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Dr K K Aggarwal

Check your BMI to know chances of future heart attack

By Dr K K Aggarwal
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If you are less than 40 years of age, male, with a strong family history of diabetes, blood pressure or heart disease, have a normal weight as judged by Body Mass Index (BMI) but have a pot belly, or have gained more than 10 kg since the age 18, do not ignore this. Go to your cardiologist to reduce your chances of a future heart attack.

A BMI of 20 to 23 kg/m2 is associated with little or no increased risk unless visceral fat is high, or the subject has gained more than 10 kg since 18 years.

  • Subjects with a BMI of 23 to 30 kg/m2 may be described as having low risk, while those with a BMI of 30 to 35 kg/m2 are at moderate risk.
  • Subjects with a BMI of 35 to 40 kg/m2 are at high risk, and those with a BMI above 40 kg/m2 are at very high risk from their obesity.
  • At any given level of BMI, the risk to health is increased by more abdominal fat (increased weight to hip ratio, WHR), hyperlipidemia, hypertension, age less than 40 years, male sex, and a strong family history of diabetes, hypertension, or heart disease.

The body mass index (BMI) is the most practical way to evaluate the degree of obesity. It is calculated from the height and weight as follows:

BMI = body weight (in kg) ÷ square of stature (height, in meters)

Overweight is defined as a BMI between 23 and 30 kg/m2 and obesity as a BMI greater than 30 kg/m2.

The majority of known risk factors for heart attack disease are modifiable by specific preventive measures.

Nine potentially modifiable factors: include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, and one should daily consume of fruits and vegetables and do 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.

Guidelines for hypertension

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As per the guidelines published by the American Heart Association and published in Hypertension in patients with resistant hypertension, the blood pressure remains above the target level despite taking three medications to lower it. High blood pressure that’s under control but requires four or more medications to treat it, is also considered resistant to treatment.

As many as 25 to 30% people with high blood pressure may have resistant hypertension inIndia.

Older age and obesity are two major risk factors for the condition. People with resistant hypertension have a high cardiovascular risk.

Successful treatment of resistant hypertension requires consideration of lifestyle factors, diagnosing and treating secondary causes, and using multiple drug treatments effectively.

Lifestyle factors include weight, salt intake and alcohol consumption.

1. Losing weight can lower blood pressure and reduce the number of medications needed to control blood pressure.

2. Reducing salt intake can lower blood pressure.

3. Reducing alcohol consumption can help lower blood pressure.

Health conditions that can contribute to resistant hypertension include: obstructive sleep apnea, renal parenchymal disease, primary aldosteronism and renal artery stenosis. Treating these conditions may improve blood pressure control.

Drugs that increase blood pressure, such as non-steroidal anti-inflammatory drugs (NSAIDs), should be reduced or halted, if possible, in patients with resistant hypertension.

Diuretics are often underused in people with resistant hypertension. Patients may benefit from adding mineralocorticoid receptor antagonists (MRAs) to their treatment regimens. MRAs treat primary aldosteronism, which is found in about 20 percent of people with resistant hypertension.

 

Restricting salt in diet can lower heart disease risk

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Restricting salt in the diet can lower the risk of developing heart disease by 25 percent and the risk of dying from heart disease by 20 percent..

Dietary intake of sodium among Indians is excessively high. Quoting a Harvard Medical School study published in British Medical Journal, Dr Aggarwal said that among hypertensive individuals, lowering sodium is quite well established to lower blood pressure, but now it has been shown that reducing salt also has an effect on cardiovascular disease.

When people with pre hypertension (blood pressure more than 120/80 and lower than 140/90), reduced their salt intake by about 25 to 35%, they were 25% less likely to develop cardiovascular disease 10 to 15 years after the trial ended. There was also a 20 percent lower death rate from cardiovascular disease among those who cut their salt consumption.

Salt restriction is best achieved by avoiding salted, salt cured and salt smoked foods such as lunch meat, hot dogs, ham, olives, pickles and regular salted canned foods, and other prepared foods, which often use more salt than homemade equivalents. Foods we would never think of as salty, such as breakfast cereals, cookies, and even some soft drinks, often contain copious additions of sodium.

WHO recommends limiting the salt intake to less than 5 grams per day.

Biggest Cardiology Stories of 2012 from Heart Wire – Hypertension

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The hottest thing right now is renal-nerve denervation.

When you cut the renal nerve, you are cutting the signal from the kidney back to the brain and the rest of the body. That is what is bringing down the blood pressure; the kidney is in a way regulating the sympathetic nervous system and telling the brain what to do.

