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September 2010
7 F.A.Q.s on
Preventing Stroke & Heart Attack
Dr. Jagdish Hiremath
Since pain has always been part of childbirth, the effort to reduce pain has also been a constant attempt. In fact, the struggle to labour without pain was part of the early feminist movement in the western world.

Are stroke and heart attack similar?
Atherosclerosis is a disease process where arteries of various organs get blocked.
  1. Blockage in the artery of the heart (coronary) results in heart attack, while blockage in the artery of the brain (carotids) causes brain attack i.e., stroke.
  2. Heart attack damages part of the heart while a stroke damages part of the brain.
  3. Similar blockage can result in the arteries of the legs (peripheral vascular disease), and in men, such a blockage can also lead to impotence.
  4. Therefore prevention of the process of atherosclerosis is of paramount importance.
How can I prevent stroke and heart attack - atherosclerosis, rather?
Maintaining ideal body parameters can result in significant prevention of stroke and heart attack.
  1. Body Mass Index of less than 23
  2. Blood pressure lower than 130/85 mm Hg
  3. Total cholesterol less than 200 mg%, with (bad) LDL cholesterol less than 100 mg% and (good) HDL cholesterol greater than 45 mg%
  4. Blood sugars lower than 150 mg%
For those who have already suffered once, the parameters are stricter. These parameters can be achieved by correct diet, regular exercise, stress management and abstinence from any form of use of tobacco.
What about my diet?
  1. Eat small quantity of food - never fill your stomach completely.
  2. Let the smallest meal be the dinner.
  3. Learn to eat for the body and eat sparingly for the tongue.
  4. Avoid butter, ghee, deep fried items and bakery products.
  5. Use fresh fruits, salads, sprouts and uncooked items in day-to-day meals.
  6. Increase your good HDL cholesterol by use of almonds, walnuts, fenugreek, flaxseed and unusual oils like olive oil and fish oil. Dark chocolate and red wine can also help to some extent.
There should be something about exercise too, right?
  1. At least 150 mins of brisk aerobic exercise per week has shown to be preventive.
  2. If brisk walks, cycling, jogging, swimming, dancing aerobics in the gym for 30 mins for at least five days a week, constitutes this aerobic exercise, it will have more benefit.
  3. Healthy sexual activity also is considered one of the better aerobic exercises.
  4. Supplementing aerobic exercise with weight training is also absolutely essential.
  5. Exercise promotes collateral artery formation, improves good cholesterol, reduces weight, reduces bad cholesterol, reduces sugars, improves blood pressure and also improves stress management.
Stress management? Does it help prevent stroke and heart attack?
  1. The World Heart Foundation considers stress on par with hypertension, diabetes, cholesterol and smoking, as a risk factor for developing stroke and heart attack.
  2. It clearly mentions that “being happy” prevents your risk of developing stroke and heart attack.
  3. aving good physical health, improvement of interpersonal relationship at home and at work place, developing hobbies, which are personally soothing and rewarding, and looking at life as a pleasant journey and not a rat-race are some basic principles of stress management.
  4. Meditation, pranayama, and a yogic way of life are helpful in stress management.
Are there any medicines for preventing stroke and heart attack?
  1. Aspirin reduces the incidence of stroke and heart attack by about 25 percent.
  2. Statin (cholesterol lowering medicine) confers benefit of upto 33 percent.
  3. ACE (Angiotensin Converting Enzyme) inhibitors are drugs, which are also shown to be preventing stroke and heart attack.
  4. All these three medicines used judiciously along with blood pressure medicines and anti-diabetic medicines can have a phenomenal effect of prevention of stroke.
  5. Combing four or five medicines together in the form of a “polypill” is around the corner - and India has already developed a polypill. Theoretically, such a polypill consumed by each individual above the age of 55 could reduce heart and stroke attack to the tune of 85 percent. Theoretically.
Despite common knowledge of most of these preventive aspects, why do strokes and heart attacks still happen?
Well, the knowledge needs to be put in practical use to see its effects! Developed countries have gone through this stage of epidemic rise of diabetes, blood pressure, heart attack and strokes. They applied these principles slowly and steadily, improving social awareness of exercise, cholesterol awareness and smoking awareness. By various activities like these, western countries are already on the downward trend of stroke, atherosclerosis and heart attacks. India though, is on the upward curve - but we can get there, definitely.
Dr. Jagdish Hiremath is Interventional Cardiologist and Chief of Cardiology at Jehangir Hospitals, Pune


    
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