Matters of the heart

Make sure you set aside half an hour daily for walking  

SUMATHI HAS had a bad week. Her father was admitted to the hospital following a heart attack. She and her sister took turns to stay in the hospital. During the interminable waiting while he underwent a coronary bypass, she and her sister had time to reflect on their own risks of developing heart disease.

"Women don't have heart attacks, do they?" she asked. Wrong. Heart disease is the leading cause of death in urban Indian women. Women can and will develop heart problems, especially if they have risk factors like high blood pressure, diabetes, obesity or abnormal levels of cholesterol and triglycerides.

In February 2004, the American Heart Association published guidelines for prevention of heart disease in women. The guidelines are appropriate for Indian women too. By following these guidelines, you can lessen the risk of developing heart disease. If you already have heart disease, you can still make a difference to the quality of your life.

Physical activity: Make sure that you set aside a minimum of 30 minutes of moderate-intensity activity, like brisk walking every day or at least five days a week. If you so wish, the exercise can be split into 10-minute sessions thrice a day or 15 minutes twice a day. For walking to be considered effective, your pulse rate must increase but you should still be able to talk without becoming breathless.

Heart-healthy diet: Establish healthy eating habits. Do make sure that you eat plenty of fruits and vegetables. Whole grains and a variety of dried beans are recommended. Stick to low-fat or non-fat milk (skimmed milk) and skimmed milk curds. Protein can be obtained from plant sources like legumes, and meats low in saturated fat (like fish and chicken). The saturated fat intake should be limited to less than 10 per cent of calories. Saturated fats can be identified as fats that are solid at room temperature like butter, ghee and coconut oil.

Weight maintenance or reduction: Women who maintain their body mass index (BMI) between 18.5 kg/m2 and 24.9 kg/m2 reduce the risk of heart disease. Your BMI is calculated by dividing your weight in kilos by your height in metres squared. It is also important to maintain a waist circumference of less than 35 inches or 87.5 cm.

Mental health: It is important to maintain a positive outlook in life. Professional help should be sought in clinical conditions like depression.

Folic acid: Indians have a risk of having high homocysteine levels, which places them at risk. Even if you have not been tested for this, daily folic acid supplementation is a good health strategy.

Blood pressure: High blood pressure is a definite risk factor. Your blood pressure must be maintained at 120/80 mm Hg or less. This can be achieved with lifestyle modifications such as decreasing salt intake, mild to moderate physical exercise and stress reduction techniques like meditation. In women with diabetes, treatment may be started even with lower blood pressure readings.

Abnormal lipid levels: Many of you would have had your lipid levels measured as part of a routine health check-up. How do you interpret the numbers? The HDL (the `good' cholesterol) levels should be greater than 50mg/dl; LDL (the `bad' cholesterol) should be less than 100 mg/dl and total triglycerides should be less than 150 mg/dl. Total cholesterol minus HDL should be less than 130 mg/dl.

Diabetes: High levels of sugar in the blood contribute to heart disease. Indians have a high incidence of diabetes. Diabetes can be controlled with a combination of diet, exercise and, if necessary, medication. One of the measures to determine the efficacy of diabetic control is the measurement of HbA1c. This level should be maintained below seven per cent.

There is no evidence, at present, to show that taking antioxidant supplements or aspirin, contributes to the prevention of heart disease in women.