atherosclerosis – Cardiac Wellness Institute

Obesity or overweight, a state of excess accumulation of fat in the body, may lead to various diseases. When an individual is obese, their excess body fat can have detrimental effects on overall health as well as on heart health.

The heart has to work harder to pump blood in obese individuals, and this extra strain on the heart can lead to hypertension, heart muscle disease, heart rhythm abnormalities, enlarged heart and heart failure. It has recently come to limelight that a condition called “Obesity cardiomyopathy” accounts for a significant proportion of heart failure and can only be managed by experienced cardiologists.

A recent study by the Indian Council of Medical Research has shown that our country now has 101 million diabetics, with a further 136 million pre-diabetic individuals in need of prevention as shown in the statistics in the Metabolic non-communicable disease health report of India, ICMR.

The study also looked at the number of people with hypertension, central obesity and generalized obesity.

The vicious cycle

There is strong scientific evidence to show that obesity plays a key role in the causation of diabetes, hypertension and cholesterol abnormalities and together they contribute to the condition called Metabolic Syndrome. The vicious cycle of obesity worsening your blood sugar, blood pressure and cholesterol levels which in turn leads to deterioration in lifestyle and pushes one into further obesity, has to be halted right in the beginning. In fact, these are the most sinister precursors of killer diseases like heart attack and stroke. If you are wondering how being obese predisposes an individual to deadly ailments, the excess fat that builds up inside the arteries supplying the heart and brain – a condition known as atherosclerosis – is the culprit.

Timely detection and an early intervention are very important in addressing the obesity burden that the world is facing today. While maintaining an ideal body weight should be high priority right from the age of adolescence, the warning signs that warrant immediate medical attention in obese people are:

Fatigue or excessive tiredness
Shortness of breath
Inability to do their routine activities
Excessive snoring and daytime sleepiness
Swelling of feet, frequent coughs and colds
Chest pain
Palpitations

People with obesity not only face many physical challenges but significant emotional challenges too. Obese individuals may develop depression, anxiety, mood swings and eating disorders; hence it is vital to keep your loved ones on a routine medical follow-up and provide them adequate emotional support.

The causes for obesity are many

Lack of exercise, unhealthy food choices, chronic mental stress, long work hours, lack of sleep are some of the modifiable causes of obesity and the Metabolic Syndrome. It is important to identify and treat any underlying medical conditions like thyroid hormonal insufficiency and polycystic ovarian syndrome while correcting the lifestyle factors.

But the solution is simple

Overcoming obesity can be simple with the right knowledge, awareness, help and guidance.

Changes in lifestyle such as making healthier food choices, exercising regularly for at least 30 minutes daily, practicing good sleep hygiene, adopting stress management strategies and keeping a track of the silent killers namely BP, blood sugar and blood cholesterol are the cornerstones of beating obesity.

A simple measure of your waist and knowing your body mass index can reveal a lot about your heart health, talk to your healthcare provider about it. Please refer to our earlier article on this topic: http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/metabolic-syndrome-a-threat-to-heart-health/

Below are a few tips that are rather simple to follow and easy on the pocket too:

Restrict use of processed and packaged foods
Stock your refrigerator / pantry with fresh fruits and veggies
Reach out to a variety of nuts and seeds like almonds, walnuts, sunflower seeds etc. as a snack instead of cookies and biscuits
Eat whole grains and pulses, limit use of refined grains and flours like maida, polished rice, sugars, and artificial sweeteners.
Learn to manage food portions well; use a smaller plate during meal times
Our humble buttermilk and lime juice are far better and healthier alternatives to soft drinks and packaged juices
Practice a good sleep routine; avoid the use of gadgets and bright screens prior to sleep
Ensure adequate water intake
Incorporate physical activity in your daily routine – use steps instead of elevators, park your vehicle a bit far away and walk to your office or the supermarket, try a walking break for 5-10 minutes every 1-2 hours while at work and learn; incorporate regular brisk aerobic exercise along with muscle strengthening exercises on a regular basis

In summary, obesity is a universal problem that significantly increases the risk of heart disease and several other chronic ailments. Taking proactive measures to address obesity through lifestyle changes is vital in promoting heart health and avoiding other comorbid conditions.

