On Saturday, May 10, marking the occasion of National Lipid Day, Health Live@Seniors Today hosted Sr Interventional Cardiologist Dr Sanjay Rajdev. He spoke on – Correct Your Lipids, Protect Your Heart
Dr Sanjay Rajdev, an accomplished Cardiac & Vascular Interventionist with fellowship training in the USA.
After his fellowships, Dr Rajdev worked at Seven Hills hospital, Mumbai for eight years, this was followed by a stint at the largest health care provider in the UAE, the New Medical Center (NMC). Dr Rajdev spent over six years at New Medical Centre (NMC) in Abu Dhabi, where he continued to achieve several “firsts” in the hospital and in the UAE.
He then returned home to Mumbai, where he established “Rajdev MediClinic,” a polyclinic featuring state-of-the-art systems for non-invasive cardiology evaluation.
His core interests include all types of Interventional Cardiology treatments including coronary angiography, angioplasty, peripheral angiography and angioplasty, closure of heart defects, treatment of thrombotic vascular disorders and pacemaker implantation.
Qualifications:: MBBS, MD (Medicine) Gandhi Medical College and Hamidia Hospital, Bhopal; DM (Cardiology) Seth G.S.Medical College and King Edward VII Memorial Hospital, Mumbai
Fellowships in Interventional Cardiology at the University of Alabama at Birmingham & Mount Sinai Medical Centre, New York, USA.
Correcting your lipids and the protection of your heart as a result.
The aim is prevention.
A few highlights:
The cardiovascular disease epidemic in India is getting worse by the day.
It is unfortunately characterised by a relatively high relative risk burden, and there are more and more people subject to getting supper affected by this particular disease entity.
There is an earlier age of onset. And unfortunately there is a higher case of fatality. That means, if you get this cardiovascular disorder, then more people are likely to die in the Indian subcontinent as compared to some of the Western people and the Western population.
We also encounter higher premature deaths as a result of these acute heart attacks, so that also underscores the importance of knowing about our risk factors and risk burden so that we can take appropriate actions in the nick of time.
Why are Indians are at an increased risk of heart disease?
Research indicates biological differences in us versus other populations mainly in the matters in which we differ from the other population in terms of lipid metabolism, abnormalities, glucose metabolism, the way our body handles glucose inflammatory states.
These are very important things for us to remember. Not many of us think that a heart block is because of inflammation, but actually it is nothing but an inflammatory disorder.
There are genetic predispositions which we need to address and check, especially in people who are dying of heart problems at a younger age.
Epigenetic influences also account for the increased cardiac risks. But the main important question is, can we do anything about it?
In India, obesity is becoming a big problem. According to a recent Lancet study, most of the Indian population falls into the category of being overweight. At least 70% of the Indian population is overweight.
BMI is Body Mass index, which is nothing but a ratio of your height versus your weight. So it gives you a number, for example, if it is more than 25 you are classified as overweight, and once it is crossed 30 you are classified as obese.
It is rather imperative that we understand that knowledge based among doctors is varied, and that leads to contradiction because everybody is not on the same page.
There are several more models of risk prediction that are available.
The ACVD – Atherosclerotic Cardiovascular Disease – Risk production, risk prediction and outcome.
Atherosclerotic cardiovascular disease means anatomical blockages in your heart arteries, the coronary arteries including the leg arteries and brain arteries anywhere where there’s a block. For example, then you tend to be labelled as, and having suffering from Acvd.
There are other risk factors also, like the heart failure which is risk, prediction and outcome, cardiovascular risk, prediction and outcome in chronic kidney disease. So there are other tools which will predict your risk of developing a heart failure. And there are other tools which will help you to develop a risk factor for developing a chronic kidney disease.
As per American guidelines, your risk is your chance of dying from heart attack in the next 10 years. So let’s say, if you are a 40 year old gentleman, and we are trying to understand what is going to happen to you in the next 10 years. What is your theoretical probability of dying from heart attack in 10 years? This is Acvd Risk.
What contributes to Ascvd?
If you have high cholesterol, it will develop in your heart arteries, causing blockages. If you have high blood pressure, that blood pressure triggers more development of injury to the interior of the arteries, and that leads to more accumulation of these lipids.
Diabetes is also associated with a wide variety of inflammatory and other vascular problems which lead to more accumulation Obesity, smoking, unhealthy diet, physical inactivity, family history of Acvd. These are all risk factors for you to eventually develop into an Acvd subset.
Nowadays we are also seeing many young patients who are coming up not only with heart blocks, but they also tend to go into heart failure and kidney failure. Now this is something which is new.
We are also trying to understand the mechanisms behind them. But this is a reality that we are confronting these days. Many young patients are developing heart failure and kidney failure, and there is a need for us to incorporate other alternative risk factor models so that we can restratify them. These younger individuals for their risk of heart failure and kidney failure also the similar way that we are predicting the risk of dying because of a heart attack.
Simply put, this would mean that younger and younger patients are dying with heart failure and kidney failure, and we need to take into account their overweight and weight, related complications also.
The emphasis on cholesterol, we will just discuss a few things about cholesterol. Obviously, all of us know that major heart disease risk factors are 3 — High blood pressure, cholesterol and diabetes.
Cholesterol is nothing but a vaccine. Cholesterol is a vaccine substance found in each and every cell. It is used by the body to make certain hormones and vitamin d.
Too much of everything is bad, so too much cholesterol is also bad. So what happens if your cholesterol is high? If your cholesterol becomes high, it increases the chances of build-up of fatty acid deposits in the heart artery, and this leads to heart attacks and paralytic attacks for strokes.
