The Risk Factor

Risk factors are the reasons, which lead to or aggravate the deposition of cholesterol or fat in the coronary arteries. There are innumerable risks factors for coronary heart disease. Williams in 1981 identified 246 risk factors that directly or indirectly lead to the development and onset of heart diseases.

TO GIVE YOU A ROUGH IDEA, THE DISTRIBUTION OF THESE RISK FACTORS IS MENTIONED BELOW

• Habits and Lifestyle, Psychosocial 54
• Physical and Biochemical 16
• Serum / Blood Measurements 44
• Medical conditions or Diseases 45
• Dietary deficiency (inverse association) 23
• Dietary excess (negative association) 21
• Constitutional, demographic 16
• Blood Clotting (Platelet) Disorders 16
• Environmental 5
• Drugs 6

Healthier Lifestyle

Nearly 20 crores under 30 years of age are hypertensive patients in India and 19% of the total deaths each year are related to heart disease. Detailed estimates from 1990 to 2016 of heart and blood vessel diseases in every state of India show that these diseases have increased. Many are struggling to recover from heart attack or stroke, while others at high risk are getting the care and making the changes necessary to lower their risk. The fact is, you can do plenty for your hearth health, even if you’ve had a bad experience. Healthy lifestyle changes will help you feel and look better! Start today to take control over your future. You’ll find that once you make one change, you are a step closer towards healthy living.

Here are the steps to take

• Quit smoking.
• Watch your eating habits.
• Be more active.
• Take your medicine to control your blood pressure.

How do I stop smoking?

• Be conscious of the repercussions and have a strong will power.
• Ask your health care professional for information and programs that may help.
• Fight the urge by going where smoking isn't allowed and staying around people who don't smoke.
• Reward yourself when you quit.
• keep busy doing things that make it hard to smoke.
• Remind yourself that smoking causes many diseases can harm others and is deadly.
• Ask your family and friends to support you.

How do I change my eating habits?

• Ask your doctor, nurse or licensed nutritionist for help.
• Avoid foods like egg yolks, fatty meats, skin-on chicken, butter and cream.
• Cut down on saturated fat, sugar and salt.
• Substitute skimmed or low-fat milk for whole milk.
• Bake, broil, roast and boil - don't fry foods.
• Eat fruit, vegetables, cereals, dried peas and beans, pasta, fish, skinless poultry and lean meats.
• Limit alcohol to one drink a day, and if you don't drink, don't start.

What about physical activity?

• Check with your doctor before you start.
• Start slow and build up to 30 minutes, 3 to 4 times a week.
• Physical activity reduces your risk of heart attack and makes your heart stronger.
• Staying active controls your weight and blood pressure; helps you relax, and can improve your mood!
• Bake, broil, roast and boil - don't fry foods.
• Look for chances to be more active. Take 10–15-minute walking breaks during the day or after meals.

Non-Modifiable Risk Factor

• AGE - The incidence of heart disease increases with advancing age but today we are seeing people getting heart attack at a younger age.
• SEX - Men are at a greater risk of heart attacks as compared to women but due to excessive stress more women are getting prone to heart diseases.
• HEREDITY - People with a strong family history of heart disease are at a greater risk. But early prevention can surely decrease the risk.

Modifiable Risk Factor

• HIGH BLOOD CHOLESTEROL - is recognized as one of the first three risk factors leading to heart disease. A fat particle with a complex structure, if present in more than adequate quantity in blood gets deposited to create blockages. A diet rich in cholesterol source is a major threat to the heart health.
• HIGH BLOOD TRIGLYCERIDES - Increased level of Triglycerides or fat in food is another factor for heart disease. A level of 160 mg/100ml is associated with increased incidence.
• HIGH BLOOD PRESSURE - A ‘silent killer’, as High Blood pressure puts an extra strain on the heart and is also a major cause for deposition of cholesterol and fat in the coronary arteries.
• OBESITY - Lack of physical exercise & wrong food habits will make a person obese and make them prone to heart diseases.
• STRESS AND MENTAL TENSION - Psychological stress is recognized as most important risk factor for heart disease. In absence of other risk factors people can still have angina, if stress is not controlled, it leads to contraction of coronary arteries.
• SEDENTARY LIFE STYLE - Modern mechanization makes everything available easily, as a result physical activity of people is almost nil which predisposes them to many diseases.
• INTAKE OF ALCOHOL - Alcohol owing to its structural similarity with glycerol is associated with major risk. It is a source of empty calories and leads to diseases of liver, gastritis etc.
• LOW HDL CHOLESTEROL - HDL also called ‘good cholesterol’ can be another factor for CHD as it binds cholesterol and removes it from blockages.
• SMOKING OR TOBACOO CONSUMPTION - Studies have proved that smoking substantially increases the risk of heart attack. Consuming tobacco in any form is equally hazardous as both are bad for health.
• DIABETES MELLITUS - Uncontrolled blood sugar levels is associated with obesity, high blood pressure and high cholesterol levels responsible for CHD.

