Heart desease is one of most common and fatal diseases the modern times. 15 years ago it was believed that once it develops it can only progress. It was a continuously progressive disease.

If you ever try to analyse you will come to know that the disease is due to the slow but steady deposit of fatty material – cholesterol and triglycerides inside the arteries of the heart and we have allowed them to grow with our modern life-style. The food with fats and oils that we are eating today cannot be utilized as we have stopped exerting physically. The unused and extra fat with the help of factors like stress of modern life, smoking habits and so on has no option other than to get slowly deposited inside the body and the heart arteries – causing heart disease.

The good news is that by bringing about small but informed changes in our life-style we cannot only prevent the growth of the heart disease but also reverse it. In other words it is now possible to to remove the fat and cholesterol deposits which obstruct the flow of blood to the heart muscles.

Medical research has now proved beyond any doubt (supplementad with angiographic proofs) that heart desease reversal is possible only with a combination of the knowledge of medical science and yoga, cooking, stress management, medication and use of common sense.

People think that cardiology has progressed, based on the commercial success of the big cardiac hospitals. Any person with a little common sense should understand that even in this era of the so called progress of cardiology, if the number of patients is growing, where is the progress. Success of a treatment system must lead to the reduction of the suffering population. If the number of patients is growing, do you think of it as success or a failure?

Medical companies and cardiologists have always promoted drugs and maintenance and emergency therapy. The result has been that no real and permanent solution has ever been seriously thought of or offered.

IECP is a unique approach, which not only looks into the causes of the dreadful coronary heart disease but also tries to prevent a long-term solution. The aim is to control all the cardiac risk factors together and prevent/ cure the disease from the root. It has combined the best of the knowledge of medical science and the best of the ancient and common art of living. The results over the past decade have shown us that this cannot only stop the progress of the blockages but also reverse it.

More and more people below the age of 40 are getting a heart disease. It is also apparent that the yonger generation is having a very wrong life-style so as to create the heart blockage in 10 to 15 years compared to 30-40 years in the past.

If we look at the causes of the disease, it is due to excessive deposits of cholesterol and fat (triglycerides) inside the tubes that supply blood to the heart muscles. Excessive intake and less utilization of these two fatty materials are the main reasons for the deposits. Factors aggravating the blockages are – excessive stress, lack of exercise, smoking, high blood pressure and high blood sugar. Almost all of them are related to our life-style. Whatever we do, if we do not remove the causes of blockage, the disease and the deposits grow.

Temporary techniques like angioplasty and bypass surgery give just temporary relief from angina, after an artificial scare caused before the surgery makes them happy but the disease remains unattended. Almost all these high technology surgeries and interventions (bypass surgery and angioplasties) would not be required in future if all the suggested life-style changes can be incorporated in the patient’s life.

If patients do not know about heart disease and the logic behind each component of the program, they tend to make mistakes and gradually drift away from the program.

The 5 Steps

Heart disease is a multifactorial disease – which means it occurs because of a number of causes. Naturally, tackling one of these causes would not be an effective solution.

Each of these five steps has components and all these sub-components have different roles to play in the reversal of heart disease. It is this overall completeness of the program that makes it so effective. When we have five iron sticks separately, anyone of them can be bent. But by putting them together the strength increases tremendously and it becomes impossible to bend them.

These five steps are education, stress reduction, diet modification, yoga, meditation and exercise.

Patients must know the optimum levels of BP, blood glucose, cholesterol, triglycerides and the effects of all these on heart disease. The reasons for blockages, ways to study them, diagnosis and tests to study heart disease, effects of medicines and the types of medicines – all are to be understood by the patients.

Heart disease is caused by a number of reasons and to cure it, you need to know all of them in a precise manner and practically to implement the knowledge. The failure of preventive medicine or cardiology is mainly because it was taken lightly and because it was used mildly. Results did not follow the treatment.

Coronary heart disease (constitutes more than 95% of heart ailments) can be called the ‘disease of ignorance’, as it develops due to lack of knowledge. If proper knowledge is imbibed, it will be very rare for a person to develop heart disease. But this knowledge must not remain only in medical books, it must be disseminated to common people. Knowledge should be simplified so that it can be easily understood.

