Uncategorized · December 4, 2020

Healthy heart- the core of a healthy life style

Dr. Rajeev Sharma

MBBS (PGI, Rohtak), PGDBA, MPA ( LKYSPP, Singapore), MD( Acu)

Practices and promotes healthy living 

All of us want to adhere to a healthy lifestyle, but what exactly does a healthy lifestyle mean? Does it mean that we have a luxurious lifestyle or a lifestyle where you feel happy? To most of us, all this means a good lifestyle or a desirable living, but it may or may not be healthy.

A healthy lifestyle is simply living healthy, free from diseases. Therefore a healthy lifestyle is one that keeps an individual in pink of health; it helps maintain our blood pressure and blood sugar levels within the normal range, ideal body weight and body mass, keeps vitals within prescribed limits and shapes an active body and healthy mind. But is a healthy lifestyle enough to keep one healthy? – Good health demands more than a healthy lifestyle however a healthy lifestyle is quintessential for good health.

The genetic constitution inherited by us from our parents sets the range of our health but it is our lifestyle that helps shape reasonable limits to a healthy and happy life. The primary function of the heart is to pump blood to every nook and corner of the body. The blood carries nutrition and oxygen along with it. The heart keeps pumping blood continuously 24×7 for our entire span of life and therefore without any doubt is the core of our health. It will not be incorrect to infer that the heart is the most vital organ for leading a healthy life. The health of our heart is what actually decides the quality of life we live and enjoy.

 

One of the leading causes of hospitalization, morbidity, and mortality worldwide is heart failure from heart disease. Heart disease is a generic term used for conditions affecting the heart such as ischemia, myocardial dysfunctions, valve malformations and malfunctions, coronary artery diseases, dysfunctions, myopathies, infections, and congenital malformations, etc.  Since there is no specific definition or symptom of heart disease, it is not well standardized. Studies correlating heart disease with other risk variables are complicated because heart disease is not well standardized unlike the definition of conditions like diabetes, hyperlipidemia, or hypercholesterolemia. Before we understand the risk associations of heart diseases and the impact of healthy lifestyles on the health of our heart, we should attempt to understand the various terms and whether heart disease, cardiovascular disease, and coronary heart or artery disease, all these terms mean the same. Coronaries are the arteries supplying blood to the heart itself and the disease affecting them is termed coronary artery disease. The bulk of the heart comprises of muscular tissue known as the myocardium and the disease of the heart tissue is called myocarditis. The diseases affecting both the heart and the blood vessels are called cardiovascular diseases, which includes coronary artery or heart diseases, vasculitis, atherosclerosis, and diseases of the heart tissue itself.

 It, therefore, becomes imperative for us to understand what a healthy heart means, what are the indicators that help us define and monitor a healthy heart. In the year 2005, Michigan State University carried out a study on the prevalence of healthy lifestyle indicators in American adults and also attempted to identify and establish a single indicator of a healthy lifestyle. The study however could not establish a single indicator of a healthy lifestyle but concluded that a combination of four modifiable healthy lifestyle characteristics (HLCs) make a healthy lifestyle index (range, 0-4)-

  1. a) Not smoking- smoking adversely affects the lungs and the cardiovascular system
  2. b) Ideal weight- having body mass index (weight in kilograms divided by the square of height in meters] in the range between 18.5 and 25 kg/m2
  3. c) Diet- it is recommended that an individual consumes 5 or more fruits and vegetables per day or its regional and cultural equivalents. Dietary constituents, their quantity, and quality determine an individual’s blood sugar and cholesterol levels, besides other parameters. Both blood sugar and blood cholesterol levels have a strong correlation with heart disease.
  4. d) Regular physical activity- for ≥30 minutes  ≥5 times per week.

All the above four indicators are closely interrelated and affect each other. Let us examine each of these four indicators one by one

Smoking:

Smoking, either active or passive/environmental, is a risk factor for coronary heart disease. It causes the formation of plaques on the inside of arterial walls which is referred to as atherosclerosis (Athero=porridge and Sclerosis=hardening). Atherosclerosis reduces the lumen of blood vessels and hence decreasing the volume of blood flowing through the arteries. When in contact with plaque, blood cells can form thrombus which are clots of blood and may get released into the bloodstream traveling further to clog/ obstruct the narrowed blood vessels leading to a significant decrease in blood flowing through these vessels and eventually resulting in cell death (ischemia/infarction). Polycyclic aromatic hydrocarbons which are present in the smoke also cause atherosclerosis and accelerate its development. Both active and passive or environmental smoking adversely affects platelet function which plays a pivotal role in blood coagulation. (As we all know deranged platelet function notoriously causes deaths in dengue hemorrhagic fever). It also damages arterial endothelium in a way that increases the risk of heart disease. Smoking also adversely affects the body’s ability to deliver and utilize oxygen. Therefore longer-term exposure to smoke builds-up plaque and also adversely affects blood cholesterol. A. J Wells has reported in the Journal of the American College of Cardiology that even passive smoking ( that is when you are not smoking, but inhaling the smoke as someone else near you is smoking) increases the coronary death rates in non-smokers by 20% to 70%.