What to do after heart Attack

• CHEST PAIN NOT RELIEVED BY REST OR SUB LINGUAL SORBITRATE - victim of a heart attack often complaints of an excruciating pain in the left part of the chest, radiating to the left arm. The pain is not relieved by taking rest or sorbitrate (or other nitrates) below the tongue.
• SWEATING - pain is often accompanied by a profuse sweating. Even in a cold atmosphere the patient perspires.
• FEELING OF INTENSE WEAKNESS - In many patients there is a feeling of intense emptiness or giddiness following a heart attack. Some of the patients feel the same as in case of a low blood pressure and low blood sugar.
• SUFFOCATION -Choking, sense of constriction in the chest. There may be feeling of breathlessness in some patients. Those who already have angina, would find worsening of the symptoms.
• BURNING SENSATION IN THE CHEST - This feeling occurs specially in people having heart attack for the first time. This uncomfortable feeling, accompanied with a gastric or acidity problem, many times confuse heart attack victims. They consider this as a gas problem and take some antacid tablets, which also relieve the feeling to some extent.

Parameter for Reversal

Causative Factors	Usual Cardiology Recommendation	SAAOL Recommendation
1	Serum Cholesterol	130 - 200 mg/dl	Less than 130mg/dl
2	Serum Triglycerides	60 - 160 mg/dl	Less than 100 mg/ dl
3	Serum HDL Cholesterol	30 - 60 mg/dl	More than 40 mg/dl
4	Cholesterol: HDL	4 - 5	Below 4 Ratio
5	Serum LDL Cholesterol	30 - 130 mg/dl	Less than 70 mg / dl
6	Blood Pressure (systolic)	120 - 140 mmHg	120 mmHg or less
7	Blood Pressure (diastolic)	70 - 90 mmHg	80 mmHg or less
8	Blood Glucose (Fasting)	80 - 110 mg/dl	70-100 mgs %
9	Blood Glucose (PP)	120 - 160 mg/dl	Less than 140 mgs %
10	Smoking/Tobacco	To be reduced	Banned
11	Exercise/Walk	Should be done	Must do, at least one hour
12	Weight	20 - 30% extra (from any chart)	Only 2 - 3 Kg extra allowed permitted from Indian Chart
13	Fiber intake	Not specified	Plenty everyday
14	Stress	Not defined, Not available	Clearly defined, optimal
15	Total fat intake	10 - 30% Calories	10% of total Calories
16	Visible-fat intake	PUFA, MUFA etc.	Banned
17	Cholesterol intake/day	Not defined	10 mg/day

Prevent Heart Attacks

The simple message is ‘Do not create more blockages. If you can reduce it, heart attack would never occur.’ It is like a bundle of notes being guarded by a rubber band. If you keep on putting more and more notes inside the rubber band one day the rubber band will break. This is the situation of a heart attack where the membrane also breaks off. Now if you stop putting more notes, the rubber band will never break. Further, if you start taking out one or two notes from the bundle every day, the rubber band will never break. The same principle applies in prevention of heart attack. By controlling all the risk factors of heart disease by adequate changes in the lifestyle can prevent heart attacks. The following are the expected parameters to prevent heart attacks:

• Cholesterol below 130 mg/dl
• Triglycerides 60 to 100 mg/dl
• HDL Cholesterol 40 to 60 mg/dl
• Blood glucose (Fasting) 70 to 100 mg/dl
• Blood Glucose(PP) below 140 mg/dl
• Blood Pressure 120/80 mmHg.
• Maximum permissible exercises.
• Body weight in proportion to height.
• Stop smoking completely.
• Control stress.
• Oil/Ghee in food is banned completely.
• Consume salads and fruits in plenty.
• Restrict consumption of milk and milk products.
• Avoid meat of any kind.