There are several studies to show that if you lower the risk of heart disease you can lower the levels of these cholesterol in your blood.
Symptoms of high cholesterol
Most people, unfortunately, have no symptoms of high cholesterol, but very occasionally some people have got fatty streaks which can be used at parts of their exposed parts of the body, like, for example, on the upper eyelids or on the lower eyelids. These are cholesterol, rich deposits visible under the skin, and these are called ankylasmal Xancy. Sometimes they are present on the body also, and these indicate indirectly that the level of cholesterol in the body so extra cholesterol is getting deposited, not only inside the heart artery, but also on the under the skin also in certain instances.
If you’re a smoker, if there’s a lack of physical activity. If you’re obese.
If you are adhering to an unhealthy diet, increasing too much salt and fat, or if you’re consuming excessive alcohol
The block’s development accelerates. If you have any of one of these factors inside you also.
There are some things which we cannot change, for example, a small family history type list of. Any male member in your family has developed a heart disease or stroke before they were before the age of 35 years, or a female in the family who develops similar problems before the age of 65 years. This indicates that you are probably carrying a part of the genetic pool which is predisposing to early heart blocks. Being a male also makes you predisposed to early blockages in the heart.
Estrogen is a protective hormone. Once women get menopause, the protective effect of estrogen is no longer apparent and no longer there they also tend to develop blocks.
How do you test for high cholesterol?
Cholesterol is tested by a single simple blood test. This can be done: Usually the testing can start with the fact that younger and younger people are getting affected at the age of 20 years for somebody that you’re testing the age for 20 years should have had a family history of heart problems, or a family history of high cholesterol. Otherwise, after 30 years of age, it is reasonable for us to scan the general population, and then, after every 3 to 5 years, depending upon what the reports we get.
There’s a myth that we should be 100% fast. There are many labs with that fasting level, but of late we have accumulated enough evidence to suggest that it is not usually necessary to fast before cholesterol test, unless we are testing for a specific type of fraction of lipids called triglycerides. In that case fasting is appropriate.
There is a bad cholesterol called LDL cholesterol, or low density, lipoprotein, cholesterol. There is a good cholesterol called high density, lipoprotein, or stn. There are triglycerides, which are nothing but after food. When you take food, this is a subtraction of lipids, which become more apparent in the bloodstream after a meal. So that is why fasting is required. The bad cholesterol should be less than 100 in the general population. But in a specific population, for example, those who have got blocks in the heart arteries. The recommendation can be less than 70 minimum, and it can go to less than 55 in certain instances.
What is the treatment of high cholesterol?
Diet, exercise, lifestyle, modification.
There are many other things also which come into play for a good cardiovascular, healthy life. Change our diet from an unhealthy diet to a healthy diet to reach a healthier cholesterol.
And it’s also advisable to reduce the saturated fat and trans fat in your diet.
Dietary change alone, they do not lower the cholesterol, much to increase the person’s risk of adverse disease
Foods which are rich in olive oil, avocados, nuts, and these can help you to lower your bad cholesterol. Some similarly polyunsaturated fats which are found in fish and flax seeds and walnuts. These are crucial not only for heart function, but also for pain function. These all also include Omega 6. These are healthy fats.
Statins
Statins are the only medical therapy which has shown consistently over several decades of preventing heart attacks or reducing the events of developing, reducing the risk of developing heart disease. So our main focus has been writing statins for subgroups of patients where we find that the risk is more so, you can reduce your risk of developing a heart attack by using statins.
Statins are polyesteroline medical therapies which have been available for the past 30 years or more. The most common side effects with statin are muscle aches and pains, and sometimes nausea and vomiting because of liver enzyme elevation.
Our Bmi, which is, as we discussed the ratio of the height and the weight
The waist circumferences should be in order, and a blood pressure of less than 140/ 90 is recommended. This definitely needs to be done either by diet modification, which means weight reduction in consuming less of salt, consuming more of potassium, grains, whole grains, vegetables, fruit, and fish.
LDL is deeply attached to the risk of developing heart blocks. So if you want to reduce both of them, what should we do?
We should avoid dietary trans-fat.
We should reduce dietary, saturated fat. Now these things, as you all know, are available in pasta, baked food, and biscuits.
We should increase our dietary fiber and use functional food with phytosterol. Phytosterol are good cholesterol amounts which are plant based, organic formulas where you can actually treat those people who are intolerant to statins. The Chinese use them a lot for providing heart healthy nutrition to people who cannot tolerate statins. This is known to improve endothelial function and reduce the amount of cholesterol in your body so you can use red yeast ice intraceuticals to reduce excessive body weight. It is very important for us to shed a few kilos.
Cereals – whole grains, don’t use polished grains, but whole grains are better.
You can have a little bit of refined red rice and pasta brown rice is recommended
Vegetables, obviously raw cooked vegetables. Avoid too much potato and butter, cream.
Legumes for good cholesterol maintenance are lentils, power beans, chickpeas, and soybean. Any fresh fruit is okay. Seasonal fresh fruits are recommended, non- caloric sweeteners are okay to be used in moderation.
Canned food to be used in only moderation, because there can be a lot of preservatives which are sweet in nature.
Meat and lean fish. Only lean and oily fish is good. For example, you can have sardines, mackerel, and salmon. Red meat should be avoided. Dairy food and eggs, skim milk and yogurt is good. Full fat cheese should be avoided.
Dressings should be a mustard dressing or a vinegar dressing. All kinds of nuts and seeds are good, unsalted ones should be used. Lemons, walnuts, pumpkin seeds, flax seeds.
The recommended way to cook is by boiling and boiling and steaming and roasting, and not by stir frying or by frying.