Half of the solution lies in the knowledge about heart disease. Heart disease is actually a result of a long period of mis-management of the heart by following a wrong life-style. With wrong food, excess fats and cholesterol, uncontrolled diabetes and high BP, low exercise, smoking and excessive stress, people start developing blockages in their arteries. Starting is always from zero. With repetitions of the same, year after year, blockages increase till the person reaches the range of about 70%. And that’s when heart disease is diagnosed.

While treating heart disease by life-style change, I realized that many people were not aware of what was actually wrong with them or their heart, though they had been taking medicines for years or had even undergone bypass surgery. Without knowing all this, it is virtually impossible to reverse heart disease.

Coronary disease – different names

Whenever we talk about heart disease, remember we are mostly referring to the disease, which is caused by the accumulation of fat and cholesterol in the arteries. It accounts for more than 95% of the heart ailments. This means that out of 10 patients with heart ailments more than nine will have obstruction in the blood flow to the muscles of the heart.

This disease of blockage of the heart arteries is medically called ‘coronary heart disease’ (CHD). Over the years the same disease has been referred to by different names. The most common of these names is ‘angina’. Angina means a pain on the left side of the chest often radiating to the left arm. Since this pain is commonly found in 80% of the people having coronary heart disease, angina also became a common name.

It is known that many patients of CHD do not have a typical chest pain but have shoulder pain, breathlessness, choking sensation or burning sensation in the middle of the chest. These are due to blockage. So we must know that CHD can occur without angina pain.

A little less known name of the same disease is ‘ischaemia’ – (shortage of oxygen). All the problems of the CHD occur due to shortage of oxygen, of course due to the blockage in the arteries. Ischaemia is a more scientific term. CHD is also referred to as the ischaemic heart disease or IHD. Another name of the disease is coronary artery disease CAD.

Of all the ailments, which may blow out life’s little candle, heart disease is the chief.

Angina – how to recognize it?

When a patient complaines of a pain in the chest extending towards the left arm, diagnosis is almost coronary blockages. Pain usually aggravates on exertion and is relieved by taking rest. It is more apparent after meals, especially after a heavy meal. Many patients complain of breathlessness on exertion but not of pain in the chest. Many of these patients have diabetes and are overweight. Palpitation is also a common complaint of a heart patient.

Burning sensation in the middle of the chest, choking sensation, uneasiness over the chest region, chest pain during excitement, sometimes shoulder pain, right-sided pain and jaw pain are also indicators of heart disease.

No age group is exempted from angina. Occurrence of angina at a younger age is a recent trend – basic reason being the process of atherosclerosis (deposition of fats and triglycerides) in the arteries that supply blood to the heart. Angina is unlikely till the blockage is more than 70%. The period over which these blockages are formed depends on the life-style of a person. If many risk factors are present and stress is predominant, angina can occur even at the age of 25 years. Previously angina was seen only at the age of 50-60 but now many patients with angina are in the age group of 30-35.

Recognition of angina depends on the patient’s knowledge about the disease and physical activity. If he performs heavy physical activity from time to time (where the heart rate is raised beyond 120-130/ minute) he can identify angina early. People who do not physically exert themselves feel and recognize angina quite late, because they never reach a higher heart rate. Many such physically inactive persons sometimes get severe heart attacks which may even result in death, simply because they could not identify angina and take preventive care.

Angina does not occur at blockages of 40% to 50%, which is widely prevalent. If it occurs, it is more likely to be precipitated by a sudden episode of coronary artery spasm, which is the most common manifestation of stress.

The symptoms of angina

• Chest pain: Angina may vary from mild to severe, whereas the pain of a heart attack is very severe. It usually occurs in the centre of the chest and radiates to the left arm, but at times it may even radiate to the right arm, shoulder or the lower jaw. The pain usually lasts for 5 to 10 minutes.
• Breathlessness or shortness of breath.
• Sweating.
• Nausea and vomiting.
• Dizziness and fainting.
• Pain or heaviness in the chest especially after heavy meals.
• Choking sensation in the throat.
• Heaviness or tightness in the chest or upper abdomen.
• Weakness and fatigue.

