Though all of us are aware that health is wealth, we tend to indulge ourselves to feed our appetite for a luxurious lifestyle at the cost of our well-being. Invariably, for most, following questions would linger in mind sooner or later.
Will I get diseases like high levels of Blood pressure (BP), Cholesterol, diabetes etc.?
Are heart ailments hereditary?
How can I prevent heart diseases?
Is it true that one cannot stop the medicines for BP etc. even after the levels are fine?
Are there any side effects if there is prolonged use of drugs?
Is there any non-invasive treatment as an alternative to angioplasty or bypass surgery?
Should I stick to vegetarian diet?
How much alcohol I can take?
We read varied responses to such questions in books and in the media. Most of us have formed our own opinions on the above. However, it would be interesting and insightful if we get a response from an expert for the above questions.
Meet here Dr Somalaram Venkatesh MD, DM, Interventional Cardiologist who is also the head of Cardiac Cath Lab at Fortis Hospitals, Bangalore. He is an alumnus of the prestigious Post Graduate Institute (PGIMER), Chandigarh, India. He has been a topper and gold medallist for his post graduate examinations. He has worked as consultant and unit chief in various hospitals including Kasturba Medical College, Mangalore and performed more than 10000 primary and complex coronary angioplasties and procedures.
Cyber Diary had a very fruitful interaction with Dr. Venkatesh, who is not only an exceptionally skilled Interventional Cardiologist but also a very pleasant, gentle, articulate and creative person.
Please see below some of the important information and opinions he shared.
Are Indians more prone to heart ailments compared to people from other countries, especially those from the west?
One can divide heart diseases into two broad categories: First is the Coronary heart disease: i.e., the disease of the coronary arteries. This is due to the deposition of cholesterol within the wall of the arteries of the heart which in turn can lead to heart attacks etc. The second category includes congenital diseases (eg. hole in the heart, blue baby etc), valvular heart disease and diseases of the electrical system of the heart. These are largely independent of ethnic factors though environmental factors, access to appropriate healthcare etc. can aggravate the condition.
There are several studies on the link between Coronary heart disease (CHD) and ethnic background of people across the world. Studies have been conducted in India and elsewhere on the people of Indian origin to examine this. Despite accounting for dietary and other cultural differences, it was found that people from the Indian subcontinent are more prone to CHD and there are reports of high incidence. In fact, statistics indicate that Indians have about four times higher tendency than Caucasian, six to seven times higher tendency than the Chinese and twenty times higher tendency than Japanese to develop CHD.
In South Asians, the disease tends to appear a decade earlier than Caucasians, more often multiple blocks are found. Heart attacks occur in younger age and the likelihood of South Asians dying of a heart attack is nearly twice that of a comparable Caucasian patient. And another disturbing fact: South Asians tend to respond poorly to bypass surgery than the white counterparts!
There is an underlying genetic tendency for Indians to develop pre-diabetes and diabetes as compared to other ethnic groups. A significant part of risk of developing CHD is related to this factor.
Am I at risk if I have a family history of cardiac problems?
India is currently riding on the upsurge of an epidemic of diabetes and CHD. While popular notion is that these diseases are lifestyle related, one cannot reject the possibility of an underlying genetic predisposition. One can't quantify the contribution of individual factors but an incisive analysis can throw following insights:
a. Exposure to and unrestricted emulation of 'western' lifestyle has triggered CHD. Similar lifestyles in western and now Indian populations have led to a far higher prevalence of CHD in India than western countries, so obviously there is an underlying genetic susceptibility.
b. We have been carrying the purported genetic risk since our civilization existed. Why should the CHD epidemic explode now? The economic boom starting 1990s and the consequent lifestyle changes seem to have brought in high prevalence of CHD in our society.
Hence, both lifestyle and heredity seem to play important and complementary role in the surge in CHD cases.
Should I become a vegetarian to save my heart?
There is no doubt that a vegetarian diet is healthier. Meat consumption has skyrocketed in the recent years. Per se there is nothing to say that meat consumption is harmful if certain precautions are taken:
a. Avoid excess of red meat. Lean portions of red meat, white meat such as poultry (without skin and avoiding leg pieces) and fish can be taken moderately.
b. Healthy cooking practices. Most people know about using less oil and the right type.
c. Avoid excess carbohydrates: since we are prone to developing abdominal obesity and diabetes - both of which can bring on CHD, curtailing carbs may be an important key.
d. Physical activity – this is the most important lifestyle change if one wishes to have a few dietetic liberties
Is it true that once on a tablet for hypertension, it is for life and should not be stopped?
This is a popular but incorrect notion.
If a patient has high BP, that will remain for the rest of his life. This is applicable for most patients. If such patients start taking BP medications, BP will come under control. If the patient stops the medication, BP will come back again. This is misinterpreted as patient becoming 'habituated' to BP medicine. It's almost like saying that a man has become habituated to food because if he stops food his hunger comes back!
A small percentage of patients however, have BP which is either due to bad lifestyle or due to an underlying medical disorder such as hormonal problem or kidney disease. Some of these patients could keep their BP permanently under control by taking care of the lifestyle issues or if the concerned medical disorder is treated properly. Such patients can definitely stop taking medicines. However, once the BP medicine is stopped, lifestyle management should continue and also BP should be regularly monitored.
