,
Salil Midha,
MD FACC
Chief of Cardiology and Director of Cardiac Cath and
Rehabilitation programs
Melrose 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 Association
 CADI Research foundation
 Mayo Clinic
 Cardiac Cath. Lab, Melrose, MA
Heart Disease Overview
 Number one cause of death in the world
 More people die of heart disease than due to
cancer and accidents combined
 Recent treatments have lowered the mortality due
to the heart disease
Heart Disease Overview
 Begins in childhood and slowly progresses
 Causes plaque formation
 Plaque rupture causes heart attacks and stroke
 No relation of severity of disease and symptoms
 Advanced warning of angina in 1/3 rd patients only
 Half 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 people
 33% below age 15
 50% below age 25
 Life 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 Disease
Definitions
 Coronary Artery Disease
 Angina
 Heart Attack/ Myocardial Infarction
 Congestive Heart failure
 Valular Heart disease
 Arrhythmia like Atrial Fibrillation and Ventricular
tachycardia
 Congenital Heart disease
Coronary artery Disease
 Heart supplies the blood and Oxygen to the rest of the
body.
 Average heart rate is 70 and BP is 120/80
 Heart 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 Attack
 During 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
Angina
 Condition 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
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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 pain
Prolonged pain in the upper abdomen
Shortness of breath
Sweating
Impending sense of doom
Fainting
Nausea 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 risk
 Change saturated and trans fats with poly and
monounsaturated foods
 Olive and Canola oils are monounsaturated
 Soybean 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 Indians
 Increased risk of Diabetes and heart attack
 Abdominal obesity
 High cholesterol
 High Blood pressure
 Low LDL( good cholesterol)
 High triglycerides
Metabolic Syndrome
Prevalence of Obesity in USA
Obesity Overview
 Major modifiable risk
 Over 400 million people are obese
 Over 1.6 billion people are overweight
 Caused by overeating and lack of physical activity
 Incidence of Diabetes increased 3 fold in men and 5
fold in women
 Preventable
 Shortens life span by 3 years
Progression of Obesity
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 rate
 10 years earlier incidence of heart attack
 10 fold increase in young adults( below age 40)
 3 vessel disease in young postmenopausal women
 Higher chance of death with heart attack
 Disease occurs with low body index and with near
normal BP and cholesterol.
Obesity in Asian Indians
Risk factors for Heart Disease
 Age over 40
 High Cholesterol and triglycerides
 Cigarette smoking
 Hypertension
 Diabetes Mellitus
 Family History of heart disease
 Lack of physical activity
 Obesity
 Stress
 Illegal drug use
Prevalence of Smoking
Heart Attack Rx & Medications
 Aspirin Blood thinner
 Super Aspirins like Plavix(clopidogrel)
 Nitroglycerin
 Beta blockers
 Cholesterol-lowering medications
 Angiotensin-converting enzyme (ACE) inhibitors
 Coronary angioplasty and stenting
 Coronary artery bypass surgery
Statin Treatment Difference
Risk Factors INTERHEART Study
 Elevated cholesterol ratio. High Apo B combined with
low Apo A levels
 Smoking
 Diabetes
 Hypertension
 Abdominal Obesity
 Stress and depression
 Failure to eat vegetables and fruit daily
 Failure to exercise
 Failure to drink small amount of alcohol
Support and Coping after Heart
Attack
 Anger
 Guilt
 Depression
 Cardiac Rehabilitation
 Support groups
Calories by Beverages in USA
Framingham Risk Score-10 year
 While 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 Prevention
 Lifestyle changes
Medications compliance
 Not smoking
 Controlling certain conditions, such as high blood
pressure, high cholesterol and diabetes
 Staying physically active
 Eating healthy foods
 Maintaining a healthy weight
 Reducing and managing stress
Life Style and Home Remedies
 Smoking cessation- Single most important thing
 Avoid second hand smoke –no ash trays in home
 Check your cholesterol – know your HDL and LDL
 Control your Blood Pressure –Ideal below 120/80
 Exercise regularly
 Maintain healthy weight-know your BMI-waist line
 Eat Healthy diet- low fat/saturated fats
 Vegetarian diet and white meat only-avoid red meat
 Manage 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 research
American Heart Association
Mayo Clinic
Recommended Treatment
For Indians
thank you for listening!