1. THERAPEUTIC LIFE STYLE MODIFICATIONS FOR THE PREVENTION OF HEART DISEASES Dr Animesh Mishra, MD, DM (Delhi university) Associate Professor, Department of cardiology NEIGRIHMS, SHILLONG-12

2. LIFE STYLE MODIFICATIONS CARDIAC REHABILITATION

3. LIFE STYLE MODIFICATIONS Dietary Modifications Weight Reduction Exercise HRT & Antioxidents Psychosocial Management

4. Dietary Modifications Reduction in daily salt consumption Reduction in fat & cholesterol consumption Increase consumption of vegetables & Fruits Increase consumption of nuts, healthy oils, legumes whole grains & fibers. Moderation in Alcohol

5. Dietary Sodium Restriction He and MacGregor’s Met analysis 100mmol/d (2.4gm sodium or 6 gm of common salt)– 2-8 mmHg SBP reduction Dose- Response relationship Not all patients are responders Benefits even in non responders Rigid sodium restriction- Difficult and counterproductive.

6. Opinion Sodium restriction to be useful for all Substitute natural food for processed food Add half sodium & half potassium chloride. Sodium content of the food to be mentioned on the labels of processed food

7. Reduction in fat and cholesterol 10% increase in serum Cholesterol is associated with 20-30% increase in the risk of CHD Benefits in Primary & secondary prevention trials Benefits in stroke and ACS No increase in the risk of nonvascular mortality

8. Recommendations for routine check up NCEP- All adults older than 20 years ACP-35-65 year in men;45-65 yr in women US Preventive services Task Force- All men > 35years; women >45 years

9. Therapeutic targets CHD Or CHD equivalents LDL<100mg/dl Multiple risk factors: LDL< 130mg/dl 0-1 risk factors : LDL< 160mg/dl TG< 150 mg/dl HDL< 40mg/dl men; 50 mg/dl for women

10. Nutritional factors known to increase LDL-C Saturated and trans fatty acid, dietary cholesterol, & excess body fat weight Dairy, meat &tropical oils:Lauric(C12:0),Myristic acid (C14:0), Palmitic acid (C16:0) Trans monounsaturated fatty acid : French fries &other fast foods : No increase in LDL-C with monounsaturated fatty acid (oliec acid) C18:1, & polyunsaturated fatty acid :Linolic acid C18:2 Saturated fat- HDL & LDL both increases Trans-fatty acid only LDL rises. Healthy oils : olive & canola and corn, sunflower

11. Dietary cholesterol are found in animal source except egg yolk and shell fish 100 mg/d of dietary cholesterol will increase 2- 3mg/dl of TC. Dietary restriction of cholesterol will reduce the serum cholesterol up to 5-10% with near maximum response in 3-4 weeks Healthy oils : olive & canola and corn, sunflower

12. Consumption of Fruits and vegetables Three to five servings of fruits/day Five to seven servings of vegetables/day 1Serving of fruits = 60 Calories 1Serving of vegetables = 25 Calories  DASH Trial, The Physicians’ health study, The women’s health study

13. Whole grain, Fibers, Legumes & Nuts… Vitamins, Phytoestrogen, Phenol, omega-3 fatty acids, resistant starch and minerals Isoflavones in legumes and soy- Beneficial effects Nuts- Walnut-polyunsaturated fatty acids, Mg, Ca, K + Almonds –mono and poly unsaturated acids 30gm of walnut and Almond each are daily recommended

14. No more than 2 drinks for men & 1 drink for women Individual should not begin alcohol to reduce the risk of coronary artery disease

15. Weight reduction All measures of metabolic syndrome can be redressed Universal sustainability ? Less use of contemporary life style Genetics + Newer pharmacological interventions are underway

16. Exercise For Primary prevention 30 minutes of moderately intense physical activity (accumulative exercise ) For secondary prevention 30-60 minutes on at least most of the days of week. An “exercise prescription”-: Jogging, walking, cycling, swimming or other aerobic physical activities Moderate physical activity: Greater than 6 METs = Brisk walk

17. HRT & Antioxidants No cardiovascular benefits in men and in post menopausal women. Possibly increased chances of AMI, Stroke, Breast cancer. No cardiovascular benefits of multi- vitamins and antioxidants, possibly harmful.

18. Psychosocial Counseling Psychological Matrices Vital exhaustion, Depression, Chronic hostility, Social isolation perceived lack of social support, Job strain, Effort-Reward imbalance, Anger…

19. Behavioral Modification Faith based organizations Life style Heart Trial Sexuality Happiness Economics :Better medical care, greater job security, and reduced crime “Gross National Happiness”