 

Over 1500 nurses participated in Divya Jyoti Nurses’ Festival in the ongoing 19th Perfect Health Mela. Various competitions including health debate, skit/health play, health model display, poster-cum-slogan writing and collage making were organized in the festival. The topics included – Should nurses spend at least two years abroad, the patient-doctor relationship, ideal clinic, natural fast food and slim with taste.

Following are the gist of discussion:

  • Nurses are the backbone of the society and an important conduit between patient care and the doctor.
  • Nurses can play an important role in educating the people about dengue fever as well as the smog menace.
  • Every doctor who practices should hire services of a nurse whose job should be to check blood pressure, pulse of every patient and for about history of smoking, alcoholism, sexual preferences and diet.
  • They should also be doing the job of talking to the patient after the doctor has seen and counseled them about the prescription details.
  • They should also telephonically call the patient at regular intervals to know about their status.

Live workshop on hypertension

A workshop on Hypertension was also organized. The faculty included Dr Vanita Arora from Max Heart Institute and Dr KK Aggarwal.

Facts about hypertension

  • The conclusion of the workshop was that every effort must be made to keep the blood pressure below 120/80.
  • Hypertension affects 15-20% of the society.
  • The first blood pressure should be checked at 4 years of age.
  • Even 5mm reduction in blood pressure reading can reduce the mortality
  • Hypertension is silent killer and if not controlled can damage the eyes, kidney, heart and brain.
  • In hypertension, in addition to controlling the blood pressure reading, it is equally important to control blood sugar and lipid profile.
  • Smoking even one cigarette can increase the blood pressure reading.
  • The harmful changes of high blood pressure can be regressed with lifestyle management.

Anmol festival for children with special needs

Anmol, a festival for children with special needs was organized in the Perfect Health Mela. The festival was coordinated by Balwant Rai Mehta Vidya Bhavan. Over 200 children with special needs participated in folk dance, yoga, painting, singing and diya decoration competitions.

Seminar on Therapeutic Value of Indian Classical Dance

A special seminar on therapeutic value of India Classical Dance was organized in MTNL Perfect Health Mela. Noted dancers Guru Jitendra Maharaj, Saroja Vaidyanathan, Nalini-Kamalini and Kanak Sudhakar participated in the seminar.

Facts about classical dance

  • Classical dance is better than western dance as in addition to exercise, it harmonizes the body’s autonomic nervous system.
  • It comes into category of an aerobic dance.
  • It gives all the advantages of doing pranayama and meditation.
  • People who do classical dance regularly have less chances of developing heart attack.

Qawwali by Urdu Academy

Urdu Academy organized a live performance of Qawwali by Mr. Ghulam Sabir Nizami, famous qawwal of Delhi.

All Pathy Consensus on Exercise

Doctors from all pathies participated in a seminar on exercise organised in association with All India Radio. The faculty included Dr. KK Aggarwal, Dr. V.A. Siddiqui (Homeopathy), Dr. BN Sinha (Ayurveda), Dr. Raisuddin (Unani), Dr. S.N. Yadav (Yoga), Dr. R.K. Tuli (Holistic medicine) and Dr. D.N. Sharma (Naturopathy).

Facts about exercise

  • One should exercise 80 minutes a day and brisk exercise 80 minutes a week.
  • The speed of walking should be at least 80 steps per minute.
  • One should do resistance or weight bearing exercises twice in a week.
  • Avoid doing strenuous exercises for the first time in life after the age of 40.
  • According to Ayurveda, one should exercise to his or her body type.
  • Diabetics who exercise should not exercise if blood sugar is lower than 90.
  • In conditions of smog, avoid walking early in the morning till sunlight appears.

Pakistani stall attracts crowd

For the first time, a Pakistani delegation has set up a stall in the Perfect Health Mela.

Thirty stalls from the Dept. of Handicrafts, Government of India (COHANDS) also have items on display that would be of interest of people who enjoy Diwali shopping.

Vacuum massaging in the Mela

The old traditional ancient vacuum massage therapy workshops are being conducted in the Mela by Mumbai team lead by Suman Srivastava and Anil Jani. The massage is good for the chronic ailments.

About 4571 people including teachers, parents, children, nurses, doctors, journalists and general public have been trained in CPR 10.

Tomorrow’s attractions

Tomorrow, the Mela will hold Medico Masti, youth festival which includes fashion show, western dance and choreography. There will also be a conference on Homeopathy Cardiology, Cardiology in Naturopathy. There will also be a session by Delhi Medical Association on Nursing Home problems.

