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Heart attack prevention: get the target levels for risk factors

Heart disease statistics for India

India is sitting on a ticking bomb of lifestyle diseases, both diabetes and heart diseases, and the trends suggest alarming level of increase in these in coming years !

Studies carried out in India and other places suggest that Asians in general and Indians in particular are at increased risk of heart attack  at a younger age (

CardioVascular Diseases , or ‘heart and vessel’ diseases were the largest cause of mortality, accounting for around one fourth of all deaths in India in 2008.  A more worrying fact is that the incidence has gone up significantly for people between ages 25-69 and is  affecting the productive population of India. The present evidence suggests an average mortality of 4% in the age group of 20-49 years and 6% in those above 50 years due to CVD

Also, among Indians, the risk of heart diseases does not show the difference in occurrence between men and women reported in western countries, where women have lower risk of heart attack for age matched men, instead studies suggest that women may lead in heart diseases in coming years

Indians have a higher risk of heart disease than western populations (CVD) and that too at a younger age!

Controlling risk factors is more helpful than than the treatment of heart disease

The best way for prevention of heart attack is by controlling the risk factors:  such as BP, blood cholesterol and sugar levels, body weight and habits: such as drinking and smoking

This is so because the screening tests for heart disease itself, such as, ECG, Exercise Tolerance Tests, in people who have no symptoms, have failed to decrease the occurrence and/or deaths from heart attack. Not only that, the complications and anxiety created by this tests have made expert agencies such as AHA, ESC etc. issue guidelines that this tests should only be done in individuals who have some symptoms suggestive of heart disease

On the other hand, the early detection and aggressive management of risk factors, has been shown to influence outcomes and now is the area of focus; move over angiography, it is the era of TLC (Therapeutic Lifestyle Changes)!

Target levels of heart disease risk factors

The table below summarises the recommendations regarding target levels  of these risk factors and advice on when to initiate lifestyle modifications or discuss drug therapy with your doctor :

Heart risk factor Consider  drugs if Consider life-style modifications if

Blood pressure

(ideal BP is 120/80 or below)

If  your BP is more than  160 systolic or more than 100 diastolic, you should see your doctor immediately

If BP>140/90, consider drugs straight away if  your CVD risk score is high or very high

If your CVD risk is moderate, try life-style modification for 6 weeks or so, and if BP still >140 systolic or >90 diastolic,  you should be put on drug(s)

If CVD risk is low, give life-style trial 3-6 months and reassess, if BP still >140 systolic or >90 diastolic , you should be put on drug (s)

If systolic >120 or diastolic > 80

Blood sugar

(Ideal fasting BS

Generally speaking: people with type 2 diabetes (Fasting BS=126 or more and/or HbA1c= 6.5 or more), whose HbA1c level at diagnosis in less than 7.5% can be given a trial of lifestyle modification for 3 months, if that fails, drugs should be started

If HbA1c is >7.5 at diagnosis, you will most likely put on drugs or insulin straight away, even at lower HbA1c levels starting drug therapy may be needed, discuss with your doctor

In certain cases, prediabetics (FBS between 100 and 125 and HbA1c between 5.7 and 6.4)  may be put on drugs, for examples

  • If your is BMI>30
  • If there is history of gestational diabetes

 

Prediabetes and diabetes is present

Blood LDL cholesterol

(Ideal LDL level is

You should see your doctor regarding cholesterol lowering drugs, if:

If your blood LDL cholesterol >190 mg/dL or total cholesterol is >300 mg/Dl

IF LDL>130 and CVD risk score is  high or very high

If your LDL> 160 and your CVD risk is low or moderate, you can do an intensive lifestyle modification trial of 3-6 months, if LDL still> 100 you should be put on drug(s)

If you are a diabetic over 40 years of age and LDL cholesterol is more than 70

If LDL cholesterol>100mg/dL

If LDL cholesterol> 70 and your CVD risk score is high or very high

Blood HDL cholesterol

(Ideal HDL level for men is >40 mg/DL and for women> 50 is ideal)

Usually life-style modification and drugs for LDL cholesterol take care of HDL levels If HDL

Blood TG (Triglycerides)

(Ideal TG level  is

You should see your doctor immediately if TG> 500 mg/dL, otherwise lifestyle trial can be undertaken for 3-6 months if TG is >150 mg/dL If TG> 150 mg/dL

BMI and 

Waist Circumference

Anti-obesity drugs aid in weight loss when combined with lifestyle modifications

If BMI> 27, discuss with your doctor

If BMI> 25 and CVD risk moderate or higher, discuss with your doctor

If WC is >90 cm in women or >100 cm in men

BMI> 22.9 or

WC :>80 cm in women or >90 cm in men

Drug for prevention:

Aspirin

If you a diabetic over 40 years of age and have any other positive risk factor such as hgh BP or smoking, discuss use of aspirin with your doctor

If you are a man of >45 years or women of > 55 years with CVD risk high or very high, discuss aspirin use with your doctor

Smoking

Quit smoking as soon as possible !

Take a questionnaire based assessment to find out if you have  nicotine dependence, if so, you made need to consider drugs for smoking cessation, follow the link below:

http://ww2.health.wa.gov.au/~/media/Files/Corporate/general documents/Tobacco/PDF/Fagerstrom_test.ashx

 

HWI Heart attack risk calculator for Indians

 

 

 

 

 

 

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