Dr. Aashish Contractor is the Head of Preventive Cardiology and Rehabilitation in Asian Heart Institute. After studying Cardiac Rehabilitation and Exercise Physiology and training under Dr. Neil Gordon, who is considered a pioneer in preventive cardiology in US, Dr. Aashish returned to India in 2001 and has been a part of the preventive cardiology department in Asian Heart Institute since its inception. Dr. Aashish has coordinated medical support for Mumbai Marathon since its initiation and was a part of the team of doctors who treated hon’ble PM Dr. Manmohan Singh after his redo bypass surgery in January 2009.
In this interview with Medimanage.com, Dr. Aashish shares his insights about heart disease and ways to keep your heart healthy.
It is observed that most people become aware about their heart ailment only after suffering from a heart attack or chest pain. Do you see reluctance on the part of the patients to do regular checkups? What advice would you give them regarding detecting heart disease early?
There is a general reluctance but over a period of time, with increasing awareness, and also, frankly, seeing people around you suffer, more people are coming for checkups. The advice I would give them is to know about their simple parameters like weight, blood sugar, cholesterol and blood pressure. Forget complicated figures, but after you cross the age of 18, as an adult, you need to monitor these simple things.
How do you know you should get your heart checked up? How often should the checkup be done?
That becomes difficult to answer as it depends upon what do you mean by check up and at what age, but there are guidelines, for example for breast cancer, if I am not mistaken, women over the age of 40 should be screened, for prostate cancer, men over the age of 40- 45 should get themselves examined.
For heart, there is no specific age but like I mentioned the moment they are adults they should know their blood sugar level, BP, etc. If the numbers are not normal, the frequency of checkups will depend on the abnormality. The doctor will prescribe some medication and ask you to follow up after a certain period. But if the figures are normal, checking once in a year or once in two years is fine. So the frequency changes depending on the specific case.
Indians are at greater risk of heart disease than the Westerners. At the same time we are people who are not generally serious about health. Is it a double blow? How do you see the trend of heart diseases in India affecting young age people?
The trend of heart disease in India is rapidly on the increase, the statistics show that from 1990-2000 there has been a rapid upward curve for the disease. Having said that, you have said people don’t take care of their health in India, but India is so diverse in every aspect that it cannot be generalized. But among the middle and upper middle class, there is an increased awareness about heart disease.
Eating non-vegetarian food, especially Red Meat, makes you more prone to heart diseases. Comment
Red meat is generally high in saturated fats. And saturated fats tend to increase cholesterol in the body especially LDL or the bad cholesterol. Hence red meat is considered to be bad for the heart. But this doesn’t mean you cannot eat non vegetarian food, even those suffering from heart ailments can still eat non vegetarian food but need to avoid red meat or reduce the frequency, they can have it once a week or ten days.
Are non vegetarians more prone to heart disease?
No, you cannot say that, I always maintain you can be an unhealthy vegetarian or a healthy non vegetarian and can be a healthy vegetarian or an unhealthy non vegetarian. Most of the patients that we see in our hospitals for example are vegetariansSo it is not that non vegetarians are more prone to the disease.
Since you have worked with Dr. Dean Ornish best known for his program for Reversing heart disease without drugs or surgery, tell us about the program.
Well, this program is a very strict program with four components which are a low fat diet, moderate exercise, yoga and group support therapy. If you do it right, you will see the results but as we are learning more and more we understand that this is not the only way, there are other ways that can be followed too.
So we can reverse heart disease without surgery?
The term reversal of heart disease needs to be understood. We think that there is an artery with 90% block and you do something and it reduces to 60% but it doesn’t work that way. The block doesn’t shrink to 60%, the only thing that is reduced is the chance of an event. So it is a physiological reversal but it is not anatomical reversal. When you take care of all these factors, a reversal is possible. That is what we also do in our cardiac rehab program. He has ‘a method’, we have ‘a method’ but the principles are the same.
Everyone knows they need to exercise and eat a healthy diet but it still seems a difficult task for stressed out, busy urbanites. What other tips could you suggest for them to keep their heart healthy?
At least in terms of exercise, there aren’t too many alternatives; you either do it or you don’t but the bottom line is you need to exercise. As far as, diet is concerned, there are hundred roads to lead to good health.
When you say exercise, what does that mean, does that mean you need to go to the gym thrice a week?
Exercise means two main things; one is being physically active throughout the day and the second is formal exercise. There should be some kind of cardiovascular exercise like cycling, walking and swimming or playing a sport and some of resistance weight training 2-3 times a week, all of these constitute exercise; you can pick and choose what you want. You don’t always have to go to the gym for that. There is a lot of variation but you have to do it. You cannot escape the fact that you need to exercise.
How does our way of dealing with stress relate to heart disease?
Stress is an area which is very difficult to quantify, unlike diabetes or cholesterol or blood pressure. There has been a very big study called as ‘Inter Heart study’ where they say that stress, or ‘psycho-social’ factors play a very important role in the development of heart disease. How or how much, we cannot really say. Another thing is stress is present in everyone’s life, especially in urban setting; like being stuck in traffic. It is about how we deal with it. Some people really react to it negatively while some people deal with it calmly.
How are genetics related to heart disease?
Genetics or family risk for heart disease is a potent risk factor. How much would they affect, it is difficult to say. Some people’s genes are so ‘bad’ they may get it no matter what but there is a difference. If they take all the care, they may get an attack at 60, that too, a mild one than getting a fatal attack at 45. So it is not that if your genes are bad, you are doomed, there are a lot of other things that you can do.
Men have a greater risk to heart disease than women. Is it true?
It is true upto a time when a woman reaches menopause. Because until she reaches menopause she has a protection in the form of estrogen, after menopause the number is equal or more than men. So in absolute sense, both have an equal risk for heart disease.
What is the common misconception about heart disease that you have observed in people?
The most common misconception is if you are thin and fit you cannot have heart disease. It is definitely not true. My classic example is driving a car; there are many factors that are in consideration when making a car accident-free. You cannot just say that my breaks were running fine and still I had an accident. That is exactly like saying I am fit and I still got a heart attack. It is good that one is fit but it is just one factor, being fit doesn’t give you immunity against other factors.
