Lifestyle choices such as poor diet, lack of exercise, smoking and excessive drinking are lifestyle paths to heart disease. Switching over to good lifestyle habits helps the heart.
Our heart is not just a pumping machine – it’s a living organ consisting of millions of organized cells functioning to deliver blood to the organs of the body. The blood carries oxygen and nutrients necessary for the optimal functioning of the body including the heart itself. The heart beats around 70 times per minute on an average, pumping about 2,000 gallons of blood per day.
Heart diseases, medically termed as cardiovascular diseases
, encompasses various conditions affecting the heart muscle, arteries, valves, lining or electrical system. The more common types of heart disease associated with lifestyle choices are:
- Coronary heart disease – Equated with coronary artery disease (CAD), it refers to the tendency to form plaque in the arteries (atherosclerosis). CAD can cause chest pressure and shortness of breath resulting in pain (Angina). This is the leading cause of myocardial infarction, simply known as, ‘heart attack’.
- Dilated cardiomyopathy – It is a disease where the heart muscle becomes weak and the heart chambers dilate releasing more blood with each beat. Excessive alcohol intake and high blood pressure contribute significantly to this disease.
- Myocardial ischemia – In this disease, the blood supply to the muscular wall of the heart decreases, causing the heart muscles to function improperly due to low oxygen levels. Angina is a symptom of myocardial ischemia. A Danish study found that high blood pressure, BMI of more than 27, diabetes and smoking were the potential risk factors for this disease.
- Hypertensive heart disease – Hypertensive heart disease occurs because of high blood pressure. The heart has to work harder to pump against the increased pressure in blood vessels. This causes the muscle to thicken and may lead to angina, arrhythmia, heart attack, stroke or sudden death.
- Cardiac arrhythmia – Arrhythmia is the result of malfunction or disruption in the timing of heart beats. The heart beats either too quickly, or too slowly, or irregularly. According to the American Heart Association about 780,000 people seek medical attention each year for cardiac arrhythmia.
Do women get heart disease? Of course they do. Both, men and women are affected by heart disease. Men, however, tend to develop the disease earlier than women. This may be due to the protective effect of estrogen abundantly present in women. But the fact remains that heart disease is the number one killer worldwide
for women. A report from the 2010 World Congress of Cardiology in Beijing reveals that heart disease kills more women than cancers, AIDS, tuberculosis and malaria put together, and eighty percent of heart disease deaths in women
occur in developing countries.
You may wonder what connection getting heart disease has with your lifestyle. An important INTERHEART study conducted in 52 countries identified nine high risk factors for heart disease, especially heart attack
. These risk factors include smoking, cholesterol, high blood pressure, diabetes, obesity
, diet, physical activity, alcohol consumption and psychosocial factors. Needless to say, all of these risk factors are associated with lifestyle choices. They found that 95 percent of heart disease is completely preventable through lifestyle changes.
Not only is heart disease preventable through lifestyle changes but it can also be reversed. A randomized, controlled trial from California suggests that comprehensive lifestyle changes
may be able to reverse coronary heart disease after only one year without the use of lipid-lowering drugs.
Lifestyle changes such as changing over to good diet, abstinence from smoking, and exercising is definitely worth the effort especially in comparison to having a by-pass surgery.
Oxidative Stress – Precursor to Heart
We’ll get to know why switching to good lifestyle
habits are important to prevent heart disease if we know the underlying
Scientists are now very clear that
reactive oxygen species (ROS),
that include free
radicals and peroxides, are involved in heart disease. These free
radicals are by-products of many biochemical and physiological processes
in our body. They interact with other molecules and cause oxidative
damage to cells.
“Oxidative stress” is a term for
imbalance between the production of free radicals and the body’s ability
to detoxify these radicals or repair the resulting damage by producing
anti-oxidants. In other words, oxidative stress results when there is an
overload of free radicals in the body and not enough anti-oxidants to
counter them. These free radicals oxidize low density lipoproteins (LDL)
which then damage the walls of the artery. Oxidative stress is one of
the factors responsible for the development of atherosclerosis
and other heart disease
shown that enzymes containing essential minerals viz. selenium, copper,
manganese and zinc fight free radicals thus decreasing their
concentration. So, if our diet cannot supply these minerals adequately,
enzymatic defenses against free radicals may be impaired and overload of
free radical occurs.
Oxidation of LDL cholesterol
is believed to occur at the initial stages of atherosclerosis. Vitamin
E, the principal anti-oxidant in the body, has been shown to inhibit
this oxidation. Similarly, studies show that Vitamin E intake lowers
risk of angina and other heart disease.
The role of
oxidative stress and consequent expression of oxidative damage has been
demonstrated in many research studies. It may be interesting to note
that although a number of studies have validated the protective role of
anti-oxidants, clinical trials have failed to prove the efficacy of
anti-oxidants in the treatment of cardiovascular disease.
Unfortunately, there is no test available to measure
the level of oxidative stress in our body, but lifestyle choices –
being overweight, diet poor in nutrition, smoking, physical inactivity,
pollution and modern day stress – raise the risk of oxidative stress.
Obesity and Heart Disease
nothing but too much body fat, and this is directly responsible for
diabetes and heart disease.
The WHO World Health
Report, 2003, estimated that globally more than one billion adults are
overweight and over 300 million adults worldwide are obese with the U.S.
leading the table with 22.3 percent of obese population.
Obesity is nothing but too much body fat. Excess fat
raises bad (LDL) cholesterol and lowers good (HDL) cholesterol. HDL
cholesterol reduces the risk of heart disease, so lower the HDL greater
the risk. Again, obesity can induce diabetes. And we all know that
people with diabetes have a greater risk of developing heart disease.
Body Mass Index (BMI)
is an index used to classify
underweight, overweight and obesity in adults. BMI is calculated as the
weight in kilograms (kg) divided by the square of the height in meters
BMI = X kg/ (Y
According to the World
Health Organization (WHO), a person is classified as
1. Obese class I -when the BMI is 30.00 to
2. Obese class II -when the BMI is 35.00 to
3. Obese class III- when the BMI is equal or
greater than 40
The WHO also noted that substantial
proportion of Asian people with a BMI varying from 22 to 25 is at high
risk for type-2 diabetes and cardiovascular disease.
Although 30 to 70 percent of obesity cases is
heredity, diets high in fat and reduced energy expenditure is
responsible for the increasing prevalence of obesity in the world. You
tend to become obese if you take in more calories than your body
requires or consume too much of saturated fat, trans-fat and cholesterol
thereby increasing your blood cholesterol levels. Lack of regular
physical exercise or a sedentary lifestyle also contributes
significantly to obesity.
Here’s a fact sheet from
the American Heart Association:
- Middle aged women with a BMI of more
than 23 but less than 25 had a 50 percent increase in risk of coronary
- Men aged 40 to 65 with a BMI of more
than 25 but less than 29 had a 72 percent increased risk of
- Hypertension or high blood pressure is
approximately three times more common in obese than normal-weight
- Dilated cardiomyopathy may be the most
common cause of sudden death in patients with severe
- The American Heart Association further
suggests restricting consumption of fat to less than 30 percent of total
calories to promote weight reduction in obese people. If you need to
lose weight fast, a calorific deficit of 800 calories per day will be
required. For less urgent weight reduction, a calorific deficit of 400
calories per day will be sufficient to lose 0.45 kg per week. It’s a
tough call but worth a try.
The INTERHEART study,
on the other hand, found that abdominal obesity is a stronger risk
factor than BMI suggesting that abdominal obesity should be the
indicator of obesity.
Diet and Nutrition
A sensible and
balanced diet can reduce the risk of heart
Obesity and overweight are directly linked
to diet and nutrition. While it’s true that genes are important in
determining our susceptibility to weight gain, our lifestyle is the
As incomes are rising worldwide,
nutritious and balanced diet is giving way to a diet with high levels of
fats and sugars. The diet thus becomes highly imbalanced. Poor diet
leads to oxidative stress in the body. Oxidative stress in combination
with lack of exercise and bad habits such as smoking causes heart
Opting for a healthy diet can reduce your chances of developing heart
and even protect your heart from further progression
of the condition. So, it’s actually never too late to start on a healthy
Here are some tips for a heart-healthy
1. Reduce salt intake
Excessive salt may lead to high blood pressure which is bad for heart.
Herbs and spices have natural salt in them, so adding these will reduce
the requirement of added salt.
2. Eat at least five
portions of fruits and vegetables
3. Eat moderate amount of fish, lean
meats, skinless poultry and dairy products.
that modest consumption of fish (1-2 servings/week) that are high in n-3
fatty acids (EPA and DHA) reduce risk of heart disease death by 36
4. Select diets that emphasize on fresh
fruits and vegetables, nuts and whole grains. According to the Lyon Diet
Heart Study, Mediterranean-style Step I
may help reduce recurrent heart disease by 50-70 percent
after an average follow-up of 46 months. Mediterranean-style Step I diet
includes more bread, more root and green veggies, fish, fruit on daily
basis, meats replaced with poultry, and butter replaced with margarine
high in alpha-linolenic acid.
5. Opt for a
low-fat diet but go easy on refined carbohydrates. It is generally
thought that dietary saturated fat is linked to cardiovascular disease
and reducing saturated fat intake will mean lowering LDL-cholesterol
concentrations. However, latest studies found no significant evidence
for concluding that dietary saturated fat is associated with increased
risk for heart disease. However, replacing saturated fat with
polyunsaturated fat or monounsaturated fats has shown to lower LDL as
well as HDL cholesterol in some studies. But it is certain that
replacing saturated fat with higher carbohydrate intake, especially
will increase the risk for
6. Increase dietary
intake of anti-oxidants
. Anti-oxidants neutralize free radicals in the
body and help curb oxidative stress. Anti-oxidant supplements are not a
good idea. Studies have shown that supplements do not replicate the
action of dietary anti-oxidants. So get those anti-oxidants from foods
such as apricot, mango, citrus fruits, strawberries, papaya, melons,
spinach, fenugreek leaves, broccoli leaves, carrot, pumpkin, sweet
potato, tomato, sprouted pulses, germinated cereals, chicken liver,
salmon, shrimp, sunflower oil, safflower oil, and peanut oil. This list
is not exhaustive of course.
. Overloading your plate can lead to intake of more
calories, fat and cholesterol. Keep track of how much you eat. Plan
ahead and create daily menus.
Physical Inactivity and Lack of
Physical inactivity is the fourth leading risk factor
for global mortality and contribute to six percent of deaths
The World Health Organization data reveals
that more than 60 percent of the world's population is not physically
active enough to induce health benefits. The reason behind it seems to
be the lifestyle choice.
We would prefer to watch
television or play computer games during leisure time instead of
participating in sports or taking a walk in the nature. Thanks to modern
gadgets and tools, domestic activities and occupational activities do
not require much of physical activity. Passive mode of transport is also
to blame for the declining physical activity levels.
The fault is not always ours. Urbanization has
resulted in environmental factors which may discourage physical
activity. Population explosion, increased levels of crime, high density
traffic in cities, air pollution, and lack of parks or greeneries, all
contribute directly or indirectly toward physical inactivity.
According to the WHO, physical inactivity is the
fourth leading risk factor for global mortality and contributes to six
percent of deaths globally. Physical inactivity is estimated to be the
main cause for approximately 30 percent of ischemic heart disease and 27
percent of diabetes burden.
Any bodily movement
involving skeletal muscles, resulting in energy expenditure can be
called physical activity. Physical activity does not mean just exercise,
it also includes other activities such as walking, playing, dancing,
cycling, house chores, and recreational activities.
Health benefits of physical activity are
- It helps control
weight. (Remember excessive weight obesity
- It helps control blood glucose levels in a
diabetic individual. Diabetics are at greater risk for cardiovascular
- It reduces blood pressure in people with
hypertension and delays or prevents development of high blood
- It can also lower blood cholesterol
levels which in turn decrease the risk for heart
- It helps improve blood circulation in the
body and enables all organs (including heart) and muscles to work
together more effectively.
- It helps promote
- Higher levels of weekly
physical activity can lower risk of 5 chronic conditions - Breast
Cancer, Bowel (Colon) Cancer, Diabetes, Ischemic heart disease and
Incidentally, you don't have to
achieve a high fitness level to get health benefits. A University of
British Columbia review study confirmed the findings that walking at
least two hours a week could reduce premature death from heart disease
by up to 50 percent. They believe that even small increases in physical
fitness are associated with a significant reduction in cardiovascular
The 2008 Physical Activity Guidelines for
Americans Report recommends at least 150 minutes a week of
moderate-intensity physical activity such as brisk walking, ballroom
dancing or gardening for adults.
Foundation recommends that we find ways to incorporate physical activity
into our daily living. They suggest at least 30 minutes of moderate
physical activity every day to keep our heart healthy. The American
Heart Association, on the other hand, recommends 30 to 60 minutes of
aerobic exercise 3-4 times a week to promote heart health.
for improving HDL cholesterol and lowering LDL cholesterol as these are
associated with cardiovascular disease. A meta-analysis of control
trials revealed that aerobic exercise for > or = 8 weeks in men
18 years of age or older significantly improved HDL cholesterol and
reduced total cholesterol and triglycerides level.
You may be surprised to know that
, too, has the potential to retard progression
and increase regression of atherosclerosis and other heart disease. An
AIIMS study from India conducted a randomized, controlled trial in which
men with coronary artery disease (CAD) were given yoga intervention for
one year. Results revealed that yoga groups had significant reduction
in number of anginal episodes per week, had significantly more lesions
regressed and showed other heart benefits including decrease in body
weight. There were no side effects.
Another study by
U.S. physical therapy researchers found that typical hatha yoga
represent low levels of physical activity, similar
to walking on a treadmill at 3.2 kph, and they do not meet
recommendations of physical activity for improving cardiovascular
fitness. However, they found that yoga practice involving sun
exceeding the minimum bout of 10
minutes may actually improve cardio-respiratory fitness
On the whole, any mode of physical
activity is beneficial to heart health as long as you do it on a regular
basis and enjoy doing it. The thing is to get physical!
Smoking and Alcohol Intake
the single largest preventable cause of premature death due to disease.
An estimated 40,000 people die from cardiovascular disease because of passive smoking
perhaps, the most widespread addiction. The WHO statistics show that
more than 15 billion cigarettes are sold daily. It is the single largest
preventable cause of premature death due to disease. Smoking related
diseases kill one in ten adults globally. Apart from causing
, it is a high risk factor in
heart disease and stroke.
is the major cause of atherosclerosis. The poisons such as nicotine,
carbon monoxide, and ‘tars’ present in the cigarette damage the cells
lining the coronary arteries and other blood vessels, and build up
deposits of fats and plaque
in them. Smoking
decreases oxygen supply
to the heart and other
tissues and increases blood pressure and heart rate leading to
development of coronary artery disease and other heart disease. The
INTERHEART study found that current smoking is the second strongest risk
after blood cholesterol risk for acute myocardial infarction (AMI).
They found that consumption of 1-5 cigarettes daily increased the risk
for AMI by 38 percent.
The risk of heart attack
increases with the number of cigarettes you smoke. The longer you smoke,
higher the risk. And that’s not all! When you smoke, you put people
around you to danger. They are also at risk for developing health
problems. This is called passive smoking and the American Heart
Association estimates that about 40,000 people die from cardiovascular
disease because of passive smoking.
The bottom line
is ‘Quit smoking before it’s too late’.
family and friends from getting heart disease because you are addicted
to smoke. The good news is your heart starts getting better from the day
you stop smoking.
Alcohol is yet another addiction
that can cause you a lot of harm if you don’t stop on time. Although
drinking alcohol, especially wine, in moderation is good for heart,
excessive alcohol consumption works the other way round and causes heart
disease. Three to five drinks per week has a protective effect for
heart (reduce it to two per week if you are a woman), but you don’t have
to start drinking to protect your heart. There are other safer ways to
protect your health. On the flip side, excessive alcohol
consumption can increase hypertension
and lead to heart
disease. A study found that the risk of hypertension increases linearly
with alcohol consumption of 50 g/day for men and 5 g/day for women.
This is how heavy drinking can affect your heart
- Heavy drinking raises
the levels of triglycerides (type of fat) in the blood. High levels of
triglycerides block the coronary artery and other blood vessels
resulting in heart disease or stroke.
- According to
the American Heart Association, alcohol damages the heart muscle and
arteries and cause cardiomyopathy.
- Binge drinking
increases risk of atrial fibrillation and cardiac arrhythmia resulting
in cardiac arrest and stroke.
- Heavy drinking causes
high blood pressure which in turn may cause stroke or heart
- Alcohol may also react with medication and
drugs causing serious side effects.
- Make the
decision to quit alcohol and be committed to your decision if you are an
alcoholic. Self help is the best help to begin
Anger and Stress – Risk Factors for Heart
William Harvey, the English physician who first
described how heart receives and expels blood during each circle, wrote
in 1628, "every affection of the mind that is attended either with pain
or pleasure, hope or fear, is the cause of an agitation whose influence
extends to the heart”.
Three centuries later, two
psychiatrists – Friedman and Rosenman – while examining the relationship
between diet and heart disease found that some people were more
susceptible to heart disease than others irrespective of their sex, age,
or geographic location. On further analysis they pinned this down to
social, cultural and behavioral attitudes, and opened up a new field of
inquiry into the mind-heart connection.
one of the modules in the mind-heart connection. So, what is this
stress? One way to define it would be “the state in which individuals
are faced with the need to make difficult or undesirable changes in
order to adapt to events and situations in their lives”. Anger,
frustration, depression, anxiety, fear, panic attacks, over-reaction to
events, work-related stress, are all emotional indicators of stress.
The Framingham study on the relationship of
psychosocial factors to coronary heart disease (CHD) showed that
prevalence of CHD was significantly higher among middle-aged and older
women who showed aging worries, tension, and anger symptoms. Similarly,
among men under 65 years, aging worries, daily stress and tension were
associated with prevalence of myocardial infarction (MI). Then
again, a review of studies on stress and coronary heart disease by
Expert Working Group of the National Heart Foundation of Australia
concluded that although there was strong and consistent evidence on
association between depression, anger, and social isolation and the
causes of CHD, there was no consistent evidence for association between
work related stressors and panic disorders and CHD.
How does stress cause heart disease? When you
are in a stressful event, physiological changes occur to meet the
associated demands in the body. A ‘fight –or- flight’ response occurs
automatically in this situation and the pituitary gland at the base of
the skull releases the hormone adrenocorticotropin (ACTH) which
stimulates the production of cortisol (stress hormone) and
adrenaline-like substances by the adrenal glands. The heartbeat
quickens, i.e., the heart pumps harder and faster and the blood pressure
rises as well. Fats are transformed into fatty acids which then are
delivered to the muscles along with the hormones.
The fatty acids are supposed to ‘burn up’ and supply
fuel in response to the challenging physical demand. But if the stress
is mental, the hormones and fats that are mobilized for action are not
used up. The high heart rate and high blood pressure increase the
turbulence in the bloodstream and may damage the cell linings of the
arteries. To promote healing, blood platelets adhere to the injured
walls and further thicken the arterial walls. The thickened arteries
attract LDL cholesterol and over time this process speeds up
atherosclerosis in the coronary arteries.
thickening of the coronary artery grows and significantly reduces the
blood flow which then is not sufficient enough to support the pumping of
the heart. This causes myocardial ischemia (MI). If the blockage in the
coronary arteries is too severe, the mobilized stress hormones close it
off further resulting in heart attack.
not lost, however. Just as fats, smoking, and alcoholism are modifiable
risk factors, so is stress. A number of activities can have beneficial effect on stress
- Aerobic exercise reduces the level of stress-related hormones circulated in the blood.
- Brisk walking may help ‘burn’
off the excess hormones produced during
- Relaxation techniques, yoga, meditation, and Tai-Chi, if practiced regularly, help reduce the
occurrence of stress.
therapy is useful for people who have had traumatic
experiences or are bereaved.
- Biofeedback, anger
management training, and stress management therapy are other programs
that help deal with anger and stress.
relieves anger, tension and hostility by over 80% and cuts heart attack
risk by over 70%.
- Take care of your
stress, take care of your heart!
Oral Health and Heart Disease
disease is a risk factor for heart disease. Periodontitis a severe gum infection
damages the tissues and bones that support the teeth.
and swollen gums are the main signs of bacterial infection in the mouth.
Inflammation caused by the periodontal disease increases the risk of heart diseases
. Periodontitis can also exacerbate existing heart
Maintaining good oral hygiene
may help in the
prevention of heart disease. Tips for Good Oral
the teeth twice daily to remove plaque.
- Replace the old
toothbrush every three months once.
- Do not brush teeth
right after meals, but after half an hour or so, as the loosened enamel could
break leading to gum problems.
- A healthy diet is
necessary for good dental health. Include vegetables, celery, apples which are
good for your teeth.
- Regular dental checkups may promote
good oral health.