माझा साक्षात्कारी हृदयरोग (ऐसी अक्षरे -२७)

मी वयाच्या 40 व्या वर्षी निवृत्त व्हायचं ठरवलं तेव्हा हे पुस्तक आणि रसेल चा एक निबंध कारणीभूत ठरले होते

परदेशी तक्ते असतात त्यात वजन, शर्करा, रक्तदाब, कोलेस्टेरॉल यांचे कमी अधिक किंवा योग्य अशी आकडेवारी पाहून अभयला वाटत होते की मला कधी अटॅक येणार नाही. तरीही आलाच तेव्हा त्यांच्या लक्षात आले की ती परिमाणं भारतात लागू नाहीत.

हे पुस्तक मी माझ्या साक्षात्कारी हृदयरोगाच्या विश्रांती काळात म्हणजे १९९२ साली वाचले होते. आता त्याला ३३ वर्षे झाली. अंनिसमधीला माझ्या बुद्धीवादी मित्रांच्या दृष्टीने या पुस्तकातील विचार छद्मशास्त्रीय होते. तो काळही अंनिसच्या ऐन बहराचा होता. मला देखील तसेच वाटले होते तेव्हा. तरीही वाचून बरे वाटले

वैज्ञानिक/अवैज्ञानिक, विवेक/अविवेक इ० ची प्रशस्तीपत्रके वाटायचा मक्ता घेतलेल्या अनिसला जीवशास्त्र किती कळते असा मला प्रश्न पडला आहे. वरील पुस्तकातले कोणते विचार छद्मविज्ञान आहेत हे न सांगता लेबले लावत हिंडणे याला विवेकी कृती म्हणायचे का?

हे पुस्तक खूप गाजले होते. अर्थातच ते वाचले आहे. उपयोगी पुस्तक आहे. मूलभूत विचार त्यात आहेत. फक्त एकच कमी जाणवते, (पुस्तकात नव्हे) तर पुढील काळात या जीवनपद्धतीचे फायदे दिसले का? पुन्हा हृदयाचा त्रास कधीच झाला नाही का? असा फॉलो अप कुठेतरी छापून यायला हवा होता. त्या पुस्तकातले आणि त्यानंतरचे सर्व लिखाण त्या दोन वर्षांतले आहे. बातम्या वाचल्या असता त्यांना पुढेही हृदय विकारासाठी रुग्णालयात दाखल करायला लागले होते असे दिसते (एकाहून अधिक वेळा). अर्थात त्याची तीव्रता कमी जास्त असू शकते. पण एखादा बदल घडवला तर त्याचे पुढे काय झाले हे समजल्यास अधिक बरे वाटते.

<तर पुढील काळात या जीवनपद्धतीचे फायदे दिसले का? पुन्हा हृदयाचा त्रास कधीच झाला नाही का?>

भरपूर संशोधन झाले आहे. हवे असेल तर माहिती मिळवून देऊ शकेन.

### Key Points
- Research suggests lifestyle modifications can reduce the risk of recurrent coronary events.
- It seems likely that changes like diet, exercise, and smoking cessation are effective, based on multiple studies.
- The evidence leans toward cardiac rehabilitation programs also lowering recurrence rates, though participation rates vary.

### Introduction
Coronary events, such as heart attacks, can recur, and lifestyle modifications are often recommended to prevent this. Research has explored how changes in diet, physical activity, and other habits impact these recurrence rates. Below, we break down the findings for a clearer understanding.

### Research Overview
Studies show that adopting a healthy lifestyle can significantly lower the chances of another coronary event. For instance, the Mediterranean diet has been linked to reduced risks, and quitting smoking post-heart attack can improve long-term outcomes. However, the effectiveness can vary based on individual factors and how well these changes are maintained.

### Cardiac Rehabilitation and Participation
Cardiac rehabilitation, which includes lifestyle changes, has been shown to reduce mortality rates by up to 21% over five years. Yet, participation remains low, with rates around 10–20% in earlier years and under 30% more recently, highlighting a need for better access and awareness.

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### Detailed Survey Note

Coronary artery disease remains a leading cause of death globally, with approximately 805,000 individuals in the US experiencing a myocardial infarction (MI) each year, nearly 25% of which are reinfarctions. Given the significant burden, follow-up research on preventing recurrence through lifestyle modification is crucial. This note synthesizes findings from recent studies, emphasizing the role of lifestyle changes in reducing recurrent coronary events and improving patient outcomes.

#### Background and Prevalence
Coronary events, including MIs and subsequent reinfarctions, pose a persistent threat, particularly post-intervention like percutaneous coronary intervention (PCI). Advances in medical therapy, such as dual antiplatelet therapy (DAPT) and statins, have improved survival rates, but recurrent events remain a concern. Research suggests that lifestyle modifications can complement pharmacotherapy to further mitigate this risk.

#### Impact of Lifestyle Modifications
Numerous studies have investigated the efficacy of lifestyle changes in secondary prevention. Key areas include:

- **Smoking Cessation**: Post-MI, quitting smoking reduces mortality risk by 37% over 13 years compared to continuing, with a 18% risk reduction for those reducing cigarette intake by 5 daily. Combination therapy (pharmacotherapy and behavioral support) improves cessation success by 70–100% compared to minimal intervention, as supported by studies like [Smoking Cessation Outcomes](https://doi.org/10.1016/j.jacc.2009.09.020) and [Combination Therapy Effectiveness](https://doi.org/10.1002/14651858.CD008286.pub3).

