Ischaemic Heart Disease – Commonest cause of death worldwide

By Prof. (Dr.) Anjan Lal DuttDr-Anjan-lal-duttaa, MD, DM(Cardiology), FACC (USA), Clinical Director – Department of Cardiology

Ischaemic heart disease (IHD) is a common heart disease of adults and it results from diminished blood supply to heart muscles. The word “Ischaemia” stands for lack of blood. IHD is now the commonest cause of death all over the world.

What is IHD?

Blood is supplied to the heart muscles through vessels known as coronary arteries and the supply is disturbed when vessel lumen is blocked due to deposition of fat & other materials. The process is known as atherosclerosis. Initially the arteries are partially blocked & finally get completely blocked. The whole spectrum is known as Ischaemic Heart Disease (IHD).

What are the symptoms of IHD?

Initially the symptom of chest pain is felt on physical exertion or on tension, or else the initial symptom may be quite deceptive. The pain may be replaced by just chest discomfort in the central part of the chest or just above the abdomen explained wrongly by most patients as “gas” or “acidity”. The pain may radiate to left and right arm, jaws or even to the back and subsides on taking rest. When the blood supply is totally blocked this may lead to heart attack medically known as “Myocardial Infarction” (MI). In this situation the pain is usually quite intense lasting even at rest associated with uneasiness, sweating or shortness of breath or sometimes even these symptoms may be absent or minimal in heart attack – known as silent MI. This is mostly seen in diabetic patients. IHD is the leading cause of death all over the world and also in India. Its incidence in India and in this part of the globe is increasing alarmingly because of our physical inactivity, wrong diet (junk food), and excess stress, high incidence of diabetes and lack of awareness. In India moreover 50% of heart attacks occur below the age of 50 years and 25% occurs below the age of 40 years. This is in contrast to patients of Western World where most of the heart attacks occur after the age of 60 years.

Are women at higher risk of IHD?

Women in general have less incidence of IHD before menopausal age which means below 50 years. But this protection is lost in diabetes. Diabetic women may have the disease at younger age like that of men. Otherwise there is no difference in overall incidence of IHD in men and women. However women having heart attack usually have greater complications and poorer outcome.

What are the risk factors of IHD?

There are five major Risk Factors (RF) for IHD. They are mainly – diabetes mellitus, hypertension (high blood pressure), smoking, high level of cholesterol or triglyceride in the blood and over weight (obesity). A person having more than one of the risk factors have two to four times greater chance of getting a heart attack compared to those who do not have it and if a person has diabetes, high blood pressure, high cholesterol in the blood & is overweight and also smokes obviously has an alarmingly high risk for heart attack. Other than the risk factors mentioned above, stress and family history of IHD are also additional factors.

Prevention of IHD

A smoker should immediately stop smoking. An overweight person should reduce his body weight with proper diet & physical exercise – what is known as therapeutic lifestyle changes. Similarly a diabetic patient should also have therapeutic lifestyle changes as well as medication for blood sugar control as per advice of the treating doctor. Hypertensive patients should see to it that his or her blood pressure is below 130/80 mmHg with the help of proper lifestyle changes along with medications when needed. Patients with high cholesterol or triglyceride in the blood should strictly follow healthy lifestyle and also take statin like medicines as and when prescribed so that LDL cholesterol remains between 100 to 70 mg % and triglyceride below 150 mg %.
The diet rich in legumes, lentils, fruits, vegetables should be encouraged & carbohydrate and other high calorie food like cheese, butter, coconut oil, prawn, etc should be restricted. Egg or meat can be taken in moderate amount provided the body weight is normal & triglyceride is not high. One should also avoid hectic activities & stress by doing yoga or meditation. Exercise in the form of brisk walking for 35 to 40 minutes a day (at least 5 days a week) is good enough. One need not go for jogging or heavy exercise without doctor’s advice. Maintaining lifestyle like this & keeping risk factors at bay will go a long way to prevent IHD. You keep your heart healthy & also help others to keep their heart healthy. It will be a great contribution to mankind.

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