The Tribune, Chandigarh, India

Heart disease is not just a problem of men
Dr Harinder Singh Bedi

"I can’t have heart trouble, I’m a woman."

If you were to repeat the above to yourself and if you got pain in the chest, you certainly wouldn’t be alone. But you could certainly be wrong — dead wrong.

The number of women who attribute symptoms of chest discomfort or pain to asthma, gas or indigestion and land up on my operating table after suffering a needless heart attack is just not funny. What is equally alarming is that even doctors are prone to not taking symptoms of heart attack seriously in women because of the misconception that women are nearly immune to heart attacks. The index of suspicion tends to be lower when treating a female patient. Thus when a woman comes to the emergency room complaining of indigestion, she is treated for indigestion. But if a man comes with the same symptoms, the first investigation is an ECG. This has been proven in numerous published studies from major centres all over the world. Even health care workers just don’t think about heart attack when it comes to women.

It is this misconception that kills. In America, one in two women die of heart disease (one in six die of breast cancer). This is because of the fact that in a heart attack scenario "time is muscle" — the sooner the appropriate treatment is started the more heart muscle can be saved from death. In women the classic heart attack symptoms (crushing, squeezing pain in the chest) may be replaced by "atypical" symptoms (chest discomfort, shortness of breath, indigestion, etc).

The good news is that on a average a heart attack is likely to strike a woman about 10 years later than a man. Many men have their heart attack between 45 and 55, but women generally do not have trouble till they reach menopause. However, exceptions to this are not very uncommon and if a woman were to get an attack between ages 45 and 55, she is more likely to die from it than a man. Also a disturbing trend that I and a lot of my colleagues have noted with concern is that heart disease is now attacking younger women too even before menopause.

Identifying the trouble

At times it may not be easy to know that you have heart trouble. Here are some pointers:

If you are having any of the symptoms for the first time — think of a heart attack

Trust your intuition — it is a fact that women have a better sixth sense and can track their bodies much better than men. If a woman walks into my clinic and says that she has an acute heart trouble, keep aside everything else and listen to her.

A chest pain can be an early sign of an impending major heart attack. The classical chest pain — called angina pectoris — is a squeezing pain that starts in the centre of the chest and can radiate to the shoulders, left arm, face or back. Angina is your body’s way of telling that the heart — the very organ that pumps oxygenated pure blood to all organs — is itself being starved of oxygen-rich blood due to a blocked coronary artery (artery supplying blood to the heart).

However, the body’s message may not always be so clear. About 1/3 of all heart attack patients feel no muscle pain at all. Angina may be replaced by a dull ache in the chest, a heart-burn or acid reflux, a vice like pressure in the chest, pain in a tooth, profuse sweating, nausea, light-headedness, fainting, palpitation or unexplained anxiety or no sensation at all — the so-called silent attack.

Preventing heart attack

Most preventive efforts have been directed towards men. Many risk factors for heart disease are actually more important in women than in men — diabetes, high blood pressure, etc. Women must be checked for the following risk factors:

Diabetes: can be easily detected by a blood test

Weight: the more overweight you are, the higher the risk of a number of diseases, including heart disease. Every an extra kilo increases the risk. Keep a weekly record of your weight. Stick to a sensible prudent diet avoiding deep fried food, fats, rich desserts and red meat. Use the tandoor, microwave and non-stick frying pans to reduce the use of oils in cooking. Steaming, boiling, poaching, baking and bar-be-cue are some easy and exciting alternative ways of cooking which you should experiment with.

Blood pressure: even mild-to-moderate hypertension increases the risk of heart disease. Please remember high blood pressure is not an infection needing treatment for just a few days. Its treatment could well be lifelong. Do not stop anti-hypertension medicines just because you "feel better". Do consult a doctor.

Cholesterol: the aim is to have low levels of the "bad" cholesterol — LDL — and high levels of the "good" cholesterol, HDL. The best way to do that is to have sensible eating habits and do regular exercise. If that fails I feel that you are not following the above properly and need proper expert counselling. If that too fails, your doctor may prescribe some drugs called statins.

Stress: women are today exposed to much higher levels of stress than their mothers were. Women are today working shoulder to shoulder with their male colleagues. The nuclear family has placed an excessive burden on the women. Women are indeed a hardier race than men, but the present-day realities of life increase stress both at work and at home. Ways to reduce stress — by appropriate time management, yoga, meditation, exercise, any interesting hobby, etc — are available.

Smoking: tobacco use is a growing problem in women because of the advertising-fed wrong notion that elegance, liberation, thinness and smoking all go together. The cigarette ad catch word of yore — "You’ve come a long way, baby" — should not attract our educated intelligent mature women any longer.

Sedentary lifestyle: some regular exercise is a must. Make sure it is something you enjoy. Walk up stairs rather than taking the lift.

Other blood factors: like homocysteine, C-reactive protein, etc, may need to be regularly checked

Hormone replacement therapy (HRT)

A controversial issue regarding the prevention and treatment of heart disease in women is the role of HRT. Expert opinions vary widely. Some believe that all women should take HRT at the time of menopause to help protect their hearts while others believe that this can make heart disease worse. The American Heart Association has very recently given certain guidelines which clarify matters. The association has recommended to doctors that the female patients who have a heart attack while on HRT should be taken off it, and that HRT should not be started in women just for heart attack prevention.

