Creating micro-level heart diseases-free groups in the community will be an effective step towards achieving success in preventive cardiology.
At the same time, education on preventive aspects can begin in schools.
Small groups – about 1,000 people per locality – can be identified and educated on food, lack of exercise and other factors that cause cardiac problems. Collectively, such sensitised individual groups will form a larger community that is free of heart diseases, says Kris Vijay, Director of Heart Failure Programme and Director of Cardiovascular Research at Scottsdale Cardiovascular Centre at Arizona in the U.S.
A heart specialist who devotes special attention to prevention/control of atherosclerosis (building of plaque on the wall of arteries), Dr. Vijay says Coimbatore can look at such a micro-level prevention programme in the community, even as the medical fraternity can impart preventive heart care education to high school students.
Speaking to The Hindu on the sidelines of a symposium on cardiovascular diseases prevention, organised by the PSG Institute of Medical Sciences and Research and South Asian Society on Atherosclerosis and Thrombosis (SASAT) recently, he points out that highlighting benefits of healthy diet and exercise and the ill-effects of alcohol and tobacco can be an effective starting point while dealing with students of this age group. From them, the awareness and its benefits can spread like infection to the adults at home.
Atherosclerosis is building up of plaque on the wall of arteries. Unchecked, the build up increases and blocks the flow of blood. This, in turn, leads to heart attack.
“We can prevent atherosclerosis. It is a huge task, but not impossible. What is needed is a health behavioural change,” he points out.
Doctors and community health workers can team up to take up small groups of people for sensitisation on atherosclerosis, what causes it and what are the ways of prevention, he explains.
“What we need to take note of when dealing with the Indian situation is that diabetes and cardiovascular diseases are parallel cases among people, contrary to these being sequential in other countries. Therefore, there must be greater responsibility in terms of prevention in India,” he explains.
Making a strong case for screening the community, Dr. Vijay points out that most people in India do not know they have a problem because they undergo a check up only when some symptoms such as chest pain show up. Community-level preventive programmes are to be taken up by India Advisory Board (a body of all medical organisations in the country) and by Global Association of Physicians of Indian Origin (see infobox).
“An undetected 40 per cent block in the artery is riskier than the detected 70 per cent block. A paradox, indeed. The larger blocks demand attention through symptoms and get it. But, the 40 per cent block is like a stealth bomber.
A plaque rupture can occur in such cases when inflammatory markers are released during a stressful situation.
This can produce a sudden cardiac arrest. Stress and high blood sugar level can release inflammatory markers,” he points out.
While regular check-up in even asymptomatic cases helps, inflammatory markers can be kept down through yoga therapy. There are preliminary data on this. The other measure is to avoid nutritional suicide by consuming only safe diet and this should begin at a very early age, he advises.
“The Paediatric Cardiology Council in the U.S. has advised cholesterol check-up from the age of 10, because the trend suggests that if you cannot catch the problem early, there will cases of atherosclerosis in people who are as young as 30,” he says.
Asked what was wrong with the approach in India, he says there is mostly secondary prevention – after the problem surfaces. But, wisdom lay in primary prevention. “There should be a paradigm shift”, he says.