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Heart disease: Are you at risk?

September 27 is World Heart Day, a day that emphasises the need for people young and old to take heart health seriously.

Heart disease, earlier believed to be a health concern for middle-aged people, is now striking more young people and women. While heart conditions may vary in degree, it is important to recognise the risk factors you may be exposed to that make you more vulnerable.

What is a risk factor?
Scientific studies have shown that certain traits and lifestyle habits increase the risk of a heart attack. These danger signs are called 'risk factors'. The progression of heart disease is a long-term process in which cholesterol and other substances build up in the inner lining of artery walls. They form plaque, which blocks the flow of blood to the heart muscle.

Risk factors tend to speed the development of plaque, and by reducing them, we can block the progression of plaque formation and decrease the chances of having a heart attack.

There are two types of risk factors: those which can be modified and those which cannot.

Blood pressure

• The force or pressure of the blood (pumped from the heart) against the walls of the arteries is known as blood pressure.
• Systolic blood pressure (top or high number) is the pressure inside your arteries when the heart contracts and pumps blood into your arteries.
• Diastolic blood pressure (bottom or low number) is the pressure inside your arteries when the heart is relaxing and filling with blood.
• The medical term for high blood pressure is hypertension. Over time, high blood pressure can damage your blood vessels and lead to serious health problems.
• The common long-term complications of high blood pressure are: heart disease, stroke, eye damage, kidney damage etc.
• Some people get nervous during a visit to their doctor's office and this causes their blood pressure to increase. They are said to have 'white coat hypertension'. This may not be a sustained condition but may lead to hypertension.
• It is a common misconception that your systolic BP should be your age plus 100. This is FALSE. The latest international guidelines for blood pressure are:

NOTE: You are considered to have the risk factor of hypertension, even if your BP is controlled with medications.

Cholesterol

• Cholesterol is a soft, white, fat-like substance made in the liver and found in your body's cells.
• Cholesterol is present in some of the foods we consume, which are of animal origin (eg meat, milk)
• The combination of cholesterol and protein is known as a lipoprotein (lipo or lipid means fat)
• The lipid profile (which your doctor may ask you to get), consists of your total cholesterol, triglycerides, LDL, and HDL.
• LDL is called 'bad' cholesterol because it causes atherosclerotic plaque to build up inside your coronary arteries.
• HDL is called 'good' cholesterol because it helps to remove LDL cholesterol from the walls of your coronary arteries.
• Triglycerides are fatty substances found in the bloodstream. High triglycerides are associated with the build up of blockages inside the coronary arteries.

Given alongside are the values recommended to keep your risk for heart disease to a minimum.

Diabetes

• Diabetes mellitus comes from the Greek word diabetes (to flow through; urine) and the Latin word mellitus (sweetened or honey-like).
• Glucose (sugar) in our blood is carried to all the cells of the body to be used for energy. The hormone insulin, which is produced in the pancreas, is responsible for moving the glucose out of the blood and into the cells. When insulin is insufficient or the body is unable to use it properly the sugar level rises, and this is called diabetes.
• Type 1 Diabetes: Here the pancreas is either completely unable to produce insulin or is able to produce only a tiny amount.
• Type 2 Diabetes: Here, excess glucose builds up in the blood mainly because the cells become resistant to the insulin the body makes. The pancreas still secretes insulin.
• Syndrome X or the insulin resistance syndrome is a new term for a cluster of conditions, that, when occurring together, may indicate a predisposition to diabetes, hypertension and heart disease.
• Diabetes is diagnosed on the basis of your fasting glucose levels. A level of more than 126 mg/dl indicates diabetes. However, this should be confirmed by another test done on a different day.
• You may have Syndrome X if you have three of the five conditions listed alongside.

Smoking

• Smoking is one of the most important preventable causes of premature death. Besides being a risk factor for heart disease and stroke, it also causes several types of cancer.
• A smoker's risk of having a heart attack is more than twice that of a non-smoker. Smoking speeds up the development of plaque in the arteries, reduces the level of the good HDL cholesterol, and increases the stickiness of blood cells causing blood clots inside the arteries.
• Smoking even one cigarette has harmful effects. It raises your blood pressure, makes your heart work harder, increases your risk for blood clots and causes spasms of your coronary arteries.
• Smoking can also trigger heart rhythm problems and may cause palpitations.
• The good news is that no matter how long you have smoked in the past, quitting will dramatically slow down the build up of blockages in your arteries.

Obesity

• Obesity can be defined as an excess of body fat. It has now been shown to be one of the leading causes of preventable deaths.
• Obesity increases one's risk of developing conditions such as high blood pressure, diabetes (type 2), heart disease, stroke, gall bladder disease and cancer of the breast, prostate and colon.
• There are different ways to measure obesity; body mass index (BMI), body fat percentage, waist-hip ratio, and waist circumference. The most widely used clinical measure today is BMI.

Physical inactivity

• Most of us do not get as much activity as we need to maintain good health. Physical activity includes the 'structured exercise' we do as well as activities of daily living called 'lifestyle physical activity'.
• Studies have shown that you can reduce your risk of heart disease by as much as 50 per cent by participating in regular aerobic exercise.
• Think of simple ways to add physical activity in your daily life, such as taking the stairs instead of the elevator, parking your car a little further away from your destination etc.
• Besides preventing heart disease and its risk factors, regular exercise also helps prevent osteoporosis, reduces risk for certain types of cancer, reduces stress, and reduces your risk for stroke.
• Regular physical activity should be encouraged from early childhood onwards.

Age, sex and family history

These are risk factors that you cannot control.

• The risk of heart disease increases with age. Studies have shown that the risk rises sharply for men after the age of 45 and for women after age 55.
• These figures are based on international data. In our country we have observed men at a much younger age also having heart disease.
• Heart disease is not a 'man's disease'; women suffer as well, but generally after menopause.
• Your genes play an important role in your risk for heart disease. If a male in your immediate family has had heart disease before the age of 55 or if a female family member has had heart disease before the age of 65, your risk is increased several fold.
• New studies are also showing that Indians have a higher risk for developing heart disease than those from other countries.

New risk factors

• More research is coming out on other risk factors which may cause heart disease. However, these have not been studied as extensively as the 'established' risk factors.
• The newer risk factors include; homocysteine, lipoprotein (a), C-reactive protein, small LDL particles, and factors which increase thrombosis.
• Homocysteine is a common amino acid (one of the building blocks that make up proteins) found in the blood. High levels of homocysteine are related to the early development of heart disease.
• Lipoprotein (a), is a variant of 'bad' LDL attached to an extra protein particle. Unlike LDL cholesterol, Lp(a) does not appear to promote fatty buildup in the arteries. Instead, its damage may come from preventing the breakup of clots.
• Stress is not yet established as a proven 'independent' risk factor for heart disease. However, more and more evidence suggests a relationship between the risk of cardiovascular disease and environmental and psychosocial factors.
• Acute and chronic stress may affect other risk factors and behaviour, such as high blood pressure and cholesterol levels, smoking, physical inactivity and overeating.