Don’t Miss A Beat: Start Saving Your Heart Right Away

Today is World Heart Day – a day of campaigning to raise awareness about the burden of heart disease worldwide. This year’s theme continues with the same slogan from last year – Don’t Miss A Beat – and r extends the scope – learn to recognize the symptoms of heart disease hiding in plain sight, actively seek out solutions to the problems of heart and create pressure on authorities to prioritize action to prevent the leading killer disease in the world.

About 75% of global cardiovascular disease (CVD) deaths occur in middle- or low-income countries like ours. Even in the Western world, 1 in 3 heart attacks occur prematurely under 70 years of age. From our own experience in Bangladesh, we see that on an average, a person suffers their first heart attack at around 50 years of age compared to around 60 years in the Western population. South Asia has the third-highest proportion of cases of a first heart event occurring at age 40 years or below. 

But it doesn’t have to be this way. Up to 80% of these early – or premature – heart diseases can be effectively prevented by creating opportunities to make healthy lifestyle choices, staying active, early screening, and affordable access to screening and healthcare.

So, what can we do on a personal level to reduce the threat of CVD?          

Heart diseases have many forms, such as Congenital Heart Disease, Cardiomyopathies, Infections, Rheumatic and other Valvular Heart Diseases, Disorders of Heart Rate and Rhythm, and Pregnancy-Induced Heart Diseases - but by far the most common, the most fearsome and devastating is the damage caused by a Heart Attack, medically known as Myocardial Infarction. 

Prevention is simple, and should start early in life. People in late teens to early adulthood (20s and 30s) are at more risk if they have -

1. Sedentary lifestyle and insufficient daily exercise - lack of regular physical activity or exercise is linked to a high risk of heart attacks. Regular physical activity/exercise improves heart health by controlling body weight, blood sugar, and fat levels, and raising good cholesterol levels.

2. Family History of heart attacks - if you have a close (first-degree relative) who has suffered a heart attack, especially at a relatively young age (less than 55 years in men and 65 years in women), your chances of having a heart attack might be higher.

3. Childhood obesity and the Metabolic Syndrome - this is a combination of at least 3 of the following things: large waist circumference (childhood obesity), high normal blood pressure, low good cholesterol (HDL), high triglycerides (TG), and high blood sugar (Impaired Fasting Glucose or Impaired Glucose Tolerance). Having Metabolic Syndrome raises the chances of having a heart attack by two times.

4. Social factors – tobacco use; illegal/recreational drug use/abuse also causes heart attacks.

5. An unhealthy dietary habit - such as a diet high in sugar, salt and trans fats and low in vegetables, fruits, fiber and healthy oils, also leads to an unhealthy heart 

As people enter their 40s and 50s, some classic risk factors become more important. These are:

1. Tobacco – in any form, it is harmful to heart and health;

1. Diabetes mellitus - diabetics are more prone to developing heart attacks because of its effect on body metabolism, fat metabolism, and causing direct damage to the inner linings of the arterial system;

2. High blood pressure - high blood pressure directly damages the arterial wall, especially the inner lining.  This can initiate the atherosclerotic process or contribute to its acceleration. The shear stress of high blood pressure can also lead to the rupture of plaques and precipitate blood clots. High BP alone in the long term can cause heart failure.

3. High Blood Lipids - High Levels of ‘Bad’ Cholesterol (LDL or Low Density Lipoprotein) and, consequently, total cholesterol are the strongest culprits causing plaque buildup. High levels of certain others, like Triglycerides (TG), also raise the chances of a heart attack, among other things. The ‘good’ (High Density Lipoprotein or HDL) cholesterol, on the other hand, protects you from heart attacks.

4. Obesity - high body weight compared to your height (the Body Mass Index or BMI) due to excess body fat, a high waist size compared to your hips, raises your chances of having high BP, Diabetes, and high blood cholesterol or triglycerides, and a low good cholesterol (HDL) level.

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As people age, even in the absence of the above, their risk of heart disease goes up. Age, especially in women, often masks heart disease, and it can present with uncommon and unusual symptoms. Undue fatigue, worsening effort tolerance, persistent nausea and indigestion, dizzy spells, and instability can indicate heart disease.

How can we lower our risks of CVD? According to studies, up to 80% of heart attacks – and strokes - are preventable by following some simple lifestyle modifications, supplemented by medical care if and when needed. These are:

1. Maintain a healthy dietary habit – Our diet should be a healthy,

balanced one to maintain a healthy heart and blood circulation. A healthy diet must include a wide variety of unprocessed and fresh foods, including plenty of fruits and vegetables (at least five portions every day), whole grains, nuts and foods low in saturated fats, sugars and salt. Avoid processed foods, which often contain high levels of salt, and drink lots of water!

2. Maintain a healthy habit of physical exercise – Take 30 minutes of moderate-level physical activity 5 days a week. Adults and seniors (aged 65+) should aim for at least 150 minutes of moderate-intensity or 75 minutes of high-intensity physical exercise every week. Children and adolescents should have at least 60 minutes of moderate-to-vigorous exercise daily.

Take every opportunity to make exercise a regular part of your life: use the stairs instead of the lift, get off the bus or car a few stops earlier, and walk the rest of the way to your workplace. These are great ways to relieve stress and control your sugar level, blood pressure, and weight.

3.  Control and maintain a healthy body weight – avoid being overweight or obese; aim for a height-weight ratio (i. e. a calculated Body Mass Index) of 24 or below. Both a healthy diet and physical exercise help in this regard. Avoiding obesity and excess body fat also improves control of blood pressure and sugar levels.

4. Avoid tobacco and alcohol – all forms of tobacco are harmful, and there is no safe level of tobacco and alcohol exposure. Your risk of coronary heart disease halves within one year of quitting smoking, and while drinking less may lower the risk, there is evidence to show that for health, it is ideal to not drink at all. Smoke-filled environments and second-hand smoking can also significantly raise the risk of a heart attack.

5. Avoid stress – exercise, relaxation techniques and leisure activities help us manage stress levels. Chronic stress can harm blood vessels, especially in women. Try to make time to do the things that you love most.

6. “Know your numbers” – this adage is an important one. To know your risks of CVD, keep track of your health indices – blood pressure level, blood cholesterol level, and blood sugar levels; Body Mass Index or simply your body weight, and waist-to-hip circumference ratios are important indices of health. To these might be added blood Uric acid level and creatinine levels for assessment of overall health status.

Some misconceptions about heart diseases can harm us:

1. It is misleading to assume that addressing just one risk factor, such as physical inactivity or excessive weight, will help. To make a significant impact on reducing the risk of CVD, it is important to take care of your lifestyle as a whole.

2. Blood pressure medication is only to be taken when the pressure is high, and can be discontinued as it becomes normal;

3. Electronic tobacco is harmless;

4. A popular term used to describe symptoms as “Gas/acidity” and is taken as indicative of dyspepsia, which in fact may be because of a developing heart attack.

So start acting early, before symptoms develop. Apart from these individual choices of healthy behaviors, regular medical screening or health check-ups may be helpful for early identification of diseases.

It must also be stressed that government policymakers have an important role to play in making sure that people have easy access to tools of healthy living. Clean air, affordable and well-regulated healthy food, and well-planned community spaces that encourage an active lifestyle, and health policies that create opportunities for easily available and affordable healthy choices are essential for motivating people to adopt a healthy lifestyle  

Don’t miss a beat - have a good, heart-healthy life!

The writer is a Senior Consultant, Clinical and Interventional Cardiology