Symposium on Diet, Health & Religion – Dr KK Aggarwal

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A symposium on Diet, Health & Religion, second in a series was held at Bharatiya Vidya Bhavan on 5th September, 2012. The Chief Guest was Shri J Veeraraghavan, Chairman, Bhavan’s KM Munshi Institute of Educational Leadership and Management.

Welcoming the gathering, Shri Ashok Pradhan, Director, BVB said that the purpose of this symposium was to examine the relation between what we eat, how it affects our health and how all religions look at this aspect. Nature is also related to our health. Nature tells us what to eat. For example, summer vegetables have a high content of water. Speaking on fasting, he observed that not eating on certain days cleanses our body.

Dr KK Aggarwal

As medical fraternity, we must know what dietary religious practices are.

Most religions agree that fasting is good for health. Pot belly obesity, diabetes, hypertension and paralysis are all linked to metabolic syndrome which is characterized by insulin resistance which can be traced to refined carbohydrates, which are white sugar and refined flour. Any food, which is refined, is bad for health.

The body has a circadian rhythm. The digestive fire is weakest between 6 and 10 pm, i.e. enzymes for digestion are at lowest levels. Foods that are mismatched should not be combined together. A predigested food such as curd should not be mixed with an undigested food, it will lead to indigestion. Ayurveda recommends against eating fermented food at night. Alcohol is also fermented and so should not be taken after sunset. Alcohol is an evening drink (evening is the period before sunset and  with sunset the night starts. Alcohol is beneficial to the body if it is taken before sunset. About 80% of Indians may have vitamin D deficiency. So, 60000 units of vitamin D should be taken with milk once a month.

 Consensus

  • Eat less or in moderation.
  • Eat seasonal and locally grown vegetables.
  • Eat variety and color.
  • Any food that is prohibited by doctors is injuries to health and should not be taken.
  • Food is a gift from God.
  • Eat only when hungry.
  • Most religions have some restriction on combination of food.
  • Avoid alcohol, as per the regulations of your religion.

1. Caffeine is consumed in coffee, tea, soft drinks, and small amounts in chocolate.

2. It is the most widely used pharmacologically active substance in the world.

3. Caffeine can acutely raise blood pressure by 10 mmHg in patients who are infrequently exposed.

4. There is no effect on blood pressure in habitual coffee drinkers

5. It does not increase the risk of incident hypertension.

6.There is no evidence that caffeine in doses used in routine can provoke a spontaneous arrhythmia in individuals with or without a history of cardiac arrhythmia. There is no protective effect of caffeine abstinence also. In heart patients with coronary disease, the risk may be increased in individuals who are slow metabolizers of caffeine and drink two or more cups of coffee per day.

7. Ingestion of large quantities of caffeine is associated with arrhythmic and cardiovascular events, especially in patients with underlying cardiac disease.

8. Patients with a history of cardiac arrhythmia or at increased risk for cardiovascular events should moderate their caffeine intake from all sources.

9. Consumption of caffeinated beverages is associated with some short-term benefits like increased mental alertness and improved athletic performance.

10. Consumption of caffeinated beverages is associated with short term adverse effects including headache, anxiety, tremors, and insomnia.

11. In the long term, caffeine is also associated with generalized anxiety disorder, depression, and substance abuse disorders.

12. Long term benefits of caffeinated beverages are dose-dependent. Caffeine is associated with a reduced risk of Parkinson disease, Alzheimer disease, alcoholic cirrhosis, and gout.

13. Both caffeinated and decaffeinated coffee is associated with a lower risk of type 2 diabetes.

14. Several studies have linked coffee consumption with prevalence of various cancers.

15. The majority of studies show there may be a modest inverse relationship between coffee consumption and all-cause mortality.

16. Caffeine withdrawal is a well-documented clinical syndrome with headache being the most common symptom.

[Source Uptodate]

Why BP should be kept < 120/80 mmHg

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1. The paralysis incidence will reduce by 35-40%

2. The heart attacks will go down by 20-25%

3. Heart failure will reduce by 50%

4. A 5 mm reduction in diastolic blood pressure can reduce heart disease risk by 21% (Magnus and Beaglehole, 2001)

5. If we can eliminate pre hypertension (BP > 120/80 and less than 140/90 mm Hg) from the society, we can prevent about 47 percent of all heart attacks.

6. Framingham Study has shown that a pre hypertensive person is more than three times more likely to have a heart attack and 1.7 times more likely to have heart disease than a person with normal blood pressure.

7. 3–4 mmHg increase in systolic upper blood pressure would translate into a 20% higher paralysis death rate and a 12 percent higher death rate from ischemic heart disease.