If you’ve ever heard of someone who experienced a heart attack, chances are that it may have been due to ischemic heart disease. Ischemic heart disease (IHD) develops when the major vessels that supply blood to the heart become narrowed or blocked.

You may have also come across terms like ‘coronary artery disease’ and ‘coronary heart disease’ — these are also other commonly used names for IHD. IHD is one of the most serious cardiovascular diseases and poses a major global health challenge. In 2015, IHD was found to be the leading cause of all health-related loss worldwide. Around 110 million people around the world were estimated to have IHD, and there were around 7 million heart attacks.

One of India’s Biggest Health Challenges

Over the past 40 years, the number of Indians with IHD has become four times higher. In 2016, IHD predominantly contributed to around 83% of all deaths due to cardiovascular diseases in India. Along with stroke, it was also responsible for around one-tenth of all healthy life years lost due to CVDs. This means that IHD robbed away the prime, economically productive years of the lives of Indians.

Despite these worrying statistics, all is not bleak when it comes to IHD. You can significantly lower your risk of IHD by making simple, healthy lifestyle choices. Even if you are diagnosed with IHD, you can manage your disease by following a healthy lifestyle and taking your medications regularly. So, having a better understanding about the signs and risk factors of IHD can help in timely detection and effective management of the disease.

How does IHD develop?

• The arteries are blood vessels responsible for carrying oxygen-rich from the heart to other parts of the body. Narrowing of the arteries can happen when plaque (a waxy, fatty substance) builds up in the walls of the coronary arteries, which supply oxygen-rich blood to the heart. This process is known as ‘atherosclerosis’.
• This reduces the crucial supply of oxygen needed for the heart to function efficiently, a state called ‘ischemia’ (inadequate blood supply and oxygen to a part of an organ).
• Atherosclerosis also affects the functioning of the endothelial cells (cells which line the blood vessels). These cells cannot relax (or dilate) the arteries and thus, the blood and oxygen flow is further compromised.
• This limited oxygen supply can cause the cells of the heart muscle to die, which could lead to potentially life-threatening events like heart attacks.

Signs and symptoms of IHD

Unfortunately, there are no obvious signs and symptoms which signal IHD, making it a ‘silent’ disease. The symptoms that people experience are those of acute events which happen as a result of IHD, such as a heart attack. Long-term lack of oxygen to the heart cells can cause pangs of pain or discomfort to the chest. This is called ‘angina’. In addition to angina, look out for the following possible manifestations of IHD and heart attacks:

• Shortness of breath
• Discomfort in other parts of the body like jaws, shoulder, back, or arm
• Sweating
• Feeling faint
• Nausea

It is important to note that this is not a comprehensive list of possible signs and symptoms, and people may experience heart attacks differently. Some people may even have episodes of ischemia (inadequate oxygen to the heart cells) without any feelings of pain. This is called ‘silent ischemia’. So, if you have any of the risk factors for IHD, it is important to remain cautious about the possibility of acute events like angina and full-blown heart attacks.

Risk factors for IHD

The build-up of fatty plaque in the walls of your arteries can begin as early as childhood, so it is important to take precautions as early as possible to prevent your arteries from further clogging. Both non-modifiable and lifestyle-related factors can play a role in the development of IHD:

• **Age**: As you get older, your arteries become more vulnerable to damage and blockage.
• Sex: Generally, men have a higher risk of IHD. However, the risk becomes similar in women after menopause. In India, there has been a larger increase in IHD-related deaths among women than among men.
• **Family history**: You may be more susceptible to IHD if your father or brother was diagnosed with a heart condition before the age of 55, or if your mother or sister was diagnosed before the age of 65.
• High blood pressure: This can harden and thicken the arterial walls, further narrowing the blood vessels.
• High **cholesterol** levels: The deposition of low-density lipoprotein (LDL) cholesterol, or ‘bad’ cholesterol, in the arterial vessels leads to the development of atherosclerosis.
• Diabetes: People with diabetes are more likely to die as a result of a heart attack, and they may also have worse IHD progressions.
• Lack of physical activity: This can further worsen the build-up of plaque in and the narrowing of the arteries. Physical inactivity may also increase the risk of diabetes and obesity/overweight, which in turn make you more susceptible to IHD. Find out about the importance of physical activity here.
• Unhealthy dietary practices: Frequently consuming foods rich in saturated and trans fats can lead to atherosclerosis. Diets high in salt and refined sugar can also heighten your risk of high blood pressure and diabetes, respectively. Find out about a heart-healthy diet here.
• Smoking: The components of cigarette smoke contribute to the damage of the arterial walls. Studies have shown that cigarette smoking may double your risk of death from IHD compared to non-smokers. Moreover, smokers under the age 50 have a 10 times higher risk of developing IHD than non-smokers of the same age. Find out how you can quit here.
• Stress: This can have detrimental impacts on cardiovascular function through atherosclerosis and inflammation. Studies have shown that stress can almost double the risk of a heart attack. Read more about it here.

Preventing and managing IHD

Just like most cardiovascular diseases, IHD is also largely lifestyle-related, so leading a healthy lifestyle can significantly reduce your risk of IHD. Even if you’ve been diagnosed with IHD or have experienced an adverse IHD-related event like a heart attack, it is still possible to keep your disease in check. Here are a few simple tips you can follow:

• A healthy diet is key in preventing and aggravating IHD. It is important to limit the intake of artery-clogging foods like butter, heavy cream, and red meat as they are high in saturated and trans fats. Include more foods rich in healthy fats and complex carbohydrates like whole grains, nuts, avocados, and vegetable-based oils in your diet. You should also avoid excess salt and sugar consumption.

• Regular physical activity can be immensely beneficial to your overall cardiovascular health and in reducing your risk of overweight/obesity and diabetes. Even low-impact activities like yoga and brisk walking can be protective against IHD.

• Stress is a major culprit behind a host of health-related problems, including cardiovascular diseases like IHD. It is crucial to find ways to effectively manage your stress levels; this could be by exercising regularly, engaging in stress-relieving activities like hobbies, and maintaining social connections with your friends and family.

• Cholesterol monitoring is important to keep track of your levels of ‘good’ and ‘bad’ cholesterol. This can be done through regular lipid profile tests. This will enable you to make lifestyle changes and start taking the necessary medications in a timely manner.

• Quit unhealthy behaviours like smoking and excess alcohol consumption. Studies have shown that the benefits of quitting smoking come into effect almost immediately.

Key take-home messages

• IHD can start developing from an early age; ensure that you and all your family members are proactive about leading a heart-healthy lifestyle
• IHD and heart attacks do not discriminate and do not evade even the fittest — athletes are also prone to sudden deaths from heart attacks.
• So remember, whether you are a seasoned sportsperson, a desk job worker, or a homemaker, don’t take it easy with your and your family’s heart health!

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