Your BMI is valuable to calculate your risk of heart attack

Your BMI is valuable to calculate your risk of heart attack High body mass index is a major risk factor for a variety of cardiovascular ailments. Keeping obesity in check through regular BMI monitoring can significantly reduce a risk of major coronary episodes, including heart attack. New Delhi, March 14, 2016: Certain risk factors contribute to the risk of a heart attack in an individual. Some of these risk factors are beyond our control and hence unmodifiable. However, the environmental componenst of predisposition to heart attack can be modified. One such factor is body mass index and it has a huge contribution to the development of a future heart attack. The body mass index (BMI) is the most practical way to evaluate the degree of obesity. It is calculated from the height and weight as follows:
BMI = body weight (in kg) ÷ square of stature (height, in meters) Overweight is defined as a BMI between 23 and 30 kg/m2 and obesity as a BMI greater than 30 kg/m2. Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA) in a joint statement said, “Diet has a huge impact on the development of a cardiovascular disorder. Being overweight makes you more likely to develop hypertension, diabetes and atherosclerosis. These conditions can put you at high risk of cardiovascular disease, including a heart attack. It is important to be aware of one’s BMI value to understand your risk of future heart attack. To determine if your weight is linked to an increased risk of heart disease, two measurements are employed- Body Mass Index and waist circumference. Together these values can help you assess if you belong to a high risk category. This will allow the start of preventive measures and lifestyle changes as early as possible.” “If you are less than 40 years of age, male, with a strong family history of diabetes, blood pressure or heart disease, have a normal weight as judged by body mass index (BMI) but have a pot belly, or have gained more than 10 kg since the age 18, do not ignore this and go to your cardiologist to reduce your chances of a future heart attack.”, adds Dr K K Aggarwal. Following are some guidelines dictating how BMI and heart attack correlate: 1. Subjects with a BMI of 23 to 30 kg/m2 may be described as having low risk, while those with a BMI of 30 to 35 kg/m2 are at moderate risk. 2. Subjects with a BMI of 35 to 40 kg/m2 are at high risk, and those with a BMI above 40 kg/m2 are at very high risk from their obesity. 3. At any given level of BMI, the risk to health is increased by more abdominal fat (increased weight to hip ratio, WHR), hyperlipidemia, hypertension, age less than 40 years, male sex, and a strong family history of diabetes, hypertension, or heart disease.

All systems of medicine should advocate a common lifestyle pattern for lifestyle disorders

All systems of medicine should advocate a common lifestyle pattern for lifestyle disorders Non-communicable diseases (NCDs) such as hypertension, type 2 diabetes, heart diseases, behavioral problems, high cholesterol and obesity are rapidly increasing worldwide, including in India. These diseases are called lifestyle disorders as they have their roots in the lifestyle - habits and behavior - of an individual. An unhealthy lifestyle can contribute to the development of risk factors of NCDs. The epidemic of NCDs in our country is mainly attributed to modernization, urbanization, sedentary lifestyles and longevity (Press Information Bureau, 20.2.17). The WHO’s ‘Global Status Report on NCDs 2014’ has identified four main types of NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes), four behavioral risk factors responsible for significant proportions of these diseases (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol) and four major metabolic risk factors (obesity, raised blood pressure, raised blood glucose and raised blood total cholesterol levels). The INTERHEART study published in the September 3, 2004 issue of the Lancet identified nine traditional risk factors for an acute heart attack: Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity. As per the study, more than 90% of the global risk for acute MI is predicted by these nine traditional risk factors. All the major lifestyle disorders or NCDs share common lifestyle-related risk factors like physical inactivity, unhealthy diet, tobacco and excess alcohol intake. These risk factors are modifiable i.e. measures can be taken to prevent them. Non-modifiable risk factors are those which cannot be changed e.g. age, family history and ethnicity. Adopting a healthy lifestyle can either prevent or delay onset and progression of these diseases. Because these lifestyle diseases share modifiable risk factors, patients should be advised a common lifestyle, which will prevent all lifestyle disorders. Instead of advocating a lifestyle for individual disease, these lifestyle modifications should be such that they not only prevent heart diseases but also type 2 diabetes, hypertension, overweight and obesity, depression and cancer. Here is my Formula of 80 to live up to the age of 80. • Keep lower BP, LDL ‘bad’ cholesterol levels, resting heart rate, fasting sugar and abdominal girth levels all less than 80. • Keep kidney and lung functions more than 80%. • Walk 80 minutes a day, brisk walk 80 min a week with a speed of 80 steps (at least) per minute • Eat less and not more than 80 gm or ml of caloric food each meal. Follow a healthy diet (high fiber, low saturated fat, zero trans fat, low refined carbohydrate, low salt, high in fruits). Refined carbohydrates are white rice, white maida and white sugar. • Observe cereal fast 80 days in a year. • Do 80 cycles of pranayama (parasympathetic breathing) in a day with a speed of 4 per minute. • Spend 80 minutes with yourself every day (relaxation, meditation, helping others etc). • Do not smoke or be ready to shell out 80 K Rs. for treatment. • Do not drink alcohol; if you do, do not consume more than 80 ml per day for men (50% for women) or 80 grams per week. Ten grams of alcohol is present in 30 ml or 1 oz of 80 proof liquor. • Avoid exposure to >80 dB of noise. • Avoid exposure to PM 2.5 and PM 10 levels <80 mcg/m3. • Take vitamin D through sunlight 80 days in a year. • If you are a heart patient, consider 80 mg aspirin and 80 mg atorvastatin a day.

