New Year Resolution

MUSCAT - December 31, 2003 The Heart is one of the most amazing organs in our body. Situated in the centre of the chest and size about that of ones' clenched fist, it is actually a very specialized pump; the right side supports the pulmonary circulation which is concerned with collecting impure blood from the body, low in oxygen content and pumping to the lungs for making it oxygen rich again; the left side is concerned with collecting oxygen rich blood from the lungs and pumping it to the various parts of the body. More

HEART AND CHOLESTEROL

Heart disease is the single most common cause of death in the developed countries and it accounts for almost 1 Million deaths in United States alone each year. Almost half of these deaths directly result from coronary heart disease, which is the medical term for diseases we commonly call 'Heart Attacks'. Situation in The Middle East is not different. The increasing economic wealth, urbanization, adoption of western diet and life style, all result in increase in the Cardiovascular disease, which is now the leading cause of deaths in the region ranging from 25 to 40% of all deaths.

What is coronary heart disease?

This disease involves the ' coronary arteries' or the blood vessels that supply the heart muscle. They become narrow with the formation of 'plaques' on their walls, ultimately leading to formation of blocks resulting in deprivation of blood and Oxygen to the heart muscle. Some times these plaques might rupture resulting in blood clotting and sudden blockage of the artery at this site. This deprives blood supply to the heart muscle distal to this block and it starves to death, resulting in what we commonly call a heart attack.

Can we prevent Heart attacks?

When doctors talk about coronary heart disease they tend to talk in terms of risk factors. High blood pressure, diabetes, cigarette smoking, and high blood cholesterol are some of the risk factors which when left untreated are likely to lead to heart attacks or blockage of coronary arteries. Advancing age, male sex and a family history of heart disease, about which we cannot do anything, are in other words "nonmodifyable risk factors" as against the " modifyable risk factors" we listed earlier. Now it is well known from various studies that by controlling or modifying the risk factors we can, to some extent prevent or even regress the process of "blockage of blood vessels" or atherosclerosis.

Importance of Cholesterol

The early experiments by a scientist called Anitschow demonstrated that cholesterol is an important content of the 'plaques', which block the arteries. Then various Epidemiological studies showed that there is a strong and graded relationship between saturated fat intake, blood cholesterol and the incidence of coronary heart disease. Recently we have plenty of data from many studies involving thousands of patients, that by decreasing blood cholesterol levels, we can prevent and decrease the deaths from heart attacks.

The types of cholesterol

Cholesterol in the body exists as various fractions, bound to proteins called Lipoproteins.
Some of these fractions transport cholesterol and fats from their storage sites and transport them for removing from the body. This fraction is beneficial and it is aptly called the 'good Cholesterol', the HDL cholesterol. When the HDL cholesterol levels are high, the chances of developing heart disease are low.

But the 'bad cholesterol' or LDL cholesterol is the fraction, which transport cholesterol from the liver to various sites in the body, including the walls of arteries. So when the level of LDL rises, naturally the chances of heart attacks also become high. The level of Triglycerides or the saturated fats in the blood, now has also shown to correlate with coronary heart disease.

What are the normal values of blood cholesterol?

The level of total cholesterol is considered optimum when it is less than 200 mg/dl in a person without heart disease. In persons with known coronary heart disease even lesser levels are optimum. The desirable levels of other Lipoproteins are given below:

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LIPID GROUP CATEGORY
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LDL Cholesterol concentration mg/dl

< 100 Optimal

100 - 129 Near or above normal

130 - 159 Borderline high

160 - 189 High

> 190 Very high

Triglyceride Concentration (mg/dl)

< 150 Normal

150 - 199 Borderline high

200 - 499 High

> 500 Very high

The level of HDL above 40 mg/dl is considered desirable and above 60 mg/dl is considered low risk. For a person with heart disease or diabetes, the LDL cholesterol goal is less than 100 mg/dl; in others it is less than 130 mg/dl.

What one should do if the Cholesterol is high?

The recommendation is to check the cholesterol level once yearly for all persons above 20 years of age. If it is found more than 200 mg/dl, a full fasting lipid profile (LDL, HDL, Triglyceride levels) should be estimated. If the levels are found higher, the first step is to change the life style. Decrease the intake of fats and more so, saturated fats; also decrease the intake of dietary cholesterol. For this, restrict the use of coconut oil, ghee, margarine etc that contain mostly saturated fat. Avoid fried food, red meats like mutton, beef etc; avoid the yellow of the eggs which contain plenty of cholesterol. Use milk and milk products sparingly and use low fat or skimmed milk only.

Chicken after removing the skin may be used occasionally; fish can be used, provided not fried; but all kinds of shellfish, prawns, and crab are rich in cholesterol and should be avoided.
Use plenty of fresh fruits and vegetables. They are rich source of vitamins and substances called Antioxidants, which actually prevent Atherosclerosis. The need to keep ideal body weight and avoiding obesity is another corner stone in preventing heart disease.

You are overweight if weight in kg
-------------------- = > 25
(Height in M)2

Which is otherwise known as body mass index or BMI.
There is another type of obesity where the BMI might not have become high; but there is a greater fat distribution in the abdomen; this type of obesity, the abdominal or central obesity is more associated with coronary heart disease. A waist circumference more than 102 cm in males and 88 cm in females is considered abdominal obesity.

Do aerobic exercises like brisk walking, swimming etc for 20 - 30 minutes / day at least 5 days a week. If the levels of blood cholesterol remain high despite trying all these measures for more than 3 months, you may sometimes require drug treatment and further assessment. So consulting a specialist doctor is desirable.

Dr.Benny Panakkal MD.,DM
Cardiologist and Medical Director,
Badr Al Samaa Polyclinic, Day
Care Surgical and Matrnity Centre,
Ruwi, Muscat.