The typical pattern of pain in the left side of the chest radiating to the left arm almost confirms the diagnosis of angina (blockage of more than 70%). Mostly the pain is related to physical exertion and stops when the physical exertion is stopped. Some people complain about the aggravation of this pain due to emotional stress or after heavy meals. Many people complain of an uneasiness or suffocation or choking – which also suggests angina in 20-30% cases. Some diabetic people may not complain of chest pain but only of suffocation or breathlessness. This is basically because they don’t feel the pain due to nerve damage because of diabetes.

The functions of the heart

The human heart retains its priority among all the important organs of the human body because it is responsible for supplying blood to the entire human system, which is essential for the sustenance of our lives. Thus, it is of utmost importance that we should make every effort to familiarize ourselves with the heart and its functions.

• Supplying blood to the entire body.
• Supplying oxygen and calorie nutrients to the whole body and to billions of cells in the body.
• Supplying vitamins and minerals to cells of the body, without which they cannot survive.
• Carrying or pulling blood back to the heart and sending the same to the lungs for a refill of oxygen.
• Help in distribution of hormones, neuro chemicals from one part of the body to another.
• Help taking the waste materials to the kidneys for purification of the blood.

Some simple but interesting facts about the heart

• The heart beats about 72 times in a minute, about 4200 times in an hour and about 100 000 times in a day.
• The heart needs about 250 ml of blood in a minute for its own use.
• The heart mainly utilizes oxygen for converting food into energy. But in an emergency it can break food particles without oxygen (anaerobic oxidation) for some time.
• The heart is an extraordinary device for maintaining blood circulation through approximately 60 000 miles of blood vessels.
• Our body has about 5 litres of blood, and about 25 trillion red blood cells, which carry oxygen from the lungs to all the body tissues. Every day about 200 billion new red blood cells are released into the bloodstream and the old cells are removed.
• During an average human life- span of 70 years, the heart pumps between 30-40 million gallons of blood. It bears nearly 2.5 billion times. Despite its small size, the heart uses about 20 % of the total blood circulated to supply to its own muscles with oxygen. Unlike other muscles of the body, the heart works unceasingly, even while a person is asleep.
• The heart is truly a remarkable piece of natural engineering. Day and night, whether we are sleeping or exercising, mere 250-350 g of heart muscles continue to act as our vital pump, maintaining the circulation of blood through our body with a smoothness and coordination that any mechanical engineer could only marvel at, and certainly never hope to replicate it in a man-made system.

How much blood does the heart get and need?

When the coronary heart disease patients lead a wrong life-style it results in deposition of fatty substances, which lead to reduction in supply of blood to the heart. Those who lead a reasonably healthy life-style may also have blockages upto 30 to 40% but will never come to know the deficiencies. Only those who consume wrong and excessive food and lead a very sedentary life and have a high level of stress can develop 70% blockage. This used to take about 30-40 years of reasonably wrong life-style to get a heart disease a few decades back.

But today, with the worsening life-style and no guidance from the doctors, this 70% blockage takes about 10-15 years. The destruction or closure work of the heart arteries proceeds at a greater speed. As a result we now see many young heart patients in 30-35 years of age.

Collateral circulation of the heart

In addition to the normal blood supply the heart has many dormant arteries, which can take over the functions once the normal arteries of the heart get clogged. These are called collateral arteries. They form a meshwork and can also supply blood to the adjacent arteries if an emergency arises.

When the heart functions normally even 30 % of the existing arteries are good enough to supply blood to the heart, even at the peak of physical exertion. But in case the blood supply is redused further (due to increased blockages) these callaterals take over. The collaterals are well developed in people who are physically very active and who have taken to sports.

Collaterals can save many patients when they get a heart attack (100% blockage of an artery). This is often referred to as a ‘natural bypass’.

Coronary heart disease

CHD remains the leading contributor to global mortality and the epidemic threatens to attain a menacing magnitude as it advances and accelerates in all the countries.

The epidemic of CHD will be a public health disaster that will strain human as well as fiscal resources.

According to the American heart association, it is a fight that you can win.

In fact, all it takes to turn these statistics around and stack the adds in your favour are a few simple precautions. Measures that can reduce risk of heart disease and increase your chances of a longer, healthier life.

