HEALTHWATCH
Clear the arterial highways
DR. V. GURUMOORTHY
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Atherosclerosis or the hardening of coronary arteries is a persistent foe and the best way to fight it is by exercise.
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Photo: N. Sridharan
Protect the heart: Walk, run or cycle but make sure you include physical activity.
Heart disease is the leading cause of death worldwide. In most cases, the culprit is coronary artery disease, which is responsible for heart attack. This is caused by cholesterol-laden blockages (plaques) in the arteries that carry oxygen-rich blood
to the heart muscle.
Constructing a new channel to detour blood around the blockage, called coronary artery bypass grafting, can be a remarkably effective reperfusion therapy. Targeting big plaques causing the most narrowing, and aiming at clearing the most tightly blocked arteries have become routine treatment.
Alternatives?
But is it the best approach all the time? Is there an effective alternative? Can such an eventuality be prevented?
Reperfusion therapy targets and corrects only tiny segments of the coronary artery tree, with the largest — rather old and stable — blockages. It does not prevent the silent progression of readily vulnerable and rupture-prone younger plaques. There are more enemies than the targeted spots alone. Having one plaque, big enough to limit blood flow, usually means many others are lurking nearby.
For every bulging fatty plaque, visible on an angiogram (mapping the arterial tree), scores of others line the coronary arteries. Some ‘hidden’ plaques — especially of the smaller branches, diffusely thickened, hardened and narrowed — are not detectable on an angiogram.
For that matter, the vast expanse of the entire arterial tree may be studded with such changes, resulting in gross malfunctioning of the various organs and systems.
In many, who undergo reperfusion therapies, venous grafts may get blocked and even stented vessels may get restenosed over the years. The heart responds by growing new vessels that can compensate for the reduced blood flow.
Signals
Many adults have narrowed coronary arteries and do live ‘normally’, without overt signs of heart disease. Responding to the steady onslaught of artery-narrowing atherosclerosis, blood vessels generate a host of chemical and physical signals.
These signals open up tiny blood vessels that lie dormant in the heart muscle since birth. They try to build up collateral circulation and provide alternate routes around a blocked artery.
Studies spanning over five decades have highlighted the great potential of this network of recruitable blood vessels. Intensive trials are on to stimulate collateral blood vessels with protein growth factors, growth promoting genes and promise-holding stem cells.
But the simplest and surest way to succeed is to do regular and rigorous physical exercise. It helps the heart musculature nurture the growth of new blood vessels in a natural way to bypass cholesterol-clogged coronary arteries, without the pain of reperfusion therapies.
Effects of exercise
Brisk walking, running, jogging, swimming, bicycling, any form of sustained physical activity that makes the heart beat comfortably faster, is good enough.
To meet the increased demands on the heart muscle due to rigorous exercising, blood flow through the coronary arteries is dramatically boosted.
This physical stress stimulates the small collaterals to elongate, grow larger and wider, get more interconnected and become more functional, thus reaching out towards existing arteries or other new blood vessels. Such well developed collateral circulation, even in the event of an acute heart attack, greatly helps limit heart attack-induced muscle damage; keep the treatment window open for emergency angioplasty, well beyond the critical two to three hours and improve long-term survival
While medications are good, exercise is even better. Lifestyle changes and medication do help patients live better and longer. This invariably produces results that even surpass the benefits of reperfusion therapy. It helps many people with narrowed coronary arteries to avoid bypass surgery or angioplasty.
Despite lifestyle changes and aggressive medical therapy, if angina (pain of cardiac origin) continues to be refractory and troublesome, affecting quality of life, angioplasty or bypass surgery is a reasonable next step.
A family physician’s holistic approach and a cardiologist’s expertise would combine well to define and tailor the management options for an individual patient.
Exercise is a great way to protect the heart and prevent heart disease. Brisk walking for at least 40 minutes a day is a reasonably healthy target. The duration is as important as that of its intensity. Its beneficial effects being legion, exercise should form ‘a must’ in one’s daily routine.
Life depends on proper delivery of oxygen and nutrition at the cellular level. The heart and its arterial extensions are constantly at it. Exercise, done regularly and consistently, helps promote their health and steers clear the entire stretch of the arterial highways of the human physique.
Healthy choices
Despite the presence of risk factors and bad genes, the heart and blood vessels can be protected by lifestyle choices that include:
A healthy diet
increased physical activity
regular exercise
restful sleep and relaxation
stress reduction
cessation of smoking
maintaining ideal body weight and waist circumference
Benefits of medication
Aggressive medical therapy, when indicated, is effective and extends enormous benefits. This may include drugs to:
reduce the harmful LDL
boost the protective HDL
control blood pressure
reduce heart’s workload
maintain the heart rhythm
prevent harmful changes in the heart’s shape
relax tight arteries
fight blood clots
stabilise vulnerable plaques
manage diabetes
eliminate infection
control inflammation
ease or prevent angina
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