Friday June 24 2005 14:22 IST
Dr Uday Khanolkar
Over one million people suffer serious heart attacks every year in our country. Studies show that Indians are more prone, both by genetic disposition and dietary habits, to problems of the heart. As if in confirmation, more and more Indians are becoming victims of Cardio Vascular diseases (CVD) and worse, the average age of the victims is getting younger. Estimates show that in India, 1990 saw 2.4 million deaths due to CVD or heart attacks. By 2015, the World Health Organisation (WHO) estimates that heart attack will be the single largest ‘killer’ in India.
In metros, 10 percent of the population is above 35 years and has heart problems. There are at least 50 million people in India suffering from heart problems. This number will double in the next six years, as heart problems are expected to rise by 103 percent in men and 90 percent in women. At this rate, by 2020, India will have the largest CVD burden in the world and it would account for one-third of all deaths. Unfortunately, many of these will be young victims.
Prevention is better than cure, and it therefore becomes necessary to wipe out the myths associated with heart disease and explain the facts.
Heart disease is an old person’s problem.
Heart disease comes in many forms such as an irregular heartbeat, problem valve, or coronary artery disease. Symptoms vary but people of any age can be affected. The American Heart Association (AHA) now recommends a “risk factor screening” including blood pressure, body mass index, waist circumference and pulse recorded at least every two years and cholesterol profile and glucose testing at least every five years starting from age 20. In addition, the AHA recommends a “global risk estimation” combining information from all existing risk factors to determine a person’s percentage risk for developing cardiovascular disease in the next 10 years. Multiple areas of slight risk can be more important than one area of very high risk. This estimation is recommended every five years for people aged 40 or older, or for anyone with two or more risk factors.
Women have an innate protection against heart attacks.
As a rule, women have higher HDL (“good cholesterol”) levels than men. The female sex hormone, estrogen, tends to raise HDL, which may help explain why premenopausal women are usually protected from developing heart disease. Estrogen production is highest during the childbearing years. However, while it is true that women aged 20 and over tend to have lower cholesterol levels than men of the same age, things change as they approach menopause. Then, LDL (“bad cholesterol”) and total cholesterol levels in most women start to rise. Loss of estrogen appears to be a significant contributor to the risk of cardiovascular disease after menopause.
If a heart attack does not kill you, you are safe.
More men have heart attacks than women, and have them earlier in life. But women have lower chances of surviving them. Studies show that 44 per cent of women die within a year compared to 27 per cent of men. During the first six years following a heart attack, the rate of having a second attack is 31 per cent for women compared to 23 per cent for men.
To get cardiac benefit from exercise, you need to get sweaty and out of breath.
Many sedentary individuals (and, indeed, many exercisers!) share the myth that you have to exercise at a fairly intense level to achieve cardiac benefits. Without question, this advice is excellent if your only goal is improving your aerobic capacity. However, if your goal is lowering your risk of heart disease, different rules apply. You simply need to become more active. Accumulating 30 minutes of moderate physical activity on most, if not all, days should be a solid goal. Don’t let the myth that you have to sweat like crazy for 30 minutes straight to keep you and your heart declining….uh, reclining on the couch.
If you have chest pain, the best thing you can do is wait and see whether it goes away.
Ignoring the symptoms of acute heart disease is a bad idea. The longer the delay before treatment of a heart attack begins, the greater the potential heart damage.
Having a heart attack means there is a greater risk of having another.
Not necessarily. About 30 per cent of all patients who survive a heart attack fall into a lower risk category and are unlikely to suffer another heart attack. Ideally, each person should be assessed individually and many positive steps can be taken to avoid further heart trouble.
A heart attack will change my whole life. I will never be back to normal.
Wrong! The heart can recover quickly. Heart attack victims do not have to become “cardiac cripples” and with the right lifestyle modifications, they can enjoy a better quality of life than before the attack.
A heart attack will have a really negative effect on my sex life.
Wrong again! The average amount of energy expended during sex is equivalent to walking up a flight of stairs and sexual intercourse, contrary to popular belief, is a rare cause of sudden death.
In my youth I always exercised regularly, and this will protect me.
Absolutely not! Even professional sportspersons have suffered from heart disease, thanks to a sedentary lifestyle later on their lives. Exercise is like a current account, and you cannot hope to bank on what you deposited years ago. You need to exercise sensibly and regularly, at least three times a week for 20-30 minutes. The exercise should make you breathe harder, while still being able to talk. There is convincing evidence that regular, sensible exercise training can reduce the risk of dying from heart disease, even after a heart attack.
Heart disease runs in my family, so there is little I can do to avoid heart problems.
Not necessarily so! It may be the bad habits that are the culprits. They may have been followed for many years within a family.
I will know when my heart condition gets worse - I will have chest pains.
This is not necessarily the case. Studies have shown that up to 10 per cent of all middle-aged men can suffer from a condition called silent ischaemia. This means that your heart is not getting enough oxygen, but you are not aware of it. So it is best to keep in touch with your doctor, and to keep a check on your cardiac health.
Worries about heart diseases are over after undergoing a heart surgery (angioplasty or coronary artery bypass surgery).
Definitely not true! If you follow the same bad habits that originally allowed you to develop heart disease, then you may damage the heart again.
The author is a cardiologist and Director, Cardiovascular and the Sciences, at the Apollo Hospital, Margao
Xeno Muller, Olympic gold and silver medalist, indoor rowing, rowing technique.
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