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Journalism of Courage
One of my patients asked me why he got a heart attack despite walking 10,000 steps a day. And I gave him the example of a young fellow doctor with whom I had worked. He went to the gym regularly, never missed his workout routines, was lean and well-built, played sports and slept on time. Yet he had a heart attack. Why?
The fact is that heart attacks are multifactorial and that’s why it’s important to assess each risk factor and control each one of them. I can roughly say that 15 to 20 per cent of your heart health comes from physical activity but the remaining 80 per cent comes from other risk factors, which might be uncontrolled and cause silent damage. In the young doctor’s case, the trigger was smoking.
Having said that, I can say that the young doctor recovered faster only because he was into regular physical activity. The benefits to the heart can even happen by doing 4,000 steps a day. So let’s look at the risk factors we often overlook, particularly those that can lead to dislodging of small, vulnerable plaques. Unlike stable, large plaques that cause chronic narrowing, these unstable plaques often cause minimal obstruction but are more prone to rupturing and triggering heart attacks.
The damage caused by smoking
Chemicals in tobacco smoke, particularly nicotine, damage the inner lining of the blood vessels (endothelium). This layer inflames, making it easier for fatty deposits or plaque to sit on them. These plaques are also small and unstable, breaking off easily. Besides, smoking makes blood “stickier” by causing platelets to clump together, which increases the likelihood of a blood clot forming quickly at the site of a ruptured plaque and cutting off blood flow.
Nicotine stimulates the release of adrenaline, which raises heart rate and blood pressure. This constant stress can wear out the artery walls, leading to plaque damage and instability. Carbon monoxide in smoke reduces the amount of oxygen the blood can carry, forcing the heart to work harder to pump blood, which further strains the cardiovascular system.
The burden of cholesterol
High levels of LDL (low density lipoprotein or bad cholesterol) can damage arterial walls too. LDL enters the artery wall through the damaged lining and starts to accumulate. White blood cells (macrophages) try to digest the trapped cholesterol, becoming foam cells. A fibrous cap of muscle cells forms over this core to contain it. But if inflammation and LDL levels continue to go up, this unstable and soft blob of a plaque ruptures and blocks blood flow in the heart vessels, triggering a heart attack.
The accelerator of diabetes
Diabetes is linked to chronic low-grade inflammation, which impairs the lining of heart vessels. Even when a plaque ruptures, high glucose levels may hinder the body’s natural ability to repair the plaque. This results in a thinner, weaker plaque made with less protective connective tissue, such as collagen and elastin, making it more vulnerable to rupture. Now plaques in diabetics tend to have a lipid rich core but with a thin film covering it, breaks off easily. Besides, diabetes affects platelet function, making them “stickier.” So if an unstable plaque ruptures, a bigger blood clot is more likely to form and block the artery.
The family tree
You can inherit genetic mutations that make you more susceptible to heart disease, such as familial hypercholesterolemia, a condition where you tend to have higher than normal cholesterol levels. Studies show that having a close blood relative (parent or sibling) with a history of heart disease, especially at a young age (before 55 for men, 65 for women), increases your risk by a significant margin. Genetics can also play a role in specific inherited conditions like congenital heart defects, arrhythmias, and cardiomyopathy.
Not only that. Families often share similar eating habits, exercise routines and attitudes toward health. So you may unwittingly share a similar risk profile. Besides, diabetes, high blood pressure, and high cholesterol can be triggered by the genetic factor.
Walking but still sitting
It all depends on how often you move and not how much you move. You may complete your steps daily but what of the long periods of sitting in between? This can lead to blood stagnation, vein valve weakness, swelling and a higher risk of blood clots. When seated, the large muscles are inactive, leading to a significant decrease in the functionality of an enzyme that breaks down fats in the bloodstream.
Heart health requires a management of all risk factors. So, monitor markers regularly.
(Dr Shetty is lead cardiologist and medical director, Sparsh Hospital, Bengaluru)
