World Heart Day is celebrated on 29th September of every year. It is celebrated to raise awareness about cardiovascular diseases and take the suitable preventive measures for its management. With economic development and changing lifestyles, non-communicable diseases like heart attack, have overtaken communicable diseases. Globally, India has higher cardiovascular disease (CVD) burden, 282 compared to 233 deaths per 100000 persons globally. Nearly 63% of total deaths in India are due to noncommunicable diseases, of which 27% are attributed to cardiovascular disease which affects 45% people in the 40-69 age group. Within India, there are regional variations with higher prevalence of risk factors for CVD in economically more developed states compared to the underdeveloped states.
What causes CVD
CVD is a denotes all diseases pertaining to heart and circulation. Coronary Artery disease refers to diseases causing less blood supply to the heart muscle and generally refer to heart attacks. Among CVD, coronary artery disease (CAD) or heart attacks are the most common. CAD can’t be attributed to any one single cause but to a group of risk factors. CVD risk factors may be classified as modifiable and nonmodifiable. Risk factor reduction can be done at individual level, community level and by governmental policies.
Individual level prevention
Individuals should strive to identify these risk factors and modify them. Preventive health checkups can start from the age of 25 years.
Nonmodifiable Risk factors
CAD increases with age and is more common in males (80%) compared to females. Family history of premature CAD is a strong risk factor and it is recommended that children of patients with CAD occurring at an early age get themselves evaluated periodically.
Modifiable Risk Factors
These include tobacco usage, obesity, high blood pressure (Hypertension), diabetes, high cholesterol, and sedentary life style, not consuming fruits and vegetables regularly and psychological stress. These are considered modifiable risk factors since they can be treated or altered leading to better health outcomes.
Tobacco: Tobacco consumption in all forms is an important cause for heart attack in young people below 45 years. A quarter of CAD patients consume tobacco. Stopping its consumption decreases the risk of CAD. Often, it’s during the high school years, adolescents get habituated to smoking and tobacco addiction. Preventing measures should be targeted during this phase.
Obesity: Obesity is multifactorial and causes include genetic traits, excess calorie consumption, sedentary life style. Ultra processed food, simple carbohydrates, excess saturated fats, salt and junk food lead to obesity. Attaining proper body mass index improves the risk of heart disease and death.
Sedentary life style: Regular exercises prevent CVD. Minimum 150 minutes of preferably isotonic exercises per week is recommended. There is data to suggest that 8000 to 9000 steps per day is beneficial. Unfortunately, most Indians lead a sedentary life.
Hypertension: Hypertension is a very common and often silent. It should be treated whether or not it is symptomatic. Periodic BP measurements are mandatory. Treatment is lifelong and the target BP should be 130/80 irrespective of age. It prevents CVD, stroke and kidney disease.
Diabetes: Obesity, inappropriate diet, sedentary life style and stress are important risk factors for diabetes. Nearly 80% of diabetics can develop CVD in their lifetime and it can be prevented. Comprehensive treatment of diabetes includes regular exercise, diet, control of sugars as well as high cholesterol and BP. Target HBA1C should be less than 7%. All diabetic patients should mandatorily receive statins.
High Cholesterol: High blood cholesterol levels are associated with CAD. Decreasing blood cholesterol levels by statins saves lives. The risk of cholesterol can be quantified using a concept of LDL-C years which is a multiple of LDL cholesterol concentration in the blood and age of the patient. Decreasing LDL-C years by decreasing LDL cholesterol concentrations will delay the age at which CAD appears in a person. Diet and exercise can decrease cholesterol levels but not to optimum levels and drugs are necessary.
Fruits and Vegetables: They contain anti-oxidants and should become part of daily dietary intake. While poultry, fish and milk, high fibre diet are good for heart, read meat and organ meats are not.
Psychological stress: Anger, Hostility, type A personality, depression, job stress (more responsibility and less power), care taker stress are important psychological factors that increase the risk of CVD.
Behaviour: Often the risk factors cluster together because of personality factors. This is beyond socio economic and educational status. Constant propaganda through social, electronic and print media, exemplary behaviour by celebrities and other role models, inculcation of the healthy habits from childhood can favourably affect behaviour.
Community level prevention
Simple preventive health checkups organized in community by NGOs, resident welfare associations, hospitals, industrial settings, offices and business organizations would help identify and treat risk factors in individuals before they lead to disease manifestation.
Governmental Policies
Government policies should include measures that nudge people to adopt a healthy life style. These include developing lung spaces in residential areas where people can exercise, decreasing pollution and improving air quality. Horticulture should be encouraged. Packaged food items should be regulated in terms of content of trans fatty acids, sugars and salt. Community health clinics should be developed that promote health of the community. Governmental focus on treatment aspects of the disease is good but prevention is better than cure.