Coronary heart disease CHD or coronary artery disease CAD or ischaemic heart disease IHD is one of the leading causes of morbidity and mortality throughout the world. It is on a constant rise now in our part of the world too. The main cause of this disease is deposition of cholesterol and fat in the inner smooth lining of the blood vessels (coronary arteries) supplying blood to the heart resulting in their blockages and obstruction of blood flow through them. An atheromatous plaque is formed which compromises the flow of blood with oxygen and nutrients to the heart.

With significant blockages, more than 60 to 70%, and exertion, the increased demand of blood by the heart is not met, and a sensation of pain is felt in the chest which may also move down the left arm, typically called angina. This is very dreaded condition and if left unattended may give rise to life threatening consequences. Certain conditions and life-style habits are now recognized and documented to be responsible for the deposition of cholesterol and fat in blood vessels as well as the increased rate at which they are being deposited.

Risk factors of heart disease

Risk factors are the reasons, which lead to or aggravate the deposition of cholesterol or fat in the coronary arteries. If one desires to know the total number of risk factors responsible for the development of coronary heart disease it will amount to hundreds. Williams in 1981 identified 246 risk factors that directly or indirectly lead to the development and onset of heart disease. To give you a rough idea, the distribution of them is mentioned below:

• Habits and lifestyle, psychological 54
• Physical and biochemical     16
• Serum/ blood measurements     44
• Medical conditions or diseases    45
• Dietary deficiency (inverse association)  23
• Dietary excess (negative association)  21
• Constitutional, demographic  16
• Blood clotting (platelet) disorders 16
• Enviromental     5
• Drugs      6

If you consider the major 10 or 15 risk factors, those which are important in the development of coronary heart disease, they have been classified into two categories:

Modifiable: These include risk factors which can be altered and prevented so that further progress of heart disease can be arrested.

• Stress and mental tension
• High blood cholesterol
• High blood triglycerides
• Low blood HDL level
• Lack of antioxidants in the diet
• High BP
• Diabetes
• Obesity
• Sedentary life-style/ lack of physical activity
• Smoking

Non-modifiable: These are risk factors which cannot be altered such as age, sex and heredity.

When there are 12 holes in a bucket – we have to close all the wholes to fill it up. The same applies to the treatment of heart disease where to control the disease one needs to control all the risk factors.

Psyhological stress is now recognized as the most important risk factor of coronary heart disease. With more scientific research results pouring in over the last 2 decades we have come to know that excessive stress can lead to the following:

• Increase in Blood pressure
• Increase in heart rate
• Increase in concentration of fat in the blood
• Increased Blood sugar
• Increased cholesterol in blood
• Spasm of coronary and other arteries
• Increased blood clotting
• Increased deposition of fat and cholesterol in the arteries.

This means that stress is such a influential factor that even in the absence of other factors it can by itself become responsible for CHD. So many people without high cholesterol, overweight and family history, having normal blood pressure developing angina only because of excessive stress.

Research has also revealed that a particular type of people who are aggressive, always short of time, short-tempered and stressful are much more prone to develop heart disease. Most young heart patients of modern day have this behavior.

It is obvious that without controlling stress we cannot stop the advancement of heart disease. Sudden stress or anger leads to the spasm of coronary arteries, which precipitates sudden angina and heart attacks. This is why many people develop heart attack when they are excessively strained or hear bad news.

High blood cholesterol

Is one of the most known risk factors of CHD. With more and more research it has become one of the first 3 risk factors. Cholesterol is a type of fat particle present in the blood in small quantities. Cholesterol has very important functions in the body as it forms a part of the cell wall, nerve coverings and the brain cells.We cannot imagine life without this molecule. So important is the requirement of cholesterol in the body that the liver has a manufacturing capacity of the minimum amount of cholesterol required by the body.

But if this molecule is present in a high quantity in the body the excess can be deposited to create coronary blockages. Not only is the heart affected, high cholesterol can also get deposited inside the brain arteries, leg arteries and also in the skin below the eyes.

Cholesterol carried in the blood is in free form, which is very dangerous and it can be also carried in combination of proteins (known as lipo-proteins). There is a strong relationship of blood level of free cholesterol and the rate of deposition of blockages in the heart arteries.

Blood levels of cholesterol are high in those people whose diet is rich in cholesterol. Foods that contain cholesterol are egg yolk, meat of any kind. Another rich source is milk and its products.

