1. LIFESTYLE MODIFICATIONS FOR PREVENTING HEART DISEASE [e.g. HEART ATTACKS] [ primary prevention of coronary artery disease ] DR S. SAHAI MD [Med.], DM [Card] (ex AIIMS) Sr. Consultant Cardiologist, Max Hospital, Noida Tel.:9810065557 Hospital

2. Primary Prevention of CAD 9/02 Indians More susceptible that any other ethnic group 3.4 times more than Americans 6 times more than Chinese 20 times more than Japanese Occurs at lower cholesterol Get the disease at much younger age 5-10 years earlier than other communities Disease follows more severe and malignant course 3 times higher rate of second heart attack & 2 times higher mortality than whites Why Should I (Indian) be Worried ? :

3. Primary Prevention of CAD 9/02 I am at risk of heart attack if I have any of the risk factors: -I am a man over 45 years or a woman over 55 years -I am overweight for my height / my waist circumference is more than 40inches [male] or 35inches [female] -My physical activity is less than 30 minutes on most days -I currently smoke or work with people who smoke daily

4. Primary Prevention of CAD 9/02 I am at risk of heart attack if I have any of the risk factors: -I have high blood pressure -I have high cholesterol -I have diabetes -I have history of coronary heart disease, heart attack, angina or stroke -My father or brother had a heart attack before age of 55, or my mother or sister had one before age of 65, or any of my family members had a stroke.

5. Primary Prevention of CAD 9/02 Cigarette smoking Elevated blood pressure Elevated serum cholesterol (or LDL cholesterol) Low HDL cholesterol Diabetes mellitus Age *Overweight and obesity (especially abdominal obesity) *Physical inactivity Male sex Family history of premature CHD Insulin resistance Left ventricular hypertrophy Hs-CRP Lp (a) Homocysteine Small LDL particles * Can be considered causal Causal Risk Factors Predisposing/ Conditional Risk Factors

6. Primary Prevention of CAD 9/02 RISK FACTOR SCREENING: Begins at age 20 y including: – Smoking status, diet, alcohol, and physical activity. –Blood Pressure, Body Mass Index (BMI), waist circumference at each visit or at least every 2 years. –Fasting Cholesterol panel and glucose every 5 years; every 2 years if risk factors are present

7. Primary Prevention of CAD 9/02 Estimating total cardiovascular risk The 10-year risk of CHD should be assessed at least every 5 y in adults >40 y with 2 or more risk factors. Framingham use a graded system based on age, tobacco, sex, BP and cholesterol to give a 10-year risk: –low risk <10% –intermediate 10-20% –high >20%.

8. Primary Prevention of CAD 9/02 Estimating total cardiovascular risk Web site for calculating risk: –http://hin.nhlbi.nih.gov/atpiii/calculator.asphttp://hin.nhlbi.nih.gov/atpiii/calculator.asp Risk assessment tool –10 yr risk of heart attack[ >20yrs & nondiabetic, no h/o CAD] Calculates using age,sex,total chol, good chol., systolic BP, any medication for BP & smoking

9. Primary Prevention of CAD 9/02 Risk Categories Low-risk patients healthy life habits. Intermediate risk risk stratification with stress testing to predict future major coronary events. High risk begin aggressive risk reduction similar to secondary prevention of CAD. Persons with diabetes or 10 y risk >20% can be considered to already have CAD.

10. HYPERTENSION >120/80 is prehypertension-lifestyle change > 140/90 –lifestyle change+medication –Goal <140/90 mmHg –<130/85 mmHg if Kidney disease/heart disease –<130/80 mmHg if Diabetic Primary Prevention of CAD 9/02

11. Lifestyle measures: BHS IV

12. Primary Prevention of CAD 9/02 Diet Encourage fruits, vegetables, grains, low-fat dairy, fish, legumes, poultry and limited lean meats. Consider reducing saturated fats to <10% of calories, cholesterol <300mg/d. Unsaturated fats (fish, legumes, veggies, nuts). Salt <6g/day EtOH < 2 pegs/60 ml a day[ men]; <1 day women

13. Primary Prevention of CAD 9/02 Cholesterol Primary goal = LDL-C (mg/dL) < 160<1 risk factor 2 RF and 10 y CHD risk <20% 2 RF and 10 y CHD risk >20% or diabetes Secondary Goals (If LDL-C is at goal) HDL >40 mg/dL men >50 mg/dL women TG <150 mg/dL

14. Primary Prevention of CAD 9/02 Aerobic,srenghthening & stretching exercises

15. Primary Prevention of CAD 9/02

16. DIABETES MANAGEMENT Goal : Glucose memory test HbA1C <7% Achieve near normal fasting plasma glucose indicated by HbA1c Treatment of other risk factors Consult Max hospital cardiologist for assessing & controlling your risk factors