Studies reveal that quitting smoking after a heart attack or cardiac surgery can decrease that person’s risk of death by at least one third. Quitting smoking after serious heart disease has been found to have reduced mortality risk to the extent of one third which is comparable or even better than results obtained by other interventions like cholesterol-lowering medications since increased cholesterol level is an established risk for coronary heart disease. Critchley and  Capewell have further found that this risk reduction associated with quitting smoking is seen across different cultures, genders, and age groups. It has been consistent regardless of differences in age, sex, country, and time period.

Cholesterol

Cholesterol is a type of lipid (fat). It is the primary sterol (modified steroid) synthesized by all animals including humans, especially in the liver. An adult weighing 68-70 kilograms synthesizes about 1 gram of cholesterol every day which is secreted in the bile juice and about half of it is reabsorbed in the small intestines. It is used by the body in synthesizing steroid hormones, bile acid, and Vitamin D in our body. Cholesterol is an important component of our cell membranes (constitutes about 30% of the cell membrane) and helps in the proper functioning of the cell membranes and hence keeping the cells healthy. Cholesterol is not water-soluble and therefore it is carried in the blood conjugated with proteins to form lipoproteins. There are two forms of lipoproteins that carry cholesterol in the blood- these are the Low-Density Lipoproteins (LDL), the bad cholesterol, and High-Density Lipoproteins (HDL), the good cholesterol in general parlance. The Association of low-density lipoprotein (LDL) with an increased incidence of coronary heart disease is well documented therefore lipid-lowering therapies primarily target lowering the LDL levels. HDLs are known to prevent the heart from coronary heart disease. The benefits of lowering plasma LDL-C levels for the primary and secondary prevention of coronary heart disease have been established. However blood LDL levels are not the only factors contributing to coronary heart disease, other lipid parameters such as non–high-density lipoprotein cholesterol (non-HDL-C) levels, triglyceride (TG) levels, and the total cholesterol (TC)/HDL-C are still associated with increased coronary heart disease (CHD) risk. Triglycerides are the main constituents of body fat in humans and form Very low-density lipoprotein (VLDL) which plays an important part in fat metabolism. 

Normal range of cholesterol and triglycerides in our body is shown below:

Total Cholestrol< 120- 170 mg/dl
Non- HDL< 120 mg/dl
LDL< 100 mg/dl
HDL> 45 mg/dl
Normal triglyceride level150 mg/dl

Plants do not make cholesterol but synthesize phytosterols which resemble chemically cholesterol. In a study carried out by Devraj et al in 2004, it was observed that foods containing plant stanols and stanol esters (sterols) may reduce the risk of coronary heart disease. Due to their structural similarity, they compete with cholesterol for intestinal absorption thus lowering blood cholesterol levels. Consumption of sterol esters reduces plasma total cholesterol and LDL-C levels.

Arsenault et al. have reported in the Journal of the American College of Cardiology that among individuals with low LDL levels i.e <100 mg/dl, the chances of future coronary artery disease is reduced in cases of individuals recording non- HDL-C < 130 mg/dl, TG< 150mg/dl and TC/HDL-C ratio< 5.

 

 

Adults above 40 years of age should get their lipid profiles checked annually.

 

 

Diabetes:

Diabetes is a systemic disease that affects all organ systems of the body because blood circulates through the entire body and causes glycation of tissues to which excess glucose in the blood attaches.

Diabetes, whether it is insulin-dependent or non-insulin-dependent, possesses an excess risk of heart disease, atherosclerosis, and high blood pressure. Heart disease appears early in the life of people suffering from diabetes than those with normal blood sugar levels (125mg/dl). People with diabetes also have reported a higher incidence of deranged lipid profiles (low HDL, high triglycerides (fat), and LDL) and hypertension. Similarly, a silent heart attack (myocardial ischemia or infarction) with no manifest symptoms and signs is more common in diabetics.

The Rancho Bernardo Study has revealed that diabetes mellitus is a stronger risk factor for fatal ischemic heart disease in women than in men. Diabetic women are at greater risk of heart disease, this could probably be attributed to the loss of preventive lipid profile in diabetic women which normally prevents them from heart disease. Altered lipid profile is a feature of diabetes mellitus and it predisposes diabetic patients to cardiovascular complications, especially coronary heart disease. Diabetic women are at a greater relative risk of coronary heart disease than men. As the adverse changes induced by diabetes mellitus in some cardiovascular risk factors, such as HDL-C, TRIG, LDL-C particle size, and blood pressure have been found to be more pronounced in women than in men. In various studies, a significantly higher level of total cholesterol and LDL-C and a lower HDL-C level was observed in female diabetics when compared with their male counterparts.