What are the side effects of prolonged use of drugs for high BP?
Most BP medicines today have no long term side effects or cumulative toxicity and are safe for prolonged use. Side effects, if any, will come to light soon after starting the medicines in most cases. If one medicine does not suit a patient, it could be stopped and a different medicine started. It is rare for a patient to have side effects for more than one or two drugs. Usually a good solution can be found among the thirty-odd choices from anti-hypertensive drugs
Is continued use of statins for high cholesterol levels harmless? Statins have been linked to decreased heart muscle function and increased risk of stroke, along with other serious side effects. What is your view?
This is a very important question.
Over decades now statins have been shown to reduce risk of heart attacks and strokes in patients with and without heart disease and in patients with and without risk factors. Perhaps no other group of medicines have been shown to have such a preventive effect across different types of patient profiles.
As most drugs, statins too have side effects. Notable ones are injury to liver and muscle. People who known to have liver and muscle side effects are not prescribed statins.
There are some other adverse effects attributed to long term statin use. Prominent among them are neurological changes especially memory loss, increased stroke risk and of late a concern about diabetes onset in patients on statins. It has not been proven conclusively that the statins exert the memory loss or increased strokes, so I personally think these are non-issues. The real concern is the new-onset diabetes in patients who are not having diabetes when put on statins. As we know diabetes is a serious problem that can potentially have multiple effects on heart, brain, kidney etc.
Experts however argue that the protection offered by statins is far greater than the risk of new-onset diabetes. For example, if a thousand patients are put on long term statins, about 35 to 40 persons will be protected against heart attacks and strokes whereas only 5 to 6 persons may develop diabetes. At the same time, scientifically it is not possible to know whether the patients who develop are the ones who are also protected. This is still a question that is being discussed and researched. At the level of practitioners, the consensus is that statin therapy is beneficial across groups and should be continued despite these few concerns.
There are many advertisements from practitioners of allopathic and non-allopathic streams about non-invasive techniques as alternatives for angioplasty and bypass surgeries. Is it safe to depend on such treatments?
Suffice it to say that there is no credible alternative therapy to standard treatment of coronary heart disease. Scientifically determined treatment includes medicines or angioplasty or bypass surgery or combinations thereof. Practitioners of alternative medical systems such chelation, magnetic therapy etc are totally unscientific and some of them can be said to be indulging in fraudulent therapy. The temptation to avoid surgery is dangerous because lifesaving surgery is delayed or refused when patients believe in alternative treatment systems.
Some practitioners of allopathic medicines also promise that, with their treatment, surgery can be totally avoided. While a number of patients of CHD can be treated with medicines and without surgery, to dogmatically deny surgery to EVERY patient is risking some lives and is wrong
What are your tips for the people below 35 to prevent any lifestyle related heart disorders? What are your suggestions to the parents of teenage children on the lifestyle formation for them?
Even the hearts of young children have been shown to have cholesterol deposits. In India, we know that young people are affected with heart attacks and some are dying prematurely. So, young people should not think that they are not susceptible for heart attacks.
Sensible eating, regular physical activities/exercise, avoiding tobacco use of all types, avoiding excess alcohol drinking, maintaining ideal body weight are some of the things that young individuals can practice.
There is a tendency to cook separate food for the adults and patients in the house. They feed unhealthy food (fatty food or food cooked with excess butter, ghee, or oil) with impunity to the young ones in the family with the thought that they are kids and are not at risk.
Historically, we see that as the physical activity is getting more and more limited, the incidence of heart disease is going up. The current generation of children have the least physical exercise of all times in history. In addition if they also take unhealthy food, which unfortunately is available in abundance now, the chances that they will develop heart disease at even younger age than what we see today. Parents of today's children should inculcate good healthy habits right from the childhood.
What are your suggestions to those who are already on drugs for hypertension or high cholesterol levels for many years?
They should undergo periodic medical checks to monitor BP and cholesterol levels. Doctors need to monitor the results for side effects of drugs, complications of consistently higher levels of BP or cholesterol on other organs such as kidney and to monitor for development of new diseases like diabetes, heart disease etc.
How much alcohol is good or bad for a person?
Western studies have shown that 21 units of alcohol per week for men and 14 units per week for women is safe as far as the heart is concerned.
Units can be calculated by formula:
Units= Quantity (ml) X alcohol percentage by volume divided by 1000.
Eg. If someone has 3 large drinks of whiskey of 45% ABV (alcohol by volume) then the units are calulated as follows:
units = 180 X 45 divided by 1000 = 8.1 units.
We do not have similar studies in Indians but given that build and body weight of Indians are less than that of caucasians, a lesser quantity should be recommended.
I must caution that if a patient has alcohol related liver damage (cirrhosis) or heart muscle weakness (alcoholic cardiomyopathy), even a single drop should be avoided.
Dr Venkatesh is currently at Fortis Hospitals, Bangalore (+91 80 66214444). He can also be contacted through his e-Mail: drvenkateshs (gmail). He writes occasionally in his blog.
Views are personal © Sibichen K Mathew
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