Heat it, Boil it, Cook it, Peel it or Forget it

Heat it, Boil it, Cook it, Peel it or Forget it Food can become contaminated at any point during production, distribution and preparation. Eating contaminated food can lead to diseases. Diarrhea, cholera, typhoid and jaundice are all food and water-borne diseases due to poor food hygiene. All these diseases can become critical and life-threatening, if not managed timely. According to the first ever ‘WHO Estimates of the Global Burden of Food-borne diseases’ published in December 2015, the global burden of food-borne disease is considerable, and affects individuals of all ages, but particularly children under 5 years of age and persons living in low-income areas of the world. Food-borne diseases are an important cause of morbidity and mortality and also adversely affect socioeconomic development worldwide. As per the report, the most frequent causes of food-borne illness were diarrheal disease agents, particularly Norovirus and Campylobacter spp. Food sold on the roadside is not safe to eat. The food is often prepared in unhygienic conditions; the water used may be contaminated and the ingredients used may be of inferior quality. The storage conditions may not be proper. WHO developed the Five Keys (as follows) to Safer Food Program to promote safe food handling behaviors and educate all food handlers, including consumers. 1. Keep clean 2. Separate raw and cooked 3. Cook thoroughly 4. Keep food at safe temperatures 5. Use safe water and raw materials Last year, the Health Ministry along with the Food Safety and Standards Authority of India (FSSAI) and Ministry of Skill Development & Entrepreneurship launched a project ‘Clean Street Food’ to raise the safety standards of foods sold on streets across the capital city of New Delhi by training 20,000 roadside vendors on aspects of health and hygiene, in the first phase (Press Information Bureau, 13th March, 2016). Proper food hygiene therefore is important as it prevents food-borne diseases. Food hygiene basically means maintaining hygiene at home while cutting, serving and eating food. Any food which has been boiled, heated or peeled is safe for eating. Peeling means removing the skin of a fruit such as banana or oranges. The best formula to remember when food hygiene is in doubt is "Heat it, Boil it, Cook it, Peel it or forget it." This means that if one is not sure about the food hygiene and/or the offered food cannot be boiled, cooked, heated or peeled (without knife), then avoid eating it. The best fruits to eat in such situations are bananas and oranges. Dr KK Aggarwal National President IMA and HCFI