Thus, it is apparent that a number of risk factors can quite easily be controlled with regular checkups, exercise, proper diet, lifestyle modification and proper medication if required. If the disease does progress, then see a doctor and insist on a complete cardiac checkup. Know enough not to ignore symptoms or to say that "its just gas, it’ll go away."

The writer is Chief Cardiac Surgeon and Chairman, Cardio-Vascular Surgery, Metro Heart Institute, Noida. Earlier, he was at the Fortis Heart Institute, Mohali. Mobile 9814060480.

AYURVEDA & YOU
Avoid incompatible food combinations
Dr R. Vatsyayan

ANCIENT ayurvedic literature sees proper diet as the most important long-term measure to gain health and longevity. Improper diet has been considered the main causative factor for disease. It is emphasised that by adopting right food we can not only add to the therapeutic value of medicines but also eliminate one of the fundamental causes of ill health. The ayurvedic approach towards food and nutrition revolves around some of the time-tested principles which aim to correct the systemic anomalies occurring in both healthy and diseased persons from time to time.

There are many factors which determine the effect of food on our body. All the food articles possess some inherent qualities and according to Charaka, the food which can derange the normal body functions has been stated as “ahitakara” or unwholesome. Some of these food articles affect our health due to their mutually contradictory properties, some by the method of preparation and others by virtue of their wrong utilisation. Supporting these principles, many ancient authors define that even the wrong application of time and place also leads to the incompatibility of various food items.

Unfortunately, the incongruity of food combinations is perhaps the most overlooked part of our diet. We knowingly or unknowingly subscribe to many of the incompatible food combinations, which over a period of time result into serious health hazards. Ayurveda believes that milk and curd should never be taken together because their combination often leads to acidity, impairing the very first step of digestion. Milk is also incompatible with fish, reddish, meat, pickles and citrus fruit. Similarly, curd doesn’t find favour to be used with hot drinks, cheese, meat and sour fruit. One should avoid taking fruits with potatoes and other starchy things. Eggs are also incompatible with milk, curd and cheese.

While discussing the incompatibility of weight and proportions of food articles, ayurveda advises that two oily substances like oil and clarified butter should not be used in equal quantity. Another classic example in this regard is of ghee and honey. If they are to be used in the same formulation or recipe, one of them should be used double than the other. Regarding the incompatibility of tastes, food articles containing sweet and bitter tastes and sweet and astringent tastes should not be consumed together. Taking aerated drinks and very cold water with warm food and eating icy delicacies immediately after food also doesn’t find approval of ayurvedic dietary rules.

Apart from the different food combinations which need proper discretion, there are factors which also affect the quality of food to a great extent. They include procedures of processing or preparing food like its cleansing, cooking, flavouring, preservation and the type of containers used for the preparation and storage of food. Latest research has confirmed that the use of chemical preservatives, colouring material, cooking in copper vessels and the storage of citrus food items in aluminium containers lead to certain toxicities in the body.

It shouldn’t be forgotten that excessive and over-use of any type of food, even if it is wholesome, can also lead to harmful effects on the body. The adjoining table tells some of the anti-dotes of commonly used food items. Still it is pertinent to remember what Acharya Sushruta has said: By taking substances which are incompatible with one another regarding their tastes, potencies and digestive transformation, a greedy and intemperate person becomes afflicted with disease.

The writer is a Ludhiana-based senior ayurvedic consultant. Contact phone nos. 2423500/2431500 email sanjivni@satyam.net.

INFO CAPSULE
Capillaries for tackling heart ailments

London
UK scientists have found that the tiniest of human blood vessels called capillaries are far more important in tackling heart disease than previously thought, according to reports published in the journal Cardiovascular Research. Experts previously thought that these tiny tubes did not have the ability to constrict and widen as arteries do to regulate the flow of blood.

However, scientists at Queen Mary's School of Medicine, Bart's and the London Hospitals, and City University, all in London, have shown that even these tiny blood vessels can do it. This means that they could potentially play a much bigger role in the part of a heart operation where the organ is taken off and normal blood flow has to be re-established. ANI

Teenage access to cigarettes

Washington: Researchers are of the opinion that new laws should be introduced to reduce easy access to cigarettes and stop smoking among teenagers.

Boys and girls in this age group, whose parents and adult friends smoked, were more likely to pick up the habit themselves, according to reports published in the American Journal of Health Behaviour.

Prof Susan Woodruff, the author of the report and a professor at San Diego State University's Graduate School of Public Health, said their research showed that these children found it easier to obtain cigarettes and that this could be a reason for them smoking. ANI

When women become more suicide-prone

Sydney: Hot summer months have a depressive effect on many people, forcing some of them to take the extreme step of suicide. But now researchers have found that women are more susceptible to the condition than men.

Russell Evans, a senior researcher at the Australian Institute for Suicide Research and Prevention at Griffith University in Brisbane, was quoted in a report in Sydney Morning Herald as saying that depression first developed in the winter months. ANI