Salil Midha, MD FACC

Chief of Cardiology and  Director of Cardiac Cath and Rehabilitation programsMelrose Wakefield Hospital, Melrose, MA

President, Boston Cardiac Foundation

www.bostoncardiac foundation.org

,

Acknowledgements

Thanks to the following web sites for the educational materials

American Heart AssociationCADI Research foundationMayo ClinicCardiac Cath. Lab, Melrose, MA

Heart Disease Overview

Number one cause of death in the worldMore people die of heart disease than

due to cancer and accidents combinedRecent treatments have lowered the

mortality due to the heart disease

Heart Disease Overview Begins in childhood and slowly progressesCauses plaque formationPlaque rupture causes heart attacks and strokeNo relation of severity of disease and symptomsAdvanced warning of angina in 1/3 rd patients onlyHalf of the sudden deaths occur in undiagnosed

Good news – Can be detected by stress test, heart scan and cardiac Catheterization

Heart Disease Prevalence Over Age 20

Deaths Due To Heart Diseases

Mortality Trends in USA

Heart Disease Indian Overview

1.2 Billion people33% below age 1550% below age 25Life expectancy is 64 years in 2008 (USA

75 for men and 78 for females)Only 5.5 % over 65( 65 million) vs. 13% in

USA (41 million our of 300 million people)2.3 million died of heart disease in India

vs. 404,000 in USA

Coronary Artery Disease in Indians

Mortality Ratios In UK Vs. Asia

Ethnic Differences

Cardiac Mortality in India

Stroke Mortality Ethnic Difference

Heart DiseaseDefinitions

Coronary Artery DiseaseAnginaHeart Attack/ Myocardial InfarctionCongestive Heart failureValular Heart diseaseArrhythmia like Atrial Fibrillation and

Ventricular tachycardiaCongenital Heart disease

Coronary artery DiseaseHeart supplies the blood and Oxygen to the

rest of the body.Average heart rate is 70 and BP is 120/80Heart is supplied by three arteries which are

known as coronary arteries. These are Left Anterior Descending, left Circumflex and the right coronary arteries

Coronary Arteries and Atherosclerosis

Heart Attack

A heart attack occurs when one or more of the arteries supplying your heart with oxygen-rich blood (coronary arteries) become blocked.

Coronary artery can become narrowed from the buildup of cholesterol. This buildup — collectively known as plaques — in arteries throughout the body is called atherosclerosis.

Causes of Heart AttackDuring a heart attack, one of these

plaques can rupture and a blood clot forms on the site of the rupture.

If the clot is large enough, it can completely block the flow of blood through the artery and cause heart attack

Atherosclerosis & Plaque Rupture

AnginaCondition when patient complain of chest

pain due to the lack of blood supply to the heart muscle

This generally happens slowly with some warning signs

However frequently there is sudden blockage of the vessel due to acute plaque rupture and closure of the artery with clot build up.

Symptoms of Heart Disease Pressure, a feeling of fullness or a squeezing pain in the

center of your chest that lasts for more than a few minutes

Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw

Increasing episodes of chest painProlonged pain in the upper abdomenShortness of breathSweatingImpending sense of doomFaintingNausea and vomiting

Prevalence of Heart Disease

Annual Rate of First Heart Attack

Estimated 10 Risk of Heart Attack

Deaths Due To Heart Disease In USA

RISK FACTORS IN ASIAN INDIANS

LDL Major risk factor

Age Adjusted CAD Death Rates

High Calcium Score and LDL

Regional Differences In India

Overview of Diet Significantly modifiable riskChange saturated and trans fats with poly and

monounsaturated foodsOlive and Canola oils are monounsaturatedSoybean and sunflower oils are polyunsaturated Total fat calories should be 25% of diet and

saturated foods should be less than 7%Omega 3 and 6 are found in oily fish, nuts and

seeds.Decrease salt intake and increase fruits and

vegetables

Corn Oil v Coconut Oil

Metabolic Syndrome for IndiansIncreased risk of Diabetes and heart

attackAbdominal obesity High cholesterolHigh Blood pressureLow LDL( good cholesterol)High triglycerides

Metabolic Syndrome

Prevalence of Obesity in USA

Obesity Overview Major modifiable riskOver 400 million people are obeseOver 1.6 billion people are overweight Caused by overeating and lack of physical

activityIncidence of Diabetes increased 3 fold in

men and 5 fold in womenPreventableShortens life span by 3 years

Prevalence of Hypertension

Diabetes Awareness, Treatment and Control

Annual Cost of Heart and Stroke

Effects of Niacin on Cholesterol

Projected Annual Cost By 2030

Indians Vs. White Populations

2-4 fold prevalence rate10 years earlier incidence of heart attack10 fold increase in young adults( below

age 40)3 vessel disease in young postmenopausal

womenHigher chance of death with heart attackDisease occurs with low body index and

with near normal BP and cholesterol.

Obesity in Asian Indians

Risk factors for Heart DiseaseAge over 40High Cholesterol and triglycerides Cigarette smokingHypertensionDiabetes MellitusFamily History of heart diseaseLack of physical activityObesityStressIllegal drug use

Prevalence of Smoking

Heart Attack Rx & Medications Aspirin Blood thinner Super Aspirins like Plavix(clopidogrel)NitroglycerinBeta blockersCholesterol-lowering medicationsAngiotensin-converting enzyme (ACE)

inhibitorsCoronary angioplasty and stentingCoronary artery bypass surgery

Statin Treatment Difference

Risk Factors INTERHEART Study Elevated cholesterol ratio. High Apo B

combined with low Apo A levelsSmokingDiabetesHypertensionAbdominal ObesityStress and depressionFailure to eat vegetables and fruit dailyFailure to exerciseFailure to drink small amount of alcohol

Support and Coping after Heart Attack

AngerGuiltDepressionCardiac RehabilitationSupport groups

Calories by Beverages in USA

Framingham Risk Score-10 yearWhile male 16%White female 11%Indian male 32%Indian female 22%Risk for Indians is at least twice as compared

to White population.

Body Mass Index BMI = Weight in pounds / Height in inches

Your body mass index (BMI) is an estimate of your body fat that is based on your height and weight. Doctors use BMI, along with other health indicators, to assess an adult’s current health status and potential health risks.

Exercise guidelines

100 % of your heart rate = 220 – your age

If your are 30 220-30 = 210

Achieve 70% of your peak heart rate for 30 minutes of exercise 3 days per week

Life Style Changes for PreventionLifestyle changes

Medications compliance Not smokingControlling certain conditions, such as high

blood pressure, high cholesterol and diabetesStaying physically activeEating healthy foodsMaintaining a healthy weightReducing and managing stress

Life Style and Home Remedies Smoking cessation- Single most important thingAvoid second hand smoke –no ash trays in homeCheck your cholesterol – know your HDL and LDLControl your Blood Pressure –Ideal below 120/80Exercise regularlyMaintain healthy weight-know your BMI-waist lineEat Healthy diet- low fat/saturated fatsVegetarian diet and white meat only-avoid red

meatManage stress decease alcohol content

CAD Risk in 60 Year Old

Helpful Guides

This presentation can be viewed anytime at

www.bostoncardiacfoundation.org

Other helpful sites

CADI researchAmerican Heart AssociationMayo Clinic

Recommended Treatment For Indians

thank you for listening!