Wednesday, January 25, 2017

Can Christmas revelry trigger heart attacks?

09 Jan, 2017, 12:54AM IST

A-   A+

Long ago, when I ran my own Coronary Care ICU (intensive care unit) in Margão, I made an attempt to compile statistics (unpublished) which seemed to reveal that in Goa there is a spurt in heart attacks during the Christmas season. Why cardiac problems spike during these holidays? Your heart may leap with delight for instance at the electronic gizmo or emerald bracelet that you’ve just unwrapped from under the Christmas tree. But you can’t say the same for that nasty holiday surprise known as the “Merry Christmas coronary”. For many years, researchers have been intrigued by a disturbing pattern: deadly heart attacks increase during the Christmas holidays.
Studies done in US found distinct spikes around Christmas and New Year’s Day. In a study carried out sometime ago in the US researchers discovered an overall increase of 5% more heart-related deaths during the Christmas holiday season. Doctors have long known that very cold weather is hard on the heart. Blood vessels constrict, which raises blood pressure. Blood also clots more readily. Frigid temperatures increase strain on the heart, and too much physical exertion can trigger a heart attack. It is not surprising that doctors have treated many patients whose heart attacks followed strenuous snow shoveling.
Goa mercifully is not subjected to extremes of temperature. So a study from New Zealand by Catherine Paddock, PhD last December may help unravel the reasons for our own plight. The study points out that death from heart-related causes rise over Christmas - but not necessarily because of cold weather since in New Zealand the festive season occurs in summer. The most important reason apparently includes change in diet with heavy eating of wrong foods and excessive alcohol consumption. 
New research reveals that consuming high levels of four major saturated fats - such as those found in butter, lard, red meat, dairy fat, palm oil - may raise the risk of coronary heart disease. It confirms that eating too much saturated fat increases the risk of developing coronary heart disease. What about coconut oil? Recently my friend, “the magnate with a heart”, Avdhut Timblo, offered me a book, “The Miracle of Coconut Oil.” Despite the book’s contrarian viewpoint, doctors insist that coconut oil is detrimental to health. It contains 90% saturated fat, which is higher than butter (about 64% saturated fat), beef fat (40%), or even lard (also 40%). Too much saturated fat in the diet raises "bad" LDL cholesterol levels, which increase the risk of heart disease.
The current guidelines recommend that people limit saturated fat consumption to no more than one tenth of total calories, maintain an overall healthy diet that includes fruits, vegetables, whole grains, nuts, legumes, fish, and low-fat dairy, and use vegetable cooking oils rich in polyunsaturated  and monounsaturated fats. 
Fatty deposits called “plaque” unbelievably begin to accumulate in our coronary arteries “since childhood”. As the plaque builds up, it can harden and break open. Hardened plaque restricts blood flow and can lead to angina (chest pain or discomfort). Ruptured plaque gives rise to blood clots that further narrow the arteries and worsen angina. If a clot is big enough, it can completely or nearly completely block a coronary artery, causing a heart attack.
Recent findings refute the idea often glibly propounded by our “coconut oil and butter fans” that 'butter and coconut oil” are back. Oh no! Researchers consistently find that a 5 percent higher intake of longer chain dietary saturated fatty acids - such as found in hard cheese, whole milk, butter, beef, and chocolate - is linked to 25 percent increased risk of coronary heart disease over a follow-up of 24 years. 
It is impractical to pick out different saturated fatty acids in making dietary recommendations, as these fats share the same food sources - for instance, dairy foods, red meat, butter, lard, palm oil, coconut oil. Instead, it is healthier to replace these fatty acids with unsaturated fats from vegetable oils, nuts, seeds, and seafood as well as fruits, vegetables and whole grains. It is one of the easiest ways to reduce our risk of heart disease.
We know about families in Goa who will during the festive season attend three or four parties in a day if not more! They crave to be invited everywhere and love to reciprocate the favour organizing their own bashes to repay “courtesies”. This creates a dangerous vicious cycle. In the end they gulp insalubrious food and put on several kilos of weight. But I do admire people like our loveable ex-CM, Digambar Kamat, to cite one instance. Accompanied by his beloved wife he attends multiple parties yet does not partake of any eatable or drink. I envy him. I wish I had as much willpower!
Alcohol which is lavishly served at these parties does much to increase the risk of high blood pressure. Excessive amounts of alcohol raise blood pressure which is one of the most important risk factors for having a heart attack or a stroke. 
If you happen to be a ‘party animal’, keep your response simple when you see many invitation cards piling on your desk. First, be firm and direct, then, separate refusal from rejection, finally don’t feel guilty to say a polite no. Does this make you sulk? Sorry! “Health is wealth.”

(Dr. Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa.)