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August 2011
Prevent Early Heart Disease
Dr. Mohammed Abdur Rafey
 
Indians are at a higher risk for heart disease compared to other races. A preventive approach is essential in order to optimize and maintain good health for the majority of Indians otherwise at risk for contracting early heart disease.

What is common to being overweight, having a high cholesterol level, diabetes mellitus and uncontrolled blood pressure (hypertension)?
All of these are preventable risk factors, which if left untreated, lead to heart disease and death.

Why is it more important to control these factors in Indians compared to other countries?
Research and data from clinical studies clearly shows that Indians unfortunately are at a higher risk for heart disease as compared to people from other regions across the world. Of note: Heart disease affects Indians at a much younger age than others.

What makes Indians more prone to heart disease and its complications when compared to people from other races?
It is still a mystery why Indians are more prone to heart disease and its complications. Long term clinical trials in the general population need to be conducted for studying different factors that place Indians at a higher risk for heart disease. It is also a fact that each year the number of Indians with these risk factors is growing. Indians are fatter than they were ever before; more Indians now have diabetes and hypertension than before.It is also possible that genetic factors may be playing an important role in contributing to early heart disease in Indians.

Are there other reversible or modifiable risk factors that could play a role in causing heart disease?
Tobacco smoking is a common modifiable factor that increases the risk of heart attacks several folds in smokers as compared to those who do not smoke.

What targets of weight are considered healthy for men and women?
A person is defined as overweight or obese based on body mass index (BMI).

Body Mass Index (BMI) is calculated from a person's weight and height. It provides a reliable indicator of body fat and is used to screen people according to weight categories that may lead to health problems.

A simple formula using a person’s measured weight and height provides the BMI: BMI = mass (Kg) / (height (m) )2

Considering the fact that Indians are at a higher risk for heart disease, experts and scientists recently redefined and tightened the definitions for being overweight or obese.

The BMI limits for Indians are now defined as follows:
  • Less than 18.4 - Underweight
  • 18.5 - 22.9 – Normal (Other countries: Greater than or equal to 18.5 but less than 25)
  • 23 - 24.9 – Overweight (Other countries: Greater than or equal to 25 but less than 30)
  • More than 25 – Obese (Other countries: Greater than or equal to 30)
What are healthy Cholesterol limits for men and women?  
Cholesterol, a fatty substance in human blood, accumulates in the walls of blood vessels (arteries) leading to blockages of important arteries supplying the heart and brain. This results in complications like heart attacks and stroke. Total cholesterol is the sum of all the cholesterol (LDL or Low Density Lipo-proteins –the ‘bad’ cholesterol; HDL or the High Density Lipo-protein– the ‘good’ cholesterol) and TGL or triglycerides, another fatty substance that can block arteries.

Total Cholesterol in health and disease
  • Desirable level: <200 mg/dL
  • Borderline-high: 200 to 239 mg/dL
  • High blood cholesterol: > 240 mg/dL
LDL or low density lipo-proteins in health and disease
  • Very good level: <100 mg/dL
  • OK level: 100–129 mg/dL
  • Borderline bad level: 130–159 mg/dL
  • Bad level: 160–189 mg/dL
  • Very bad level: 190 or above
HDL or the high density lipo-protein in health and disease
  • Good level: >60 mg/dL
  • OK level: 40-59 mg/dL
  • Bad level: < 40 mg/dL
TGL or triglycerides in health and disease
  • Good level: < 150 mg/dL
  • Borderline bad level: 150–199 mg/dL
  • Bad level: 200–499 mg/dL
  • Very bad level: > 500 mg/dL
In June 2011, European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) came out with new targets to control cholesterol levels in the blood. These are more stringent than previously defined goals. LDL cholesterol remains the primary target in patients with elevated cholesterol.

Patient’s level of risk for Cardiovascular Disease Goal LDL Level
Very High <70 mg/dL if this is not possible than a >50% reduction in LDL cholesterol
High <100 mg/dL
Moderate risk <115mg/dL

What are the healthy blood glucose levels for men and women?
  • Fasting blood glucose levels define whether an individual has diabetes or not. 
  • Normal — Fasting plasma glucose (FPG) <100 mg/dL
  • Impaired fasting glucose (IFG) — FPG between 100 - 125 mg/dL
  • Diabetes mellitus — FPG at or above 126 mg/dL

What are the fit blood pressure limits for men and women?
Indian guidelines for hypertension define the hypertension as having a blood pressure greater than or equal to 140/90 mmHg.

Category Systolic(mmHg)   Diastolic(mmHg)
Optimal < 120 and < 80
Normal < 130 and < 85
High-normal 130-139 or 85-89
Hypertension

Stage 1
140-159 or 90-99
Stage 2 160-179 or 100-109
Stage 3 > 180   > 110
Isolated systolic hypertension (Grade 1) 140-159 and < 90
Isolated systolic hypertension (Grade 2) > 160 and < 90

Dr Mohammed Abdur Rafey is Consultant Nephrologist and Hypertension Specialist Apollo Hospital Hyderguda, Hyderabad


    
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