Most premature deaths due to heart attack can be avoided with lifestyle changes. Sadly not many people know that.

World Heart Day (the last Sunday of September every year) aims to prevent heart attacks in all its stages: Primordial, Primary, Secondary and Tertiary. A joint effort of the World Heart Federation, the WHO and the UNESCO, the theme this year is “Work with heart”.

Cardiovascular disease is the leading cause of heart disease all over the world claiming over 17.2 million victims each year. In the case of Indians, the risk is four times that of Westerners and 20 times more than the Japanese. Of late, there has been an alarming increase in the number of 25-30 year olds dying of heart disease.

Many people don’t realise that 80 per cent of premature deaths due to heart disease and stroke can be avoided if risk factors are under control. These risk factors are stress, unhealthy diet, physical inactivity and smoking.

Reaction to stress

An individual can work any number of hours provided he/she enjoys it. Otherwise it causes stress. Negative personalities like Type A (agitated, aggressive and impulsive) and Type C (concealed, compressed and non-communicative) trigger negative psycho-neuro-humoro-viscero-immune chain reaction. This increases the hormones of fright, fight and flight (adrenaline, noradrenaline and cortisol) resulting in a rise in heart rate, blood pressure, blood sugar, bad cholesterol (LDL) and decrease in good cholesterol (HDL). This leads to the narrowing of coronary arteries namely left and right (in turn endangering the blood supply to the heart muscle (myocardium), which in turn causes an imbalance between demand and supply of oxygen to the heart.

These individuals generally see their work as stressful, tend to over eat, lead a sedentary life, are obese and also smoke. This kind of a lifestyle leads to hypertension, diabetes mellitus and hypercholesterolemia,0 which culminates in coronary heart disease (CAD) and other health problems.

There are three mechanisms of CAD: narrowing of the coronary arteries by the deposit of excess cholesterol or plaque; the erosion or rupture of plaque causing an instantaneous blood clot; acute coronary spasm. Obstructions up to 70 per cent in the coronary arteries are sometimes compensated by coronary reserves, a gift of Nature. But beyond 70 per cent, it manifests as effort angina or chest pain caused by exertion. Total or 100 per cent block leads to a heart attack.

The increasing incidence of CAD among youngsters can be attributed to a combination of stress, insecurity and unhealthy lifestyle. A majority of the heart attacks occur between 5.00 a.m. and 8.00 a.m. due to over anxiety about work.

Positive reactions

On the other hand, Type B personalities (calm, happy, balanced) have a positive chain reaction that results in increased secretion of hormones like endorphins, melatonin and serotonin that help the organs including the heart to function normally.

A healthy work culture along with lifestyle modification not only helps in primary prevention of heart disease but also in reversing blocked coronary arteries. Intermittent breaks, mild stretching exercises, including more vegetables and fruits in diet and mental relaxation help improve one’s performance.

Globally about 30 per cent of heart attack victims die within 2-3 minutes of the onset of pain. The only solution is primary prevention. Interventions like stenting and bypass surgery are temporary measures. The only permanent cure is effective lifestyle changes. Three mantras for a healthy heart: positive thought; healthy food; adequate exercise.

The writer is a Cardiologist and Emeritus Professor, Cardiology, Dr. MGR Medical University, Chennai

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