Heart attack

New Age Killers

Rank ( year 2020)
1
Heart attack
2
Depression
3
Road accidents
4
Cerebro vascular diseases
5
Lung diseases
6
Tuberculosis
7
War
8
Diarrhea
9
AIDS

Heart Attack
91 people die every hour in the world

Urban to rural ratio is 3:1

Indians are more prone

Women are also suffering

Heart Attack
In India, 100 million are suffering

One in seven Mumbaikars below 35 has

cardiac problem

There is a strong association

between blood cholesterol and
heart attack

Blood cholesterol
LDL
Transport cholesterol from
liver to body cells
Cell membrane repair
Synthesis of steroids and
bile salts
Excess amounts promote
atherosclerosis

HDL
Lowers LDL cholesterol
Removes excess
cholesterol from body

Blood lipid profile

Cholesterol: Total
LDL
HDL
Triglycerides

LDL / HDL = 3

200 (mg / dl)

130
35 - 75
150

Heart Attack
Risk Factors
Physical
Family history
Overweight
High BP
Diabetes
Lack of exercise
High cholesterol
Smoking

Emotional
Type A
Anger
Hostility
Depression
Hopeless
Pessimism

TYPE A PERSONALITY
Time urgency

Aggressive

Impatient
Ambitious
Hostility

Competitive

TYPE A
Anticipate loss of
control
Aggressive behavior
Suppress and deny
fatigue

Endure high stress levels

Delay in seeking medical
help

TYPE A FEMALE
Perceive less threat or challenge
Economize stress response

Depression

Anhedonia
Loss of pleasure
Joylessness

Early symptoms of Depression

Depression
Low energy
slow starter in morning
Low B.P.

Excess sleep
Increased appetite
Alcohol intake

DEPRESSION

Disturbed sleep
Fatigue
Pain
Weight loss
Loss of appetite

Depression

Life is not worth it

I am not worth it

DEPRESSION

Crying spells
Low self esteem
Guilt

Depression

Indifferent

philosophical

Depression
Negative cognitions

Negative outlook
Self
Life
Future
Focus on past

What causes depression?

Competition
Technology
Chronic ailments
No time to
unwind

Depression
Unaware
Underdiagnosed
Under treated

Social stigma
Fear of discrimination

Childhood depression
Irritability
Aggressive

Lethargy

Aches and pains

Bed wetting

Disturbed sleep and appetite

Depressed child
Consequences
Drug abuse
Run away
Obesity
Loneliness

Poor academic performance

Social
withdrawal

Depressed child

Risk of heart attack in adulthood

Depressed child
Undiagnosed
Untreated

Parents not aware

Living in a disadvantaged neighborhood

increases the risk

Neighborhood
Fear of crime
No social support
No medical help

No open space
No recreation

Decreased risk

Large public spaces

Recreation facilities
Medical facilities

No crime

social support

Security

Less noise

Heart attack
60% of heart patients
in the world are
Indians

Indians are 4 times

more susceptible.
They are younger,
and poorer than in the
West

Heart attack
Most victims in India
are the poorest

Death rates in the

West have dropped
steeply

Heart Attack
Who suffers?
Low control over life
Low in social hierarchy

Social gradient plays a role in illness & death

Who suffers?

Those who believed they were treated unfairly

Angina pectoris
Pain during exertion
and relieved by rest
Triggered by
Physical exertion
Cold exposure
Heavy meals
Intense emotions

Myocardial infarction

Complete obstruction in
coronary artery

Coronary angiography

Coronary angiography

Angioplasty

Insertion of stent

Stent

Coronary Artery disease

Primary prevention
Modify risk factors
through diet and
change in lifestyle

 Sleep
Eating habits
Smoking
Physical activity
Alcohol
Leisure time
Coping with stress

Modern Lifestyle
Urbanization
Overcrowding
Pollution
Noise

Modern lifestyle
Irregular diet
Lack of sleep
Lack of exercise
Stress

Modern lifestyle
Sedentary habits
Working couples
Nuclear families
Eating outside

Hunter Gatherers

HUNTER GATHERERS

Hunter gatherers
No obesity
No malnutrition
No vitamin deficiency
B.P. decreases with age
Blood cholesterol 120 mg%
Lowest in the world

Hunter gatherers
Food habits
Meat
Roots & tubers
Mongango nuts
Wild honey

No salt, sugar and oil

Present dietary habits

Increased

Decreased:
Cereals
Pulses
Vegetables/ fruits

Fats
Sugar
Salt
Meat
alcohol

Irregular diet
Refined food
Fast food
Processed food
Ready to eat foods
Food for all seasons

Fast foods

Frozen foods

Street food

Heating of cooking oil

Lowers smoking point
Darkening of color

Oxidation (free radicals)

Do not use left-over oil

Do not use :
Sunflower oil

Complications
Decreased immunity

Suffola
Trans fats

Decreased HDL
Central obesity

All oils are zero cholesterol

Sesame oil

It lowers blood pressure and cholesterol

A study from Fukuoka university , Japan

How much?
5 tsp/ day

Artificially hydrogenated
Margarine
Vanaspati
Dalda

Trans fats
Long shelf life
Good taste

Increased risk of heart attack

As bad as food spoiled by poor
refrigeration

Trans fats
Burgers
Cakes
biscuits
Pastries
Puffs/pattice
French fries
Cheese spreads