Celebrate Holi with joviality, not violently

Celebrate Holi with joviality, not violently New Delhi, March 12, 2017: Holi is a festival of colors, joy and understanding, which unites not only loved ones but hesitant individuals as well. Not only in India but world-wide the day of Holi is celebrated by people with love and gaiety. Many festivals around the globe are inspired by Holi (like Colorjam Color Music Festival, Holi One etc) which truly demonstrate the importance of this festival. Padma Shri Awardee Dr K K Aggarwal, National President, Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said that, “Holi can also be associated with various health issues, injuries and even death, making it a perilous festival among all. Hence, preventive awareness must be raised and necessary precautions should be taken. Consumption of ‘Bhang’ (Cannabis) mixed thandai results in acute abnormal mental behavior, psychosis, high blood pressure and tachycardia (increased heart rate). Adverse effects of bhang can be significantly prevented by pre-treatment with beta blocker. Therefore, it is advised to celebrate safe and healthy Holi. We at Indian Medical Association wish everyone a Happy Holi.” “We celebrate Holi to commemorate legends associated with this festival, like legend of Prahlad and Hiranyakshyap, legend of Radha-Krishna or to celebrate Kaamadeva’s sacrifice for Lord Shiva. The underlying reasons for celebrating Holi are many but the objective remains the same, which is enjoyment, free from violence. Enjoy this multicolored festival and savor the reasons for its celebrations” added Dr K K Aggarwal. A few dangers of Holi include: · Green and bluish-green chemicals are injurious to eyes as they contain malachite green toxic compound · Use of phototoxic colors like Auramine, methyl violet, rhodamine and orange II can give rise to dermatological problems · Large amount of alcohol or Bhang consumption can increase chances of accidents and even death · Balloons can precipitate eyes and head injuries. Some tips · Avoid eye-contact to toxic colors, as it can damage your eyes. Wear sunglasses to keep eyes safe. If problem persists seek medical advice. · Use organic colors instead of chemical dyes. · Never play Holi with strangers. · Wear sunglasses to keep eyes safe from the harmful chemicals of the colors. · Wear full-sleeved dark colored cloths to avoid direct contact with colors. · Avoid colors to enter your mouth. · Apply sufficient amount of oil on your skin as it will assist in easy removal of color. · Use lukewarm water to wash-off the color and keep eyes and lips tightly closed. · Cover the head/hair with a scarf or a hat as it may protect hair from being colored with hard-to rinse colors. · Never play Holi with mud, eggs or gutter water. · Never color anyone with ‘abir’ as it contains mica which has toxic properties. · Never forcibly applying color on hesitant people. · Don’t walk alone on the streets on the day of Holi.

Forget me Not: IMA Campaign for the Elderly

Forget me Not: IMA Campaign for the Elderly The global demography is changing with a considerable increase in the older population in almost all countries. A greater understanding of etiopathogenesis of many diseases leading to newer and more effective treatment options has improved life expectancy. Not just medical advances, economic growth and social development too have contributed to the rising aging population. “According to Population Census 2011 there are nearly 104 million elderly persons (aged 60 years or above) in India” (Elderly in India 2016 Report). “The global share of older people aged 60 years or over is expected to increase from 11.7% in 2013 to 21.1% by 2050. Presently, about two thirds of the world’s older persons live in developing countries. By 2050, nearly 8 in 10 of the world’s older population will live in the less developed regions. An Indian born in 1950 could expect to live for 37 years, whereas today India’s life expectancy at birth nearly doubled to 68 years, by 2050, it is projected to increase to 76 years. As a result, India’s population will rise from 1.3 billion today to an estimated 1.7 billion by 2050, with a much larger elderly share of around 340 million” (Press Information Bureau, March 22, 2016). Heart disease, dementia, diabetes, arthritis, cataract, sleep problems, depression, anxiety are some of the common health conditions prevalent in the elderly. And, most of these conditions co-exist, giving rise to polypharmacy, which has its own associated set of problems. In addition to these are the issues of disability, financial insecurity, isolation, loneliness, neglect. Left alone at home, they are also exposed to crime. From being usefully occupied for most part of their lives, they find themselves with plenty of time on their hands post-retirement. Hence, the challenges are not just health related but also economic and social. The elderly are a vulnerable group and need to be looked after. They can still contribute to the society. By neglecting them, we are losing out on their skill and years of experience. Efforts need to be made to improve quality of their lives and integrate them in the society. Health care for this population group in particular should be accessible and affordable; they need to be protected from ill-treatment and neglect. Those who wish to be productively engaged should be encouraged to do so. “Article 41, a Directive Principle of State Policy, provides that the State shall, within the limits of its economic capacity and development, make effective provision for securing the right of public assistance in cases of old age. The Maintenance and Welfare of Parents and senior Citizen Act, 2007, also known as “Senior Citizens Act” explicitly states that it should be the duty of the children to maintain their parents.” (Press Information Bureau, October 1, 2015). “The National Policy on Older Persons (NPOP) announced in 1999 envisages State support for the elderly to ensure financial and food security, health care, shelter, protection against abuse and exploitation, and training of human resources for their care and support etc. The policy also covers issues like social security, intergenerational bonding, family as the primary caretaker, role of Non-Governmental Organizations, training of manpower, research and training.” (Press Information Bureau, August 5, 2014) The “National Programme for the Health Care of Elderly” (NPHCE) was launched in the year 2010 to address health related problems of elderly people. Last year, the Ministry of Health & Family Welfare launched the Longitudinal Ageing Study in India (LASI) to generate data on various issues of the elderly. It will survey more than 60,000 elderly over 25 years plan. October 1 has been designated as the International Day of Older Persons by the United Nations to raise awareness about issues affecting the elderly. “Forget me Not” is a campaign proposed by the Indian Medical Association (IMA) for the elderly population enabling them to lead a healthy and productive life with dignity. Doctors need to be trained to take care of the special needs of the older people. As doctors, we should not only provide them medical care, but also be a support to them. Dr KK Aggarwal National President IMA and HCFI

