Metabolic Syndrome is a threat to heart health

At our centre, we regularly come across individuals with multiple health problems, particularly those related to heart disease. Very often, they need robust prevention and rehabilitation programs to help improve their physical, physiological and psychosocial wellbeing.

One such condition which we encounter commonly these days is “Metabolic Syndrome”. As the name suggests it is a combination of multiple risk factors of heart disease such as abdominal obesity, high blood pressure, increased blood sugar level and abnormal cholesterol level. This condition is growing in number day by day in India and expected to grow exponentially across the globe. The fact that several risk factors are present in the same individuals puts them at a very high risk of heart attack and stroke.

Based on multiple research findings, the rise in the incidence of obesity and diabetes was found to be the main reason behind the increase in metabolic syndrome. Also, the younger population, that is individuals between 25 and 35 years of age, are most affected suggesting that it is high time the youngsters take note of it!

The criteria for diagnosing Metabolic Syndrome as per the International Diabetes Federation guidelines in 2006 are:

  • Higher waist circumference – more than 102cm for men; more than 88 cm for women & higher BMI
  • Increased blood sugar level – more than 100 mg/dL
  • Abnormal cholesterol levels – increased triglycerides and decreased High-Density Lipoprotein
  • Increased blood pressure – more than 130/85 mmHg
Obesity
Diabetes
Unhealthy Diet

The unhealthy lifestyle choices of our people such as

  • Physical inactivity
  • Unhealthy diet
  • Chronic stress
  • Disturbed sleep pattern
  • Increase in tobacco and alcohol consumption

are the culprits causing this sudden surge in metabolic syndrome.

One important fact to be highlighted here is that all the above risk factors are interrelated which means that the occurrence of any one of the risk factors could pave way for the others as well.

If an individual has been diagnosed with metabolic syndrome, the following management should be initiated at the earliest:

1. Intensive lifestyle modification

An intensive lifestyle modification program is the first and only step in fighting metabolic syndrome, especially in individuals who are young, whose blood pressure, blood sugar and cholesterol levels are borderline elevated and who are free of organ damage. The program typically consists of health education about the condition and its effect on the body, tailor-made exercise training which focuses on controlling blood pressure, lowering blood sugar and cholesterol levels and education about the importance of exercise, along with personalized dietary guidance. Psychosocial counselling to help individuals cope better with their mental stress and emotional problems is also included in the program.

Importance of Exercise Training in Metabolic Syndrome

Exercise training is the cornerstone in the lifestyle program because of its multiple benefits:

Aerobic Training

  • Helps to improve endurance and stamina
  • Results in fat and carbs being used up as calories
  • Lowers blood sugar, normalises cholesterol level and also controls blood pressure
  • Aids in weight loss

If you are wondering how much aerobic exercise is adequate, here is my recommendation:

Frequency Intensity Duration Type
5-7 days/week Mild to moderate Intensity 30-60 minutes/day walking, jogging, cycling, swimming, hiking, treadmill,
EFX

Strength Training

  • Helps to improve muscle strength and power
  • Aids in calorie expenditure and weight loss
  • Increases muscle mass and reduces fat mass
  • Can be done with the help of equipment or use of bodyweight too

Guidelines for strength training:

Frequency Intensity Duration   Type
2-3 days/week Mild to moderate Intensity 20-30 minutes/day Bodyweight (push-ups, pull-ups, squats), dumbbells, barbells,
machine-based

Other types of exercise training such as flexibility training, interval training and circuit training can be incorporated in the exercise program as per the individuals’ needs and health goals.

2. Medications

In individuals with advanced metabolic syndrome, that is high levels of blood sugar, abnormal cholesterol and uncontrolled blood pressure, medications such as anti-diabetic drugs, anti-hypertensive drugs and cholesterol-lowering drugs should be initiated along with the lifestyle intervention.

3. Surgery

Fat-reduction surgery or bariatric surgery is sometimes needed to address severe obesity especially if it does not respond to lifestyle changes and medications.

