has a strong family history such as one of the parents succumbing to a heart attack at age thirty five, he should have a different plan. He has a very high risk profile and has to be aggressive in getting his baseline blood checked up and be more particular in his regular check ups. He should have a different threshold for treatment for his risk factors and should have different targets to achieve. As against that a sixty year old male with no positive family history has a rather benign profile, he should get his tests done annually and keep his eyes on laboratory values. A lady at fifty with positive family history of heart attack in a sibling or parent is at very high risk. She has to be aggressive in looking for all the risk factors and their reduction wherever required. She needs more frequent cardiac checkups and a strict eye on all the risk factors.

What are the modifiable risk factors? These are the risk factors which can be altered and have an important effect on eventual outcome. The list is very long and new factors are being added to it as the research continues. Most important among these are the presence of diabetes, high blood pressure, high level of total cholesterol and specially high LDL and low HDL cholesterol, and smoking. Obesity and lack of physical activity contribute directly and indirectly towards heart attack. Novel risk factors are newly identified risk factors and their role and the effects on reduction have not been thoroughly studied in large trials. Their cause effect has to be established and the cost effectiveness of their reduction has yet to be proved. These are important risk factors and assume more importance when the traditional risk factors are absent in a young person with heart attack.

The most important of modifiable risk factors is diabetes. There has been a growing awareness about diabetes and there is a large data base to establish the effects of diabetes on heart and vessels – tubes carrying blood to all parts of body. Diabetes mellitus is a scourge which is now assuming the status of an epidemic. Whereas other epidemics follow a certain course and wither away, unfortunately it has come here to stay for good! The real danger of diabetes is accelerated process of hardening of vessels called atherosclerosis with high mortality and higher morbidity. The worst effects are through involvement of small and medium sized vessels effecting almost all systems of body. Main targets are heart, brain, eyes and peripheries. Involvement of vessels in diabetics is more severe and diffuse.

Though effects on all target organs are profound and diffuse, let us focus on heart for the time being. More diabetics succumb to heart attacks as against non diabetics. Diabetics afflicted with heart attack have more complications and higher death rate. Lesser number of diabetics are amenable to procedures like by pass surgery and angioplasty as compared to non diabetics due to diffuse involvement of vessels. Diabetics undergoing these procedures are more likely to have complications during the procedure. The changes of recurrence of symptoms and disease are higher in diabetics. It is due to incomplete revascularization and the aggressive course of disease that follows.

Diabetes for all practical purposes is one of the strongest risk factors. According to new guidelines for treatment of high cholesterol, it is being considered as equivalent to established cardiac disease. Diabetes has accumulative effects in combination with other risk factors like high blood pressure, high levels of total cholesterol and especially high LDL and low HDL cholesterol, and smoking. The effect is synergistic and new goals for treatment have to be defined.

How can diabetics help themselves? Should there by a different strategy for diabetics? Should they wait for complications to occur and only then take action? Do diabetics get a fair deal and optimal therapy in our setup? The answers to all these questions are neither simple nor straight forward. Diabetic should have good working knowledge of diabetes and its complication. They should understand the importance of looking for other risk factors, effects on target organs and treating them aggressively. Over and above they should believe in aggressive treatment and the merits of such treatment right from the start. Recent studies have documented the importance of tight control with reduction in many end points because unless the patient is convinced he cannot demand better treatment from his doctor.

The strategy for diabetics has to be different. The criteria and goals of treatment for associated risk factors like high blood pressure and high cholesterol are different. For example diabetics should have lower blood pressure and the threshold of treating high blood pressure is lower and the aim is to bring it down to systolic 130 mmHg and diastolic 85 mmHg. Similarly cholesterol especially LDL has to be lower around 130 mg/dl to start therapy and the aim should be less than 100 mg/dl. The threshold of starting therapy and the necessity of lower goals has to be appreciated by the patient himself and only then it can be put in practice.

The importance of meticulous diabetic control has to be ingrained in the minds of diabetics and especially those at higher risk of developing heart attack. This can be done by strictly adhering to treatment regimen and observing all dietary restrictions and regular exercise and control of other risk factors. All diabetics should have the background to look for and monitor different complications. Though diabetics should not treat themselves like ‘people form Mars’ yet they need to have strong belief that meticulous control will mitigate their sufferings and keep them safe from heart attacks and many other complications.

___________________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah