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Dr K K Aggarwal

ECG not a reliable marker for predicting heart disease

By Dr K K Aggarwal
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Doing an ECG has limited utility when it comes to predicting future heart problems for people being examined for chest pain.Chest pain is the most common reason for seeking medical care for a possible heart trouble, and an ECG is commonly done in such people. ECG results can come out as normal in the first six hours, even in frank heart attacks. The commonest mistake made in the emergency rooms is missing the diagnosis of heart attack on ECG.

The history and physical findings continue to be the most important parameters.• Chest pain, which can be pinpointed by a finger, is not a heart pain.• Pain lasting for <30 seconds is not related to heart.• Heart pain presents as diffuse pain in the center of the chest, which lasts more than minutes and is characterized by heaviness, burning, discomfort, or pain often triggered by physical or mental exertion.An exercise stress test should be done when there is doubt. If negative, reassess the patient for potential risk factors.

If the patient is found to be at high risk, then even with negative treadmill test, he should be subjected to risk reduction management in a bid to prevent future heart attacks.

High risk patients include smokers, those with high blood pressure, obesity, high cholesterol and diabetes.

Diet for heart disease prevention with special reference to edible oils

By Dr K K Aggarwal
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  • Food of plant origin contains no cholesterol. Only animal foods have cholesterol, therefore, all oils which are of plant origin will have zero cholesterol while animal fat like Desi Ghee (cow or buffalo) will have cholesterol.
  • A saturated fat will be solid at room temperature, while the fat, which is unsaturated will be liquid at room temperature. All plant oils, therefore, will be unsaturated and desi ghee, butter will be saturated. When an unsaturated liquid oil is hydrogenated, it becomes hydrogenated oil, solid at room temperature and therefore, will be saturated.
  • Unsaturated oils can be polyunsaturated or monounsaturated. Polyunsaturated oils will oxidize on heating and may not be suitable for reuse. Monounsaturated oils are heat stable and the oils can be reused after frying or boiling.
  • Omega-3 fatty acids in unsaturated oils are the key for cardiovascular prevention. The N3:N6 ratio is the one which classifies various oils. More N3 means more omega-3 fatty acids.
  • When choosing unsaturated oils, a blend of oils is better than single oil and, if one oil has to be used, then it is preferred to be monounsaturated. A single oil if used should be mustard oil, groundnut oil or olive oil. A study has shown that Mediterranean diet, which involves consumption of pure virgin olive oil in adequate amount, can cause regression of heart diseases. Virgin olive oil has also been shown to dissolve gallbladder stones. There are blends of oils available, which are a mix of poly and monounsaturated oils and if they have more N3:N6 ratio, they can be consumed from healthy point of view.
  • Trans fats are the biggest culprit (hydrogenated oils). Saturated fats increase LDL cholesterol while trans fats increase LDL cholesterol and simultaneously reduce HDL cholesterol. It is better to consume desi ghee than vanaspati ghee.
  • Moderation and variety is the answer. One should not consume more than ½ kg of ghee, oil, butter in a month, which means 3 teaspoonfuls in a day.
  • One should not re-fry or deep fry food articles. One should use non-stick pans for reducing the amount of oil in cooking. The smaller pieces of vegetables you cut while cooking, the more will be available surface area and more will be oil consumption. One should boil the vegetables and cook them to reduce the amount of oil required for cooking.
  • There are some medicines available such as lipase inhibitors, called cheating drugs, which do not allow fat to be absorbed if taken in excess in parties. As per naturopathy, consuming a glass of water with lemon after half an hour of eating food may help in washing off the fat lined on the intestinal lining.
  • A 1% rise in bad cholesterol increases the chances of heart attack by 2% and 1% reduction in good HDL cholesterol reduces the chances of heart attack by 3%.

Lifestyle counseling can reduce heart disease

By Dr K K Aggarwal
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An intensive effort to change the lifestyle in people at high risk of heart disease can help them reduce such risk factors as high blood pressure, cholesterol and smoking.

A trial, called the Euroaction study, published in The Lancet, compared the results of added counseling on lifestyle issues such as diet, physical activity and smoking to the usual care. It included more than 3,000 people with coronary heart disease and 2,300 who were at high risk of developing the disease. Half of the group were counseled by a team of nurses, dietitians, physiotherapists and the treating doctors. The counseling was given to families as well as individuals.

Two groups of patients were studied. One group included patients who already had developed coronary heart disease. The second group included those who were asymptomatic but at high risk because of a combination of risk factors that increase the chances of developing heart disease over 10 years.

Fifty five percent of those getting the counseling reduced their intake of saturated fat vs. 40 percent of those not getting the advice. Increased consumption of fruits and vegetables was seen in 72 percent of the counseled group, and 17 percent of them also increased their consumption of heart-friendly oily fish, compared to 35 percent and 8 percent in the other group. Similar results were seen for blood pressure, cholesterol and physical activity, but it proved difficult to have people seen in general practice quit smoking.

Spirituality, The Key To Health

By Dr K K Aggarwal
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To stay healthy, one needs to eat right, get plenty of exercise and rest and avoid bad habits such as smoking. But now it is said that “what you believe in” can have a big impact on health and longevity. Many studies show that patients with strong spirituality can improve their health from a variety of chronic conditions, like hypertension, heart disease, recovery from surgery and more.

Research indicates there are real health benefits from spirituality:

  1. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.
  2. Positive thinking produces nearly a 30% drop in perception of pain.
  3. Spirituality and the practice of religion have been associated with a slower progression of Alzheimer’s disease.
  4. Those who regularly attend organized religious activities may live longer than those who don’t. Regular participation lowers mortality rate by about 12% a year.
  5. People undergoing cardiac rehabilitation feel more confident and perceive greater improvements in their physical abilities if they have a strong faith.
  6. Increased levels of spirituality and religious faith may help substance abusers kick their habit.
  7. Spirituality stimulates the relaxation response. When the body is relaxed, your heart rate, blood pressure and breathing rate all go down, which decreases the body’s stress response.
  8. Spirituality can affect immune system function. Spirituality, faith, church attendance improves immune function in ways that can be measured, like an increase in white blood cells.
  9. Prayer heals the heart.
  10. Positive talking and thinking in the ICU produces better results.

Spirituality is what brings you peace and safety. It can be achieved through God or Goddess, nature, a beautiful sunset, a meditation, Pranayama, religious meeting, chanting, mind-body relaxation, etc. Spirituality is something that can help all the way from promoting wellness to helping with recovery.

(Disclaimer: The views expressed in this write up are my own).

Spiritual Prescriptions: Prefer Meditation and Not Medication

By Dr K K Aggarwal
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Meditation, and not medication, should be the first-line of treatment for most lifestyle disorders. The very fact that our body has a receptor for each and every drug means it has the capacity to produce that drug. God did not make these receptors for pharmacological agents or drugs. The key lies in achieving the undisturbed state of consciousness, which can be obtained by either controlling the disturbed state of mind or bypassing it by using the mantra.

The subject of spiritual medicine should be included in schools, colleges and medical sciences.

Confession and communication are two easy modules of controlling the disturbed state of mind. As darkness is absence of light, negative thoughts are absence of positive thoughts. To reduce negative thoughts, one should inculcate positive thoughts, actions and behaviors. One cannot hate a stranger. One can only hate a person whom he or she has loved. Hatred is therefore withdrawal of love, and it can only be removed by bringing the love back.

It has been shown that diseases like diabetes, high blood pressure, heart disease, paralysis, asthma and acid-peptic disease can be kept under control with meditation without or with minimal medicines.

(Disclaimer: The views expressed in this write up are my own).

Clinicians should aggressively treat unhealthy lifestyles

By Dr K K Aggarwal
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Unhealthy behaviors should be managed as aggressively as hypertension, high cholesterol, and other heart disease risk factors, according to an American Heart Association policy statement published in the journal Circulation.

Doctors should create “interprofessional practices” to connect patients with behavior-change specialists.

They must implement five As when caring for patients

  1. Assess a patient’s risk behaviors for heart disease
  2. Advise change, such as weight loss or exercise
  3. Agree on an action plan
  4. Assist with treatment
  5. Arrange for follow–up care.

Passive smoking can cause dementia

By Dr K K Aggarwal
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People exposed to secondhand smoke may face as much as a 44 percent increased risk of developing dementia. Smoking is already known to increase the risk for dementia and Alzheimer’s disease.

A study from Peninsula Medical School in Exeter, England published in the British Medical Journal has shown an association between cognitive function and exposure to passive smoking. The risk increases with the amount of exposure to secondhand smoke. For people at the highest levels of exposure, the risk is probably higher.

The study collected data on more than 4,800 nonsmokers who were over 50 years old and tested saliva samples from these people for levels of cotinine, a product of nicotine that can be found in saliva for about 25 hours after exposure to smoke. The researchers found that people with the highest cotinine levels had a 44 percent increased risk of cognitive impairment, compared with people with the lowest cotinine levels. And, while the risk of impairment was lower in people with lower cotinine levels, the risk was still significant.

Passive smoking is also associated with an increased risk of stroke and heart disease.

Smoking makes you 5 years older

By Dr K K Aggarwal
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  • Men have a greater chance of dying than women, and smoking increases any adult’s risk of death just as if five years were suddenly added to their age.
  • For men who have never smoked, heart disease presents their greatest risk for death at any age, exceeding the odds of dying from lung, colon and prostate cancer combined.
  • Male smokers face a lung cancer risk that is greater than the odds of heart disease taking their lives after age 60, and is tenfold higher than the chance of dying from prostate and colon cancer combined.
  • The chances of dying from heart disease and breast cancer are similar for nonsmoking women until age 60, when heart disease becomes a greater risk.
  • For female smokers, dying from lung cancer or heart disease is more likely than dying from breast cancer after age 40.

Nine modifiable risk factors for heart attack

By Dr K K Aggarwal
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The majority of known risk factors for heart attack are modifiable by specific preventive measures.

The nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, daily consumption of fruits and vegetables and regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

Women Beware of Heart Disease

By Dr K K Aggarwal
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Cardiovascular disease is very common in women. The warning signals of heart attack include:

  • Uncomfortable pressure, squeezing, fullness or pain in the center of the chest. It lasts more than a few minutes, or goes away and comes back.
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Breaking out in a cold sweat, nausea or lightheadedness.

However, women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

  • Neck, jaw, shoulder, upper back or abdominal discomfort.
  • Shortness of breath.
  • Pain in one or both arms.
  • Nausea or vomiting.
  • Sweating.
  • Lightheadedness or dizziness.
  • Unusual fatigue.

In the presence of any of the above, one should not wait for more than five minutes and get to a hospital right away.

More than 80% of cardiac events in women can be prevented by modifying diet, exercise and abstinence from smoking.

A mix of exercise protocol is better

By Dr K K Aggarwal
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A combination of weight training and aerobic exercise is the best prescription for overweight patients at risk for diabetes and heart disease.

Only aerobic exercise is also good as it reduces weight and inches off the waistlines. Just weight lifting alone has very little benefit.

According to a study published in the American Journal of Cardiology, people in the weight-training group gained about 1.5 pounds and those in the aerobic group lost an average of 3 pounds and half an inch from their waists.

Those who did both weight and aerobic training dropped about 4 pounds and 1 waistline inch. This group also saw a decrease in diastolic blood pressure and in metabolic syndrome score.

Both the aerobic-only group and the combined-exercise group also lowered their levels of triglycerides.

Tips to prevent future heart disease in women

By Dr K K Aggarwal
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  • Do moderate intensity physical activity for at least 30 min and for 60 to 90 min for weight management on most days of the week.
  • Avoid and stop cigarette smoking and passive smoking.
  • Keep waist circumference less than 35 inches.
  • Consume a heart-friendly diet.
  • Control cholesterol level, high blood pressure and diabetes.
  • Women who smoke should avoid oral contraceptive pills.
  • Aspirin 80 mg should be added for women older than 65 years of age.
  • Treat underlying depression.

Smoking makes you 5 years older

By Dr K K Aggarwal
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  • Men have a greater chance of dying than women, and smoking increases any adults risk of death just as if five years were suddenly added to their age.
  • For men who have never smoked, heart disease presents their greatest risk for death at any age, exceeding the odds of dying from lung, colon and prostate cancer combined.
  • Male smokers face a lung cancer risk that is greater than the odds of heart disease taking their lives after age 60, and is 10-fold higher than the chance of dying from prostate and colon cancer combined.
  • The chances of dying from heart disease and breast cancer are similar for nonsmoking women until age 60, when heart disease becomes a greater risk.
  • For female smokers, dying from lung cancer or heart disease is more likely than dying from breast cancer after age 40.

All about Diabetes

By Dr K K Aggarwal
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  • India is the diabetes capital of the world.
  • People with diabetes are nearly two times more likely than people without diabetes to die from heart disease, and are also at greater risk for kidney, eye and nerve diseases, among other painful and costly complications.
  • Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications.
  • In type 1 diabetes, the body does not make insulin. In type 2 diabetes, the body makes insufficient insulin or does not use insulin well.
  • Gestational diabetes occurs in some women during pregnancy. Though it usually goes away after the birth, these women and their children have a greater chance of getting type 2 diabetes later in life.
  • Type 2 diabetes has begun to affect young people.
  • Losing a modest amount of weight — about 15 pounds — through diet and exercise can actually reduce your risk of getting type 2 diabetes by as much as 58 percent in people at high risk.
  • In type 1 diabetes, tight control of blood sugar can prevent diabetes complications.
  • Choose healthy foods.
  • Take a brisk walk every day.
  • Talk with your family about your health and your family’s risk of diabetes and heart disease.
  • If you smoke, seek help to quit.
  • Make changes to reduce your risk for diabetes and its complications — for yourself, your families and for future generations.

What type of a vegetarian are you?

By Dr K K Aggarwal
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There are 4 main types of vegetarian diets:

  • Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood
  • Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood
  • Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood
  • Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.

Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.