Sunday, 24 November 2013

Coronary heart disease- The Do`s and Do not`s list

Cardiovascular Disease
Cardiovascular disease is defined as medical conditions affecting the cardiovascular system, including heart, blood vessels(arteries and veins).
I. Coronary heart disease
Coronary heart disease is defined as a condition of narrowing coronary arteries that lead to blockage of the blood flow in the arteries as a result of hardening arterial wall, cholesterol building up in the arteries, chemicals, such as cadmium clog up arteries, etc. affecting the small blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is the leading cause of death in the United States.
D.1. The Do`s and Do not`s list  
1.  Healthy diet
In the study to compare two strategies for atherosclerosis treatment: drugs and healthy lifestyle, found that Statins act mainly as lipid-lowering drugs but pleiotropic actions are also present. Healthy lifestyle, on the other hand, is effective and inexpensive and has no harmful effects. Five items are associated with lower cardiac risk: non-smoking, BMI ≤25, regular exercise (30 min/day), healthy diet (fruits, vegetables, low-saturated fat, and 5-30 g alcohol/day)(31).
a. Low intake of saturated and trans fats
Saturated and trans fats raise your low-density lipoprotein (LDL), or “bad,” cholesterol level, as it can cause clot up and hardening arterial wall, thus increasing the risk of cardiovascular risk and mortality(27).
d. Increase intake fish and olive oil
Studies indicate that the use of fish oil is associated with coronary heart disease risk reduction. A number of mechanisms may be responsible for such effects. These include prevention of arrhythmias as well as lowering heart rate and blood pressure, decreasing platelet aggregation, and lowering triglyceride levels. The latter is accomplished by decreasing the production of hepatic triglycerides and increasing the clearance of plasma triglycerides(28). Other researchers indicated that in both sexes consumption of olive oil and vegetable oil was inversely associated with serum cholesterol and glucose levels and systolic blood pressure(29).
c. High amount intake of in fiber 
Consumption of dietary fiber from cereals and fruits is inversely associated with risk of coronary heart disease. In a study of over 6 to 10 years of follow-up, 5249 incident total coronary cases and 2011 coronary deaths occurred among 91058 men and 245186 women. After adjustment for demographics, body mass index, and lifestyle factors, each 10-g/d increment of energy-adjusted and measurement error-corrected total dietary fiber was associated with a 14% (relative risk [RR], 0.86; 95% confidence interval [CI], 0.78-0.96) decrease in risk of all coronary events and a 27% (RR, 0.73; 95% CI, 0.61-0.87) decrease in risk of coronary death. For cereal, fruit, and vegetable fiber intake (not error corrected), RRs corresponding to 10-g/d increments were 0.90 (95% CI, 0.77-1.07), 0.84 (95% CI, 0.70-0.99), and 1.00 (95% CI, 0.88-1.13), respectively, for all coronary events and 0.75 (95% CI, 0.63-0.
Fiber is found in whole grains, fruits, and vegetables. A fiber-rich diet not only helps lower your LDL cholesterol level, but also provides nutrients that may help protect against CHD(30).
d. Low intake of salt and sugar
d.1. Manage your blood pressure and reduce intake of salt, beverage and sugar
The worldwide increase in the incidence of metabolic syndrome correlates with marked increase in total fructose intake in the form of high-fructose corn syrup, beverage and table sugar. Increased dietary fructose intake in rodents has been shown to recapitulate many aspects of metabolic syndrome by causing hypertension, insulin resistance and hyperlipidaemia(32).
d.2. Prevent weight gain and control diabetes and prediabetes
In the study to test a 16-week group-based weight reduction intervention combining exercise, diet and behaviour change strategies aimed to increase self-efficacy (Healthy Eating and Exercise Lifestyle Program-HEELP) on weight, body mass index (BMI), waist circumference and exercise, found that The HEELP resulted in weight loss and improved exercise behaviour in obese people with CHD and T2DM(33).
d.3. Mediterranean style low-carb diet
The best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly(34).
2. Moderate exercise
Intensive exercise is not healthy for any age as it lowers the immune function prone for disease invasion, especially to elder. Moderate exercise enhances the blood flow and immune function, thus protecting again diseases and reducing the risk of progression of chronic diseases. Although most health organizations agree that 150 min . wk(-1) of physical activity will reduce the risk of all-cause and cardiovascular mortality, few randomized, controlled studies have examined whether completing more physical activity than the recommended amount will yield additional benefits. Findings from the present study suggest that there is a dose-response relationship between exercise duration and numerous health outcomes in postmenopausal women, including cardiorespiratory fitness, body mass, body composition, waist circumference, and HDL-C(35).
3. Maintaining a healthy weight
Over weight or obesity can cause increased risk of coronary heart diseases. Dr. Park YS and Dr. Kim JS. at the Sungkyunkwan University School of Medicine showed thjat WC is associated with increased CHD risk regardless of the level of BMI. Men with normal BMI and obese WC tend to be associated with CHD risk than those with obese BMI and obese WC(36).
4. Quitting smoking
Prevalence of smoking is increasing in women in some populations and is a risk factor for coronary heart disease. Whether mechanisms underlying the sex difference in risk of coronary heart disease are biological or related to differences in smoking behaviour between men and women is unclear. Tobacco-control programmes should consider women, particularly in those countries where smoking among young women is increasing in prevalence(37).
5. Moderate consumption of Green tea, coffee and alcohol
Regular consumption of moderate quantities of coffee and (green) tea seems to be associated with a small protection against CAD, results from randomized clinical trials about their beneficial effects are less evident. As for other diffuse consumption habits, such as that of alcohol, moderation is the key word. In fact, both for coffee and chocolate, the optimal healthy effects on CAD have been observed to be associated with a moderate intake, while healthy outcomes vanish at heavy consumption(38).
6. Managing stress
Music listening may have a beneficial effect on blood pressure, heart rate, respiratory rate, anxiety, and pain in persons with CHD. However, the quality of the evidence is not strong and the clinical significance unclear. Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist(39). Other researchers in the study to determine the prevalence of anxiety and depressive symptoms in patients referred to a cardiology outpatient clinic for performing the stress test suggested that the prevalence of anxiety and depressive symptoms was estimated to be 42% and 31%, respectively, in the total chest pain population. Males with abnormal test were depressed but females experienced more anxiety symptoms. Patients with negative tests had significantly higher scores for anxiety and higher depression scores than those with positive tests. Eleven percent of the patients with positive tests were women and 23% were men(40).
7. Say No drug
There is a report of a 31 year old man with a 17-year-history of drug abuse (heroine and cannabis) was admitted with recurrent chest pain over a period of about three weeks. Chest discomfort severely worsened during the 5 hours before hospital admission. Electrocardiography revealed poor R-wave progression and non specific repolarization abnormalities. Echocardiography showed extensive left ventricular anterior and apical wall motion abnormalities and a ventricular thrombus located at the apex of the left ventricle was present. Subsequently, a diagnosis of acute coronary syndrome was made(41)
8. Relaxation
In the study to observe the effect of regular yogic practices and self-discipline in reducing body fat and elevated lipids in CAD patients, showed that Reduction of SBP, DBP, heart rate, body fat%, total cholesterol, triglycerides and LDL after regular yogic practices is beneficial for cardiac and hypertensive patients. Therefore yogic practices included in this study are helpful for the patients of coronary artery disease(42).
9. Etc.

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