Blood pressure and your heart

High blood pressure (BP) or ‘hypertension’ means that the pressure exerted by your blood on the inner walls of your blood vessels is higher than normal. It depends on several factors like pumping capacity of your heart, volume and viscosity of your blood, and state of your vessel wall.

You would have noticed an inflatable cuff from the BP apparatus fixed to your upper arm when someone wants to measure your BP. The electronic device measures your BP by a method called “oscillatory method” whereby inflation of the cuff to a high pressure followed by deflation allows blood flow in the artery in a cyclical pattern that is captured as BP by the device.

You must have heard the term “120 over 80”; this is nothing but the upper limit of normal BP in adults. The upper number denotes systolic BP (SBP) or the peak pressure in the arteries during contraction of the heart and the lower number is the diastolic BP (DBP) or the least pressure in the arteries when the heart is actually filling with blood from the veins. Apart from BP, your heart rate (number of times the heart beats in 1 minute) is also shown on the BP monitor. The normal heart rate in a healthy adult ranges from 60-80 beats per minute in a resting condition.

The most recent international guidelines for hypertension classify BP as Normal, Elevated and High as shown in this table:

If you have never had your BP measured earlier, now is the time! You should not wait for warning signs of hypertension because quite often there are none. That is exactly why hypertension is termed a “SILENT KILLER”. Diabetes (high blood sugar) and dyslipidemia (abnormal cholesterol level) are the other two Silent Killers. All 3 should be measured at least once every year to catch abnormalities early.

Prevalence and Types of hypertension

An article published in the Journal of Hypertension in 2014 estimated that 1 in 3 persons living in cities and towns and 1 in 4 individuals living in rural areas in India are hypertensive.

Primary hypertension is the most common type where there is no specific cause for the high BP. General preventive measures like reduced salt intake, high fiber diet, regular exercise and stress reduction techniques should be the first line of management in this case. Medications are often prescribed to control your BP, it is best to take them as advised by your doctor and not stop them on your own.
Secondary hypertension is less common and denotes that there is an underlying medical problem for the high BP like kidney disease, hormonal disorder, structural problem in the major artery leaving the heart or other cardiac diseases. Very high BP at the time of diagnosis, blood pressure not responding to medical management and presence of other health issues are clues to this type of hypertension. Appropriate treatment of the underlying cause will help to manage hypertension in this case.

Impact of hypertension on your heart and other systems

Your heart is constantly pumping blood and supplying oxygen and energy to each and every cell in your body through your arteries. The health of your arteries is a very important factor that determines the health of your heart.

Constant increased pressure of the blood flowing through your arteries can damage the inner wall and lead to hardening or stiffening – Atherosclerosis. This in turn can lead to heart attack, stroke and other serious problems. Another life-threatening effect of untreated high BP is Aneurysm or weakening and bulging of important blood vessels like those supplying the brain and the major blood vessel leaving the heart. Rupture of these bulging arteries can lead to instant death.
Heart failure is one of the common complications of high BP wherein the pumping capacity of the heart drops below normal. This is measured by an echo test and the symptoms are weakness, breathlessness and swelling of feet.
Chronic kidney disease is again very common in hypertensive individuals and is due to damage to the blood vessels supplying the kidneys. The kidney function gradually drops which is seen as rising urea and creatinine levels in blood and reduced urine formation.
If you have high BP, regular eye checks are a must because an increased pressure in all the arteries including the arteries of the eye is possible. This can lead to damage to the back of the eye called Hypertensive Retinopathy, which can impair vision.
Memory loss, dementia and cognitive impairment are neurological complications of hypertension.

With World Heart Day fast approaching (29 September), let us all take a pledge to know our blood pressure and keep it under control!