Risk factors for heart disease 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 plaques, which block the flow of blood to the heart muscle. Risk factors tend to speed the development of plaque, and by reducing them, we can stop the progression of plaque growth and thus, 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 doctors office and this causes their blood pressure to increase. They are said to have white coat hypertension. It is a common misconception that the systolic BP should be your age plus 100. This is FALSE. The latest international guidelines for blood pressure are as under: Category Normal Pre-hypertension Hypertension, stage I Hypertension, stage II Systolic BP Less than 120 120-139 140-159 More than 160 And Or Or Or Diastolic BP Less than 80 85-89 90-99 Greater than 100

NOTE: You are considered to have the risk factor of hypertension, even if your BP is controlled with medications.Source: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Cholesterol Cholesterol is a soft, white, fat-like substance made in the liver and found in your body's cells. Cholesterol is present in foods of animal origin. The combination of cholesterol and protein is known as a lipoprotein (lipo or lipid means fat). The lipid profile 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. The following are the values recommended to keep your risk for heart disease to a minimum: 1. Total Cholesterol Less than 200 mg/dl 2. Triglycerides Less than 150 mg/dl 3. HDL Cholesterol More than 40 mg/dl Less than 130 mg/dl (less than 100, if you have heart disease or 4. LDL Cholesterol diabetes). 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 rises, and this is called diabetes. Type 1 Diabetes With Type 1 diabetes, the pancreas is either completely unable to produce insulin or is able to produce only a tiny amount. Type 2 Diabetes With type 2 diabetes, 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 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 3 of the following 5 conditions: Risk Factor Obesity Waist circumference:Men Waist circumference: Women Triglycerides HDL cholesterol Men: Women: Blood pressure Fasting blood sugar Cut-off level More than 35 inches (as per Indian standards) More than 31 inches(as per Indian standards) More than 150 mg/dl Less than 40 mg/dl Less than 50 mg/dl More than or equal to 130 / More than or equal to 85 More than or equal to 110 mg/dl

Smoking Smoking is the 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 smokers risk of having a heart attack is more than twice that of a nonsmoker. Smoking speeds up the development of plaque in the arteries. It 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, and increases your risk for blood clots and cause spasm of your coronary arteries. Smoking can also trigger heart rhythm problems, and cause palpitations. The good news is that no matter how long you have smoked in the past, if you quit you will dramatically slow down the build up of blockages in your arteries. Obesity Obesity can be defined as an excess of body fat. 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 To Calculate Your BMI BMI = weight in kg / (height in meter)2 E.g. If you weigh 70 kg and are 1.7 m tall, your BMI will be 70/2.89 = 24.2 kg/m2 BMI Less than 18.5 18.5-24.9 25-29.9 More than 30 Weight Category Underweight Normal Overweight Obese

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% by participating in regular aerobic exercise. Think of simple ways to add physical activity in your daily life, such as taking the steps 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, which 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 mans 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 years or if a female family member has had heart disease before the age of 65 years, 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. Newer Risk Factors More research is coming out on other risk factors which may cause heart disease. 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 behaviors, such as high blood pressure and cholesterol levels, smoking, physical inactivity and overeating. Exercise Your Heart Exercise has been shown to modify all the risk factors for heart disease in a positive manner and is the most powerful and safe medicine for your heart. The next logical questions are, How much exercise should you do; and what type of exercise? An easy way to remember the recommendations is to think of the FITT principle. F- Is for FREQUENCY of training, which should be 4-6 days a week. I - is for INTENSITY, that is, how hard should you exercise. To obtain maximum cardiovascular benefit, you should exercise between 55-90% of your maximum heart rate. Your maximum heart rate is 220 minus your age. Therefore if you are 25 years old, your maximum heart rate is 195, and you should exercise between 137 and 166 beats per minute, which corresponds to 55 to 90% of your maximum heart rate. The lower end of the heart rate range is for older and de-conditioned people. As your fitness level improves you can start exercising at the higher end of the heart rate range. If you do not want to actually measure your heart rate a simple way of monitoring exercise intensity is the talk test; if you are too breathless to carry on a conversation with someone beside you, then you are probably working too hard and need to slow down. A third method is to use a system called Rating of Perceived Exertion (RPE). Using this, you should exercise at an intensity, which you perceive to be between fairly light and somewhat hard. T is for TIME. The recommended time is 20-60 minutes of continuous or intermittent aerobic activity. New research has shown that you can split up your exercise bouts into three intermittent bouts of minimum ten minutes each and derive the same benefit as one continuous thirty-minute bout. T is for TYPE of exercise. The best type of exercise to develop and maintain cardio-respiratory fitness is aerobic exercise. The term aerobic exercise, simply means using oxygen for energy. It is any exercise, which uses large muscles, such as the arm, legs etc., and can be performed continuously. Examples include brisk walking, jogging, cycling, swimming, rowing, and other similar activities. What about weight training? The other aspect of training is strength, and is best achieved by resistance training, which translates to lifting weights. Contrary to popular belief, you do not need to be young to engage in, and benefit from resistance training. In fact, to the contrary, the greatest benefits may be experienced by post-menopausal women, in whom osteoporosis is a major problem. Resistance training helps by strengthening the bones, and has shown to positively influence quality of life measures, in various studies. Another popular myth is that to benefit from weight lifting, one must do at least three or more sets. For health benefits you should do one set of 8-10 exercises that condition the major muscle groups 2-3 days per week. Multipleset regimens may provide greater benefits if time allows. Most persons should complete 8-12 repetitions of each exercise. Safety Tips Warm-up before exercising. During the first five minutes, exercise at a slower pace. If you get chest discomfort, nausea or giddiness stop exercising and consult your doctor. If you have more than 2 risk factors for heart disease consult your doctor before starting any exercise.