Jelebies
Gulab jamun
Laddus
Balushahi
Nan katai
Mysore pak
Upma
Sheera

Every American eats 2 Kg.

of trans fats in a year

New York city votes to ban the use of

trans fats

KFC decides not to use trans fats

in their outlets in U.S. and Canada

Read packing labels carefully

Trans fats:
Hydrogenated vegetable fats
Partially hydrogenated
Margarine
Vanaspati

Young people at risk

Fast and fried food
overweight
High cholesterol

Low intake
vegetables
fruits

Low levels of HDL

whole grains

Soybean

Addition of soybean to the diet may reduce the

risk of coronary heart disease
(Approved by U.S. FDA)

Whole wheat flour

Intake of whole wheat flour reduces the risk

of heart attacks

Wheat flour
Extraction rate
95%
Atta
85%
Rava
70%
Maida

Loss on extraction
Protein Fiber
Minerals Vitamin B

Bran
5%
15%
30%

Breads
Enriched wheat
Partially hydrogenated oil
HFCS
A lengthy list of ingredients
with no nutritional value

Look for the bread

made with whole grains

White bread
White whole wheat bread

from refined wheat

grain

Whole grain with the taste

and texture of white bread

Brown bread
Brown bread
Whole wheat
OR
White bread colored brown

Package labels
Look for the words that
appear as the first
ingredient

Whole wheat bread

Whole wheat flour
Whole wheat spaghetti
Whole wheat macaroni
Whole wheat vermicelli
Whole oatmeal
Popcorn

Not whole grain

products

Wheat flour
100% wheat
Multi grain
Stone ground
Enriched wheat

Physical exercise
Frequency
Aerobic
Intensity
Isometric
Duration

Yoga
Ahar (Diet )
Vihar (Recreation)
Achar (Daily routine)
Vichar (Value system)

Diet in heart disease

Decrease
Saturated fats

Increase
Whole grain cereals
Complex carbohydrates

Cholesterol
Red meat
Alcohol (moderate intake)

Garlic (10 g/day)

Onion ( 100 g/day)
Fish
Soybean

Eat more omega -3

Mustard oil

Rajma

Fish

Pure ghee

Fruits

soybean

Green leaf vegetable

Healthcare
Patient

Doctor

Active participant

friend, philosopher & guide

Not a passive recipient

Whose health is it anyway

Pharmacist as a counselor

Neighborhood

Fear of crime
Insecurity
Lack of social support
Lack of medical help
Noise

Lack of open spaces

No recreation

Heart attack

Living in a disadvantaged neighborhood

increases the risk

Alcohol
Different perceptions:
Religious
Economic
Ethical
Medical

Alcohol

Social drinking
Habituation
Addiction

Alcohol
Benefits

Risks

Increased life span

Rise in B.P.

Protects from heart attack

Depression
Malnutrition
Accidents

Dose
30 ml daily

Avoid Eating out

Health promotion
Clean water

Diet

Environment

Exercise

Overcrowding

Coping with stress

Noise

Smoking cessation
Moderate alcohol intake

Eat this than that

Ice cream (vanilla)

Kulfi

Rasgulla

Gulab jamun

Bhel / misal

Farsan / samosa

Roti / phulka

Puri / paratha

Eat this than that

Plain rice

Jeera rice

Boiled egg

Omlet

Idli

Medu wada

Paneer

Cheese

Fresh butter

Amul butter

Stop Eating out

Angioplasty

Coronary angioplasty

Depression
Loneliness

Life is not worth it

Suddenly indifferent

I am not worth it

suicidal ideas

Anger on small issues

Winding up
Giving away prized
possessions
Become philosophical

Insertion of stent

Coronary bypass

Anhedonia

Loss of pleasure
Joylessness

Early symptom of depression

Type A personality
Time urgency
Deadlines
Competitive drive

High responsibility & No authority

Aggressive
Anger &
hostility

Depression
Low energy
slow starter in morning
Low B.P.
Excess sleep
Alcohol intake

Loneliness
Feeling sad, lonely and disconnected

No one to share highs and lows

Eat more omega -3

Mustard oil
Fish
Fruits
Green leaf vegetable

Rajma
Pure ghee
soybean

PUFA -6
Sunflower oil
Safflower oil
Cereals
Pulses

PUFA 3

Mustard oil
Fish
Green leaf vegetables
Rajma
Pure ghee
Soybean

What causes depression?

Competition

Technology

Stress
No time to unwind

Chronic ailments
Changing social fabric

High intake of PUFA 6

Low intake of PUFA 3
Complications:
Central Obesity
Increase in B.P.
Decreased Immunity

Clotting of blood
Decrease in HDL

TYPE A
Perceive more threat
Anticipate loss of
control
Aggressive and
competitive behavior
Suppress and deny
fatigue

Endure high stress

levels
Delay in seeking
medical help