Cholesterol is mostly deposited in the heart arteries, after it is converted into LDL cholesterol, the so-called bad ‘low density lipo-protein cholesterol’.
The total intake of cholesterol in the diet of a person should be as low as 10 mg/ day.

In most of the developed countries it is compulsory to put a display on the food labels – the exact content of cholesterol in every food. When it is not done, it becomes difficult for the general people to know what food to eat and what to avoid.

Regular physical exercise, stress management, stopping of smoking can also lead to lowering of the cholesterol in the blood, besides control of diet.

High blood triglycerides

The other fat, besides cholesterol, that has gained importance in the recent research is triglycerrides, a major cause of heart disease. Almost all fat that we eat in our food are nothing but triglycerides. This is the other name for oils. Triglycerides also form a part of the blockage. Tri means tree and glycerides comes from glycerol. Triglycerides are a combination of one glycerol molecule with tree fats (or fatty acids). In other words, three chains of fat molecules when attached to one glycerol can constitute triglycerides. These three chains of fatty acids, depending on the number of hydrogen atoms that they contain, can be saturated, mono-unsaturated or poly-unsaturated in hydrogen.

On the other hand if one hydrogen is missing in the fatty acid chain it ceases to be saturated. Since it is unsaturated by one hydrogen only it is called mono-unsaturated fat. It is something like 29 hydrogen atoms instead of 30 (as in saturated fat). That makes very little difference.

If one more than one hydrogen is missing in the fatty acid chain (like 28 out of 30) this fat becomes poly-unsaturated. Literally and structurally there is hardly any difference between these three types of fats. They look alike as well. Even from the heart disease formation angle all of them contribute almost equally to the blockage formation. While one does 90% harm, the other two do 88% and 86% harm.

It is through the bad and unethical advertisements for promoting their products that the oil companies have created an impression that triglycerides are good for the heart disease (which is interpreted by the patients as ‘helping to cure heart disease’).

Small amounts of triglycerides are manufactured in the liver. All food items also contain some invisible oils. These two combined can make up for the minimum amount of oil requirement of the body and we recommend no additional oil intake by heart patients.

Low HDL cholesterol

HDL cholesterol is the so-called ‘good’ cholesterol and can be measured from a fasting blood sample. It has a very high affinity to bind cholesterol and can remove cholesterol from the blockages.

HDL cholesterol level in the blood should be maintained above 40 mg per 100 ml of blood to prevent heart disease.

High blood pressure

It is a very common disease and about 20 to 30% of adults suffer from hypertension all over the world, but a majority of the people are not even aware that they have this disease because it does not produce any symptoms in a vast number of cases. This is why this disease has been correctly called the ‘silent killer’. High blood pressure puts an extra strain on the heart and the arteries supplying blood to the other organs of the body. Many diseases are caused by high blood pressure such as heart attacks, heart failure, kidney failure, stroke (damage to the brain) and damage to the eyes. Higher the blood pressure, greater are the chances of getting the above diseases, especially heart attack.

High BP can be classified as mild, moderate and severe. It is also one of the major causes of deposition of cholesterol and fat in the coronary arteries. It damages the endothelial lining of the arteries, making them more prone to fat deposition. Besides a high intake of salt, phychological stresses are also implied as important causes of high BP.

Diabetes

Diabetes has a strong association with coronary heart disease and I responsible for the increased rate of deposition of cholesterol. Its control is a must.
Diabetic patients have a higher chance of developing coronary blockages. They are also prone to several other diseases like kidney damage, as well as damage to the nerves and eyes. Patients with diabetes are usually obese, have high BP and high blood cholesterol levels, all responsible for blockages. Heart attacks may occur at a younger age in severe diabetics. It is important for heart patients to control diabetes.

Obesity

Obese individuals have greater chances of getting heart desease. They have increased chances of having high BP and diabetes and thereby blockages, tend to develop excessive mental tensions resulting in hypertension and heart attacks. The chances of getting a heart attack increases by 15 times for obese people as compared to lean and thin individuals.