Diabetics are at greater risk of death post-infarction; they also have reported poorer prognosis as compared to the non-diabetics. Diabetes is known to accelerate the risk of coronary heart disease. A study conducted by the Pittsburgh Epidemiology of Diabetes complications reveals a link between insulin-dependent diabetes and fatal cardiovascular disease

Blood Pressure:

Higher blood pressure (hypertension) is the most prevalent cardiovascular disease and is one of the most powerful contributors to cardiovascular morbidity and mortality. Cardiovascular disease is the most prominent cause of premature death across countries. Incidentally, high blood pressure is one of the most important modifiable risk factors.

Modern lifestyle diseases like obesity, hyperlipidemia, diabetes, and smoking pose a considerable challenge to public health and are important causes of morbidity and mortality. These risk factors have been also reported to be higher among patients with higher blood pressure as compared to those with normal blood pressure. Studies have revealed deranged levels of serum triglyceride, blood glucose, and HDL levels in hypertensive persons.

Today with a better understanding of lifestyle diseases and related risk factors, medical experts have realized that the risk factors are associated with metabolic functions of our body and hence they have put together these group of associated risk factors such as insulin resistance, dyslipidemia, abdominal obesity, and high blood pressure under the head Metabolic Syndrome. The syndrome is associated with an increased risk of cardiovascular disease and type 2 diabetes mellitus.

Further in a study JD Neaton et al have observed that serum cholesterol levels above 180 mg/dL, systolic BP above 110 mm Hg, and diastolic BP above 70 mm Hg are associated with mortality due to coronary heart disease. Similarly, smokers men with high levels of serum cholesterol and systolic BP levels had 20 times greater death rates than nonsmoker men with normal systolic BP and cholesterol levels. In fact, systolic and diastolic BP, serum cholesterol level, and cigarettes smoked per day were significant predictors of death due to coronary heart disease in all age groups.

Exercise and Fatigue:

An article in the American Heart Journal authored by MD Richard Stein et al has recorded that exercise training has been associated with a decrease in total cholesterol and an increase in protective high-density lipoprotein (HDL) cholesterol and aerobic exercise training has a favorable effect on plasma lipoprotein profiles.

Another article published by Vente et al in the British Medical Journal reported higher resting heart rate and elevated cortisol (stress-fighting hormone) levels during the first hour after awakening in burnout/ stressed patients than healthy controls.

It has not been ascertained with certainty as to how much exercise is essential for positive health benefits and the actual amount of exercise required for preventing lifestyle diseases. However, those who ran 7 to 14 miles per week at mild to moderate intensity showed statistically significant improvements in levels of HDL (Good) cholesterol as compared to those who did not exercise.

Poor Oral Hygiene:

For most of us, it will be surprising to know how oral hygiene is related to heart disease even though there is no connection between the digestive system of which our mouth is a part and the circulatory system to which our heart belongs. Studies have shown an association between poor oral health and coronary heart disease. A study conducted by the Harvard Medical School has demonstrated that loss of a tooth may be associated with increased risk of coronary heart disease, primarily among those with preexisting periodontal disease.

Poor oral hygiene indicated by decay, tooth loss, or foul smell,  depending on its extent and severity can cause odontogenic bacteremia and also infective endocarditis (involves the inner layer of the heart muscle). Scientific evidence exists of association among periodontal infections, atherosclerosis, and vascular disease. Bacteria such as H. pylori and C. pneumonia and cytomegalovirus which cause infections in the human body are known to be associated with coronary heart disease. However, this causal link cannot be established beyond doubt because many confounding variables like smoking, alcohol intake, diabetes, generalized systemic inflammation due to oral infections may be also independently associated with coronary heart disease. 

Conclusion:

Persons who adopt and practice healthy lifestyles likely have reduced rates of cardiovascular events. Healthy lifestyle behaviors such as not smoking, maintaining optimum body weight, regular physical activity, and a healthy diet can improve cardiovascular health in the general population.

Hence it should be safe to conclude that a favorable lifestyle (defined as at least three of the four healthy lifestyle factors) is associated with a substantially lower risk of coronary events than an unfavorable lifestyle.

At a Glance

What is heart failure ?

it is a progressive condition where the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen.

 

When to undergo a periodic check up-

If diabetic or suffering from high blood pressure or other co-morbid conditions.

Safe practice-

Eat healthy food

Exercise regularly ( avoid heavy exercises)

Keep body weight in check

Take medicines on time as prescribed by your doctor.

Consult a doctor if you experience –

Breathlessness while bending forward

Swelling around the feet

Excessive tiredness and fatigue

Loss of appetite

Increased frequency of urination

Irregularity in heartbeats.

This information is for general guidance and reflects the opinions and experience of the author. It is not intended to replace specialist consultation or provide treatment advice for specific cases.