As metabolic syndrome is on the rise and so is the incidence of heart attack and stroke, we need to adopt a healthy lifestyle that includes regular exercise, balanced diet, well-managed stress and adequate sleep, along with regular medical checks. It is never too early and never too late to make a change that will improve your health and your overall wellbeing.

The 9 cardiovascular risk factors we should watch out for

As a Preventive Cardiologist, the question I get asked most often is this:

“I (or someone I know) have no bad habits and have not had any health problems in the past, but ended up with a heart attack. How come doctor?”

My immediate response is that there are 9 risk factors for serious heart and blood vessel disorders like heart attack and stroke. In fact, each of these 9 are independent risk factors which can cause disease by itself and when present in combination poses a very high risk of fatal heart disease.

The 9 cardiovascular risk factors: The Framingham (1) and the INTERHEART (2) studies are both landmark research works that have clearly identified the cardiovascular risk factors in all populations. The image below depicts the 9 risk factors that we should all be aware of and should watch out for.

A questionnaire-based survey was conducted this World Heart Day by Cardiac Wellness Institute to study the presence of behavioural risk factors for heart disease among college-going women in Chennai. Of the 554 students aged 15-30 years who responded to this survey, almost 40% reported to be chronically stressed. We have also noted a similar trend of staggeringly high rates of chronic mental stress among young corporate employees. Intensive lifestyle modification supervised by medical professionals has proven effective in changing dietary, exercise, sleep and stress-related risk factors in all age groups including young adults.

Hypertension, Diabetes and Dyslipidemia are the three silent killers which can only be identified by routine health check up. All 3 conditions often co-exist in the same individual but do not cause any symptoms leading to a very high risk of sudden death. Simple tests like blood pressure measurement and blood sugar and lipid level analysis will throw light on your risk profile. Mild variations from normal and early stage of disease can be managed with lifestyle changes alone but more severe abnormalities will require medications in addition to lifestyle changes.

Unhealthy diet, Inadequate exercise, Obesity, Mental stress along with tobacco use and alcohol abuse are the risk factors that are soaring high in our population. Spreading awareness about the ill-effects of these lifestyle choices is the first step in curbing them. The second and most crucial step is providing the right tools to help people modify their risky behaviour. Exercise training, meal planning guidelines, stress management techniques, goal-setting to become fit, and professional help to quit smoking and drinking are some ways we help individuals succeed in making these difficult but salient changes that impact their health in a very positive way.

If you have a family history of cardiovascular disease, that is your parents or siblings have had a heart attack, stroke or other cardiac problems, you need to be even more vigilant about the 9 risk factors and take all steps to lead a heart-healthy lifestyle.

Action Point 1 If you are over 40 years old and have not had a medical check yet, it is time you saw your doctor for a cardiovascular risk assessment. If you have had a doctor check up more than 2 years ago, you need to repeat one now.

Action Point 2 If you are over 20 years old and think you have 1 or more of the above risk factors, you should get a doctor’s opinion and blood examination every 5 years.

Action Point 3 If you have been taking medicines for any of the above risk factors, you need to revisit the problem along with your doctor to understand the response to medications and the need for lifestyle modification to reduce and eventually even stop medicines if all parameters are well controlled.

The 4 components of exercise to counter high BP

High blood pressure (BP) or hypertension is a major threat to your health and your quality of life. It can lead to life-threatening conditions like heart attack and stroke. The youth in India is more and more affected by this medical hazard. In fact, 1 in 5 young adults in our country is suffering from hypertension, according to a recent press release (1). So it is time to shift our focus to preventive rehabilitation in the younger generation.

Preventive rehabilitation is designed to reduce risk factors and prevent diseases. It is teamwork of physicians, exercise therapists, nutritionists and psychologists. In this blog post, I would like to share some exercise tips for the prevention and cure of hypertension.

Are you aware that exercise can reduce blood pressure? Indeed, regular physical activity not only reduces the stiffness in your blood vessels but also makes your heart more efficient hereby lowering your blood pressure to a desirable level.