Spurious drugs in India

Spurious drugs in India Fake drugs constitute 25% of domestic medicines market in India: ASSOCHAM New Delhi, March 11, 2017: Spurious drugs are mainly the products which are deliberately and fraudulently mislabeled and manufactured to mislead and misrepresent the patients by concealing their identity, source of manufacture and its content to profiteer on the popularity of fast moving branded or generic medicines. It may or may not contain the active ingredients in the manner mentioned on the label. Fake drugs were found to be available as popular medicines like Crocin, Voveran, Betadine, injections of calcium and syrups like Cosavil which are fake, counterfeit or substandard. Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said, “What drives trade in fake drugs is lack of adequate regulations, shortage of drug inspectors and a lack of lab facilities to check purity of drugs, adds the paper. It says the other key factors include storages of spurious drugs by the chemists, weaknesses in drug distribution system, lack of awareness among consumers and lack of law enforcement.” Other than the NCR, concentration of fake drugs was found to be present in Bahadurgarh, Ghaziabad, Aligarh, Bhiwadi, Ballabhgarh, Sonepat, Hisar and Punjab. Agra is also increasingly becoming a hub for fake drugs in India, as per ASSPCHAM report. “According to a World Health Organisation report, every year about one million people die globally due to spurious drugs. Keeping that in mind, India must not lag behind in taking stringent measures to stamp out the counterfeit drugs. Authentication solutions would be a step forward.”, adds Dr K K Aggarwal. Law: Drug shall seem to be spurious if it falls within the definition as per Chapter IV, Sec. 17B of the D&C Act: • If it is manufactured under a name which belongs to another drug; or • If it is imitation of or is a substitute for another drug or resembles another drug in a manner likely to deceive or bears upon it or upon its label or container the name of another drug unless it is plainly and conspicuously marked so as to reveal its true character and its lack of identity with such other drug; or • If the label or container bears the name of an individual or company purporting to be manufacturer of the drug; which individual or company is fictitious or does not exist; or • If it has been substituted wholly or in part by another drug or substance; or • If it purports to be the product of a manufacturer of whom it is not truly a product.

New ACC/AHA/HRS guidelines for evaluation and management of syncope

New ACC/AHA/HRS guidelines for evaluation and management of syncope The American College of Cardiology, American Heart Association and the Heart Rhythm Society have jointly released a guideline for the evaluation and management of patients with syncope to be published simultaneously in the Journal of the American College of Cardiology, Circulation and Heart Rhythm. The new recommendations from the 2017 ACC/AHA/HRS guideline include: • If a patient faints, a doctor should perform a detailed history and physical examination during the initial evaluation. • The most common cause of fainting usually occurs while standing when blood pressure drops, reducing circulation to the brain and causing loss of consciousness. This condition is not life threatening although it can cause worries and interfere with one’s quality of life. Physicians should inform patients that common faints are not life threatening. • Using an electrocardiogram (ECG) when initially evaluating patients who faint is useful. It is important to find out the cause of fainting and treat the heart condition in the patient if he or she has an abnormal ECG after fainting. • If a person has a serious medical condition that could be related to their fainting, they should be evaluated and/or treated at a hospital after the initial assessment. • There are a number of tests that are not useful in evaluating patients who faint. These include: routine laboratory testing, routine cardiac imaging, like an MRI or CT scan, unless the patient has a suspected cardiac issue, and carotid artery or head imaging, unless there is a specific reason why the patient needs to be evaluated further. • Implantable cardioverter-defibrillators (ICD) can be helpful for certain patients who faint because they have irregular heartbeats that are life threatening. • Beta-blockers can be a good choice in patients who faint and who have certain heart conditions as defined in the guidelines. • Patients who faint and who also have certain types of heart issues as defined in the guidelines should restrict their exercise. • A pacemaker may be helpful for some patients who experience reoccurring common faints that are associated with a very slow heart rate. Drugs are usually not very effective in treating patients with common faints. • Heart rhythm monitoring can be a good choice for patients with unexplained fainting who may have intermittent heart rhythm issues that cause fainting. • An athlete who has problems with fainting should have a heart assessment done by an experienced health care provider or specialist before returning to competitive sports. (Source: AHA Press Release, March 9, 2017) Dr KK Aggarwal National President IMA and HCFI