Sedentary life-style/ lack of physical activity

Sedentary life or lack of exercise in our daily life becomes the most important reason of heart disease in modern life. Research has shown that low physical activity is often associated with high incidence of coronary heart disease. Regular exercise can break fat, decrease cholesterol, reduce blood sugar, control blood pressure, reduce overweight by consuming stored fat in the body and make the heart more healthy and strong to respond well to unexpected physical activity needs. The absence of the same will have the opposite effect. Without exercise more and more people will be prone to heart disease, diabetes, high BP, obesity and low level of fitness, besides joint diseases and so many other ailments.

Smoking

People who smoke are four times more prone to develop heart disease as compared to non-smokers. The Framingham heart study carried out in USA studied more than 5000 people and their families for more than three decades. It confirmed that smoking substantially increases the risk of heart attack. It was also shown in the follow-up studies of the same group, that even after cessation of smoking, people were still prone to heart attack.

Smoking induced risk for heart disease can be related to the degree of smoking and the risk increases with a longer duration of smoking. A person who smokes 10 cigarettes a day is almost doubles the risk than one smoking 5 cigarettes per day.

Tobacco that is inhaled while smoking is the major cause of erosion of the coronary arteries. Out of the thousands of chemicals in tobacco – nicotine, tar, alkaloids etc. cause this damage and make the layer more susceptible to cholesterol and fat deposits. It is like painting the inner lining with glue which would catch cholesterol and stick it on the wall.

Tobacco causes damage to the lungs, resulting in bronchitis and asthma. It also causes lung cancer, can aggravate the peptic ulcer. Those who live with smokers or work with them are also prone to the bad effects of smoking and also prone to develop heart disease. These people are called passive smokers. The World Health Organisation WHO now has smoking prevention on its priority list.

Alcohol

Alcohol intake is also a known risk factor of coronary heart disease – directly or indirectly. It leads to increased triglycerides, owing to its similarity of structure with glycerol, a component of triglycerides. Alcohol is often associated with increased stress and bad interpersonal relationships in the family. Alcohol is also one of the major causes of liver disease and failure besides gastritis and neurological damages.

It has been shown that alcohol can increase the HDL levels in the blood, but it also increases the triglycerides – it does more harm than benefit to the patients. We must see all the effects rather than one isolated parameter.

Many studies have also shown that alcohol also leads to an increased incidence of heart disease.

Non-modifiable risk factors
Age

Heart attacks are most frequent between the age of 40-55 years, but it is not unusual for heart attacks to occur even below the age of 40 years. These days we can see an increasing number of heart patients at a young age.

Heart attacks occurring at younger ages are correlated to a strong family history of high BP, diabetes and high cholesterol levels. Heavy smokers also get heart attacks below the age of 40.

Sex

Most of the heart patients are male though the number of females is on a steady rise. The incidence of heart attacks in females is markedly less before menopause as the hormone estrogen protects them, the exact mechanism of this hormonal protection is yet to be clearly understood but after they attain menopause (by the age of 45 – 50), they are exposed to an equal risk of getting heart attacks as males.

Coronary heart disease can present itself in a various ways ranging from mild chest discomfort to a heart attack or even sudden cardiac death. Once the disease sets in, whatever is its form, it relentlessly increases unless preventive methods are employed to check its course.

In accordance with the latest reports more than 20 % of the adult population is suffering from coronary heart disease and this figure is constantly on the rise year after year.

Heredity

Strong history of heart disease in the family makes the person predisposed to coronary problems in his life. This cannot be changed. But one must remember that food habits, exercise and stress are the three main causes of heart disease and are probably responsible for about 90 to 95% of the causes of heart disease.

Thus it is obvious that those who have a disadvantage from the heredity point of view should be more careful about their food habits, exercise, stress reduction and control of other coronary risk factors are concerned.

Most of the heredity effects among these persons come through excessive production of cholesterol and triglycerides in the liver. Liver makes these two elements little more than the body’s requirement. Obviously, their chances of having a heart disease will multiply if they do not restrict the fat intake in food.

In many cases, even after strictly following the health program, if these persons can still not control their cholesterol or triglycerides, the doctor prescribes lipid-lowering medicines to them as a last resort.

Angiography: excessive commercialization

Angiography is an overused investigation being done more often to push the patient to the table of bypass surgery or angioplasty than to diagnose the extent of heart disease.

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