 When exercising in the heart, make sure you drink plenty of water before, during, and after the exercise. Cool-down at the end of exercise. Do not suddenly stop the exercise; gradually slow down over the last 5 minutes.

Coronary Artery Disease (CAD)

There are four conditions associated with coronary artery disease: atherosclerosis, insulin resistance, high homocysteine and angina pectoris. Atherosclerosis - Overview Atherosclerosis is a condition in which cholesterol-rich plaque builds up along the arterial walls. Atherosclerosis is thought to develop when an injury occurs to the endothelial (inside) lining along the artery wall. In response to the injury, white blood cells, along with lipids, begin to accumulate along the inner layer of the artery. The muscle layer of the artery may also grow, forming the basis of a plaque, which many grow large enough to block the artery. If the plaque is disturbed, platelets may begin to accumulate at the site and form a thrombus, or clot. A clot can continue to grow until it completely blocks an artery, cutting off the oxygen supply to a vital organ, or a clot can break free from the vessel wall (become an embolus) and become lodged somewhere else further downstream. This could lead to a heart attack or stroke if the clot completely blocks the blood and oxygen supply to a major artery leading to the heart or brain. Causes and Symptoms Recent studies have shown that children with one or both parents who have had heart disease before age 60 were more likely to have atherosclerosis themselves, and the risk of CAD increases progressively with age. Other risk factors for developing atherosclerotic plaques include high cholesterol, smoking, high blood pressure, diabetes, and the use of birth control pills or estrogen replacement therapy. Suggested Lifestyle Changes Those with atherosclerosis should try to: Get more exercise. This will help maintain the health of the vessels leading to the heart, as well as strengthening the heart muscle itself. Lower your intake of saturated fats, and control cholesterol. Stop smoking. Control your blood pressure.

Nutrition and Supplements Fish oil. The omega-3 fatty acids in fish and fish oil supplements have been shown to be an effective preventive strategy against heart disease. They can lower triglyceride levels, increase HDL cholesterol, help minimize inflammation and blood clotting, and keep blood vessels healthy.

Coenzyme Q10 (CoQ10). This antioxidant is thought to be one of the most important antioxidant supplements for protection against many forms of cardiovascular disease. It helps protect LDL cholesterol from oxidation, maintain healthy blood vessels, protect against clots and plaque rupture, and support optimal functioning of the heart muscle.

Insulin Resistance - Overview Insulin is a hormone that facilitates the transport of glucose from the blood into cells where it is used as fuel. When blood sugar rises after a meal, the pancreas secretes insulin into the bloodstream. With insulin resistance, the normal amount of insulin secreted is not enough to move glucose into the cells - thus the cells are "resistant" to the action of insulin. To compensate, the pancreas secretes even more insulin, and is able to maintain fairly normal blood-sugar movement into cells and a normal blood-sugar level. The resulting high level of insulin, however, has several negative effects elsewhere in the body. It influences the enzymes in the liver that produce cholesterol and acts on the kidney (which can contribute to high blood pressure). High insulin levels also have a role in the process that regulates inflammation. Eventually, blood-sugar levels will continue to rise because the pancreas stops producing enough insulin or the cells become more and more resistant to the insulin that is produced. In time, insulin resistance can lead to Type 2 diabetes, itself a risk factor for heart disease. A simple way to diagnose an insulin resistance problem is to take a blood test that looks for a low HDL cholesterol, along with a high triglyceride level, a high fasting insulin level or a high uric acid level. Causes and Symptoms Insulin resistance is often due to: Genetic factors, such as a family history of diabetes, high blood pressure or heart disease. Excess weight, with the extra pounds accumulating in the abdomen (the classic "apple" shape). However, thin people can also have the problem and be at the same risk for heart disease, high blood pressure and diabetes.