- **Dietary Changes**: The Mediterranean diet, rich in fruits, vegetables, whole grains, and olive oil, showed a 72% reduction in recurrent nonfatal MI and 56% mortality reduction over 4 years in the Lyon Diet Heart Study. The PREDIMED study found a 30% reduction in cardiovascular events with Mediterranean diet supplemented by extra-virgin olive oil or nuts. The DASH diet, reducing systolic blood pressure by 5.5 mmHg and diastolic by 3.0 mmHg, also showed benefits, particularly in hypertensive patients, with effects comparable to one antihypertensive medication (DASH-Sodium Trial). Vegetarian diets were associated with 30% lower ischemic heart disease mortality compared to non-vegetarian diets, while ketogenic diets, despite weight loss benefits, showed increased post-MI mortality with higher animal fat intake.

- **Exercise and Physical Activity**: Post-MI, remaining active or increasing activity reduces mortality by 71% and 59% at 1 year compared to remaining inactive. Guidelines recommend 150–300 minutes of moderate or 75–150 minutes of vigorous weekly activity to maintain cardiovascular health.

- **Weight Management**: A 5% weight reduction improves blood pressure, cholesterol, and glycemic control. Bariatric surgery in obese patients reduced all-cause mortality by 45% and cardiovascular mortality by 41%. The SELECT trial with semaglutide showed 10% weight loss and a 20% reduction in cardiovascular outcomes, highlighting the role of weight management.

- **Stress Management and Psychological Health**: Cardiac rehabilitation (CR) programs, which often include stress management, reduced 5-year mortality by 21% in Medicare cohorts, with dose-dependent benefits. Participants attending more sessions showed improved MI and death outcomes, with a 63% decrease in depressive symptoms and 73% mortality reduction in depressed CR participants.

#### Cardiac Rehabilitation and Participation Challenges
CR is a cornerstone of secondary prevention, integrating lifestyle modifications with supervised exercise and education. It reduces 5-year mortality by 21%, with greater session attendance linked to better outcomes. However, participation rates are low, historically at 10–20% in 2005 and under 30% by 2014, due to barriers like low referral rates (men 1.5 times more likely referred than women), age over 60, and socioeconomic factors. Alternatives like home-based CR (HBCR) showed better 6-minute walk test results, quality of life, and completion rates (>85%) compared to facility-based programs, with hybrid models being non-inferior at 1 year.

#### Long-Term Observational Insights
Long-term studies like the Nurses' Health Study and Health Professionals Follow-up Study provide insights into lifestyle impacts on CVD risk, including coronary events. These observational data underscore the sustained benefits of lifestyle modifications, with higher quality diets associated with lower all-cause mortality post-MI, as seen in recent cohort analyses.

#### Comparative Analysis
The following table summarizes key lifestyle interventions and their impact on recurrent coronary events:

| **Intervention** | **Impact on Recurrence** | **Supporting Evidence** |
|--------------------------|-------------------------------------------------------|-----------------------------------------------------|
| Smoking Cessation | 37% mortality risk reduction over 13 years post-MI | [Smoking Cessation Outcomes](https://doi.org/10.1016/j.jacc.2009.09.020) |
| Mediterranean Diet | 72% reduction in nonfatal MI, 56% mortality reduction | Lyon Diet Heart Study, PREDIMED Study |
| DASH Diet | Reduces blood pressure, comparable to one drug | DASH-Sodium Trial |
| Exercise (150+ min/week) | 71–59% mortality reduction at 1 year post-MI | Guidelines and observational data |
| Weight Loss (5%) | Improves BP, cholesterol, glycemic control | SELECT Trial, bariatric surgery outcomes |
| Cardiac Rehabilitation | 21% reduction in 5-year mortality | Medicare cohort, dose-dependent benefits |

#### Conclusion
Follow-up research clearly supports the role of lifestyle modifications in reducing the recurrence of coronary events. From dietary shifts like the Mediterranean and DASH diets to smoking cessation and increased physical activity, these changes offer significant benefits, often enhanced by CR programs. However, challenges in participation and implementation highlight the need for improved access and tailored interventions, particularly for underserved populations.

### Key Citations
- [Smoking Cessation Outcomes in Post-MI Patients](https://doi.org/10.1016/j.jacc.2009.09.020)
- [Combination Therapy Effectiveness for Smoking Cessation](https://doi.org/10.1002/14651858.CD008286.pub3)

हृदयाघाताचा मला ही भरपूर अनुभव आहे. आमच्या कार्यालयातील जोतिषाचा शौक असलेल्या एक बाबू मला एकदा म्हणाला होता पटाईतजी आपके कुंडली में राहू बहुत स्ट्रॉंग है, यमराज बेचेरा हार के लौट जाता है. पाच वेळा हृदयाघाता , पाच वेगळे हॉस्पिटल्स, तीनदा अंजीओ, एकदा स्टेन्ट, एकदा बायपास. मजेदार प्रत्येक वेळी हृदयाची गती 110/70 होती. वजन ही जास्त नव्हते. बाहेरचे खाणे ही नाही (आता वाढले आहे), पान सिगरेट तंबाकू दारू ही नाही. कारण कार्यालयात जास्त वेळ काम करणे आणि स्ट्रैस असावा.

बेचेरा नाही बेचारा वाचावे.