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?
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| Image: Heart-ingalls.org |
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?
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| Image: Pharmacy.about.com |
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?
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| Image: drinks.seriouseats.com |
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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tells lucidly and in simple style. answers many questions one thinks of asking but did nit know whom to ask.
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