Suggested Lifestyle Changes For those with insulin resistance, try the following: Watch your carbohydrate intake. The classic low-fat, high-carb diet that was the standard recommendation for preventing or treating heart disease for years can actually make insulin resistance worse. Carbohydrates (starches and sugars) raise blood sugar levels and trigger the release of insulin. A moderately low carbohydrate diet (40 to 45 percent of calories) emphasizing low glycemic index sources of carbohydrate (those that raise blood sugar levels slowly rather than quickly) is recommended. In general, foods very rich in fiber are healthy.

Cut saturated fats, but keep healthy fats. Include moderate amounts of monounsaturated fat (30 to 35 percent of calories) rather than following a strict lowfat diet. Eat generous amounts (five or more servings) of non-starchy vegetables and one to two servings of low-glycemic index fruit every day. Lose weight if you are overweight. Even small amounts of weight loss can improve insulin resistance. Exercise. Vigorous aerobic exercise decreases the cells' resistance to insulin. Eat fish frequently. The best are cold-water fish that are high in omega-3 fatty acids, like wild Alaskan salmon and sardines. This type of fat seems to improve cells' response to insulin. Eat small, frequent meals to keep blood sugar levels as stable as possible.

Earlier, it was believed that a person who had just suffered a heart attack should not exercise. Is that correct? One should not venture into any strenuous activity immediately after a heart attack, but should commence activity gradually as per one's cardiologist's advice. There is no harm in practising the simpler yogic techniques like Yogendra Pranayama IV or IX, or meditation or relaxation techniques. But these have to be done only under a yoga teacher's guidance. One can start physical exercise only two months after a heart-attack, and that also only after re-assessing one's cardiac status. How can Yoga asanas help prevent heart disease? Yoga is a holistic approach. Yoga is the science of health, good health is a by-product of yoga, and while they can help no doubt, changes have to be brought about in one's lifestyle to experience well-being and good health. To experience good health, positive changes have to be brought about at the very root, in our Aahar, Vihar, Achar, Vichar i.e. in our dietary habits, in our methods of recreation, our behaviour and our thoughts and attitudes. Disease including heart disease is only a result of our constant abuse and neglect of our body and mind. Does Yoga exercise affect stress levels also? Involuntary functions of the body, like respiration, circulation, digestion are controlled by the autonomic nervous system and the endocrine system. The autonomic nervous system is divided into two: Sympathetic Parasympathetic. When the Sympathetic Nervous System is stimulated, a person's fight response to stress increases. For example, the heart rate, respiratory rate, muscle tone increases. This can happen in the course of our day-to-day living if we are subjected to stress. High sympathetic tone results in, decrease in HDL level, rise in oxidised LDL level, and increase in vascular spasm. These changes can cause accelerated atherosclerosis, plaque formation, and plaque rupture. In addition, it can also increase the platelet stickiness. All of the above can result in more incidences of clot formation. Prolonged stress is known to cause a number of phychosomatic disease like IHD, Hypertension, diabetes etc. The Parasympathetic Nervous System on the other hand works against sympathetic stimulation. Normally, both these systems work continuously and strike a balance depending upon the stress level.

Yoga predominantly stimulates the parasympathetic system and works against stress. Relaxation exercises help to develop the witness attitude (sakshi bhava) and help one, to distance oneself from the causes of stress. The guiding thought behind this is: You can't drown if you are standing outside the water. A spiritual approach, a relaxed approach to life leads to contentment, concentration, confidence, love and care. The self-controlling personality can give rise to anger, hostility, resentment, jealousy, fear, vanity, egoism and criticism. These negative emotions give rise to increased sympathetic tone, leading to biochemical changes like increased secretions of catecholamines and steroids. These hormones increase the irritability of the myocardium and can also lower the threshold of arrhythmias. Also negative emotions are known to bring down the immunity level of a person, leading to an overall deterioration of health. In a study (1976) on relaxation responses by Benson and Klipper in New York it was found that good relaxation was followed by remarkable parasympathetic predominance. This was indicated by decrease in blood pressure, heart rate, and respiratory rate. Also, there was reduction in oxygen consumption and blood lactate levels. The tranquility was indicated by increase in alpha waves in the brain. Thus Yoga practices certainly affect stress levels.