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Sunday, 1 December 2013

Angina pectoris - The do and do not list

Angina pectoris, also known as Angina, a symptoms of  Ischemic heart disease, is defined as a condition of chest pain caused by poor blood flow through the blood vessels due to obstruction or spasm of the coronary arteries resulting of lack of blood that lead to lack of oxygen supply and waste removal. 

Preventions
A. The do and do not list
1. Life style change
a. Relaxation
Stress and emotion may increase the risk of Angina pectoris, a symptoms of schemic heart disease. According to the study of Emotional triggering of cardiac events at the University College London. Dr Steptoe A, and the research team indicated that the psychobiological processes underlying emotional triggering may include stress-induced haemodynamic responses, autonomic dysfunction and parasympathetic withdrawal, neuroendocrine activation, inflammatory responses involving cytokines and chemokines, and prothrombotic responses, notably platelet activation. These factors in turn promote coronary plaque disruption, myocardial ischaemia, cardiac dysrhythmia and thrombus formation(9). 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(10). 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(11).
b. If the disease is caused by physical activity, slow down or take rest more often can be helpful
2. 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)(12).
a. Low intake of saturated and trans fats
High levels of bad cholesterol and triglyceride partial block the blood flow in the vessels, it not only increases the risk of high blood pressure but also the risk of ischemia if the blood circulation diminishes.
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(19). 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(13). 
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(14).
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(15).
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(16).
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(17).
2. Tobacco
Cigarette contains high levels of cadmium, inhaling the chemical during smoking or second hand smoke can cause building up of plaque along to the arterial walls as a result of oxidation.

3. 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(18).
4. Maintaining a healthy weight
Obesity increases the risk of ischemia as it is normally associated with high levels of cholesterol, high blood pressure.
5. 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(19). 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(20).
6. Etc.
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