Aerobic exercise, strength training and flexibility exercise are the three components of exercise that work hand in hand to bring down your elevated BP to normal levels. And together with breathing exercises, you definitely have the upper hand against high BP!

Aerobic Exercise

Any activity that you do use a large muscle group for a long duration which increases your heart rate and breathing rate is known as aerobic exercise. The best examples are walking, cycling and swimming.

Strength training or Resistance Exercise

I am often faced with the question “Is resistance exercise safe?” The answer is YES. It has long-term health benefits on all muscles including the cardiac muscle and also reduces the overall resistance in the arteries which is the underlying culprit causing high BP(2).

The American heart association recommends 2 days per week of resistance exercise for cardiac and hypertensive patients.

Flexibility Exercise

It improves flexibility and blood flow in the muscles. Regular flexibility exercise improves muscle endurance. Yoga is the best example of this group of exercise. It is not only a mind-body aligning tool but also a great stress buster.

Breathing Exercise

Find a comfortable spot at home or at work and start breathing deeply and slowly in a relaxed way for 10-15 minutes. This is known as deep breathing or regulated breathing or pranayama and it helps to relax your mind and your body. Special breathing techniques need to be learnt from experts and practised the right way for maximum health benefits.

The above-mentioned exercises are ideal for hypertensive patients. In addition to exercise, dietary changes and stress management training for all and BP lowering medication for a few are the best tools to reduce blood pressure. Most importantly, consult your physician before beginning your exercise program. We provide personalised preventive rehabilitation programs for individuals with high blood pressure, diabetes, cholesterol problems, body weight issues and psychosocial problems including chronic stress and addictions. The outcomes of our programs are excellent and our results have been published in international medical journals.

Reference

  1. https://www.escardio.org/The-ESC/Press-Office/Press-releases/One-in-five-young-adults-in-India-has-high-blood-pressure
  2. https://www.ahajournals.org/doi/pdf/10.1161/JAHA.112.004473

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!

 

 

Relax, Refresh, Recharge

In the midst of our busy lifestyle, we very often forget to relax and rejuvenate our mind and body. Relaxation is nothing but a state of physical and mental calmness. Being relaxed automatically gives us the ability to manage psychological stress and anxiety in all situations. There are many techniques to help us attain a relaxed state, in this blog, I’m going to walk you through the popular stress-buster called “Progressive Muscle Relaxation Technique”.

As the name implies, this involves sequentially contracting and relaxing various muscle groups in our body.

The two steps to be followed in this technique are:

  1. Contract  (or) tighten
  2. Relax (or) release

Who should do it?

While anybody who desires a relaxed mind can follow this technique, anxious, stressed out and psychologically disturbed individuals should definitely practice this method for an improved state of mind.

Before starting…

  • Set a quiet place in your room
  • Wear loose, comfortable clothing
  • Free your time
  • Sit (or) lie down on a mat on the floor or on a firm bed
  • Initially take 5 deep breaths

Steps

  • Inhale and contract one muscle for 5 to 10 seconds
  • Then exhale and suddenly release the tension in that muscle
  • Give yourself 10 to 20 seconds to relax, and then move on to the next muscle
  • Try to focus on the changes when the muscle is relaxed
  • Gradually work your way up the body contracting and relaxing muscle groups

Note

  • The muscle contraction must be gentle, not too strong and painful
  • The technique must be performed slowly and your mind should be focused on it
  • It takes some time (probably a week or two) to get the right technique
  • Each session would take about 10 minutes, you can start by doing it 2 times per day.
  • Stay relaxed for a bit, and then slowly returns to daily life.

Benefits

  • Alleviates stress and anxiety
  • Reduces blood pressure
  • Relieves insomnia
  • Prevents heart ailments by keeping the risk factors under control
  • Improves symptoms of chronic pain
  • Improves memory and concentration as it is a form of meditation when done right

Contract-Relax and Feel Relaxed