Harinder Singh Bedi
Eating sarson ka saag and makki ki roti with a dollop of butter, gajjak, rewari and groundnuts, sitting around the fire, cuddling up in a warm blanket and – guess what – having a heart attack You’re more likely to experience them in the winter! The risks of having a heart attack during the winter months are twice as high as in the summer time – and the winter attack is also more likely to be fatal.
Clot formation: Cold weather poses danger for those with heart disease, for a variety of reasons. Heart attacks usually occur in people with a build-up of fatty plaque in their arteries. For a heart attack to occur, some sudden event must cause the plaque to crack and rupture, at which point blood platelets get sticky and form a clot in the artery.
In a study published in Circulation, the journal of the American Heart Association, The “Merry Christmas Coronary” and “Happy New Year Heart Attack Phenomenon,” by Dr Prof Robert A. Kloner, researchers found that the rate of heart disease-related deaths rose sharply between December 25 and January 7.
Even otherwise, a study carried out in collaboration with the Registrar General of India ( RGI) and the Indian Council of Medical Research (ICMR) has shown that heart ailments have replaced communicable diseases as the biggest killer in rural and urban India. About 25 per cent of deaths in the age group of 25- 69 years occur because of heart diseases. About 9.5 million deaths, which is about one in six deaths worldwide, occur in India every year. There is an increase of about 10 to 20 per cent incidence of cardiac arrests in winters as compared to warmer months. Temperatures often plummet to less than 5 degree Celsius in the peak winter months in North India. While the season affects everybody in the same way, increasing the amount of labour required by the heart, a person with a normal heart hardly feels the increased level of stress. The same can be dangerous for a person with a weak heart.
Risks of the cold weather
There is a combination of factors that increase heart attack risk in winter:
SPASM OF ARTERIES: When a person gets exposed to cold weather, the body’s automatic response is to narrow the blood vessels to the skin so that heat is retained. But for people who already have arteries filled with plaque, the narrowing of the blood vessels raises the risk that it will become blocked, triggering a heart attack. The problem is higher in India as we do not live in artificially regulated temperatures as in the West.
INCREASED BLOOD PRESSURE: Due to the narrowing, higher blood pressure leads to a strain on the heart. This has the effect of a double whammy. Not only does the heart have to work harder but its blood supply is reduced. While this may be tolerated well by a normal heart -in a diseased heart it can precipitate an attack. With every one degree centigrade drop in temperature, the blood pressure increases by 1.3 / 0.6 mm (systolic / diastolic).
THICKER BLOOD: In cold weather, blood platelets appear to be more active and stickier and, therefore, are more likely to clot. In fact, even the levels of cholesterol too rise during the winter.
FEASTING & UNACCUSTOMED EXERCISE: People tend to eat and drink more, and gain more weight during the holiday season and winter months. This coupled with unaccustomed exercise is unhealthy. Every January 1, millions of people join gyms as part of their New Year’s resolution to get in shape – and many may overexert themselves too soon. One should start an exercise regimen under the supervision of your doctor if you have heart disease risk factors.
INCREASED STRESS HORMONES: During the winter months, there is a change in the ratio of daylight hours to dark hours, which causes an increase of stress hormones eg cortisol.
SNOW SHOVELLING: Believe it or not, studies from Shimla show that heart attack rates jump dramatically in the first few days after a major snowstorm, usually a result of snow shovelling. One of my patients – a PT teacher at a boarding school in Shimla – suffered a heart attack as he was showing his students how to work in the snow.
STRESSFUL SEASON: Seasonal affective disorder (appropriately acronymed as SAD) is caused by the lack of exposure to sunlight during the winter months. People with depression are more susceptible to heart attacks.
FLU (INFLUENZA): Winter also raises your chances of getting the flu due to low humidity brought on by cold weather and indoor heating. A flu infection can increase blood pressure, stir up white blood cell activity, and change C-reactive protein and fibrinogen levels in the blood – which is all bad news for your heart. Flu and other respiratory disease in winter cause inflammation – which in turn make plaque less stable and may dislodge it – contributing to heart attacks.
If you come down with the flu, a cold or a cough, ask your doctor before taking any over-the-counter decongestants as some of these can raise blood pressure, which can increase the chances for heart attack. Elderly people should get vaccinated against influenza in the winters.
DELAY IN SEEKING TREATMENT: The risk of having a heart condition is also higher on the holidays because people commonly delay seeking treatment for symptoms during this time of year. In the Circulation study, researchers suggested people might delay getting treatment because they don’t want to disrupt Christmas and New Year’s festivities. In fact, I vividly remember a polite elderly patient in Sydney who apologised profusely for having ‘disturbed’ me in the holiday season with a heart attack that he had been nursing for the last two days. Other factors may play a role, such as emotional stress and overindulgence. During the holidays, legions of Indians eat too much of rich and fried food and meat and drink more alcohol — while ditching their exercise routine. Needless to say, this combination isn’t exactly healthy for the heart.
TAKE-AWAY TIPS FOR A HEALTHY TICKER
So does this mean you have to fear the winter and huddle indoors all the time? Not at all. The take-home message is not to be afraid of the winter but to know that winter is a period of increased risk and to look for ways to minimise that risk. So during the winter, try to keep your heart healthy by keeping the following pointers in mind:
* Stick to your normal exercise plan
* Take ‘sunshine’ walks and avoid going outdoors in the very early morning – wait for sunrise
* Wear proper attire, that is a thermal inner, muffler, cap, warm socks and a jacket with a hood are good investments to enjoy a healthy walk. Wear clothes in layers. You can sport a monkey cap or a cap and ear muffs. For Sikh gentlemen, a turban offers good protection to the head and ears from the cold.
* Start slow – avoid sudden changes.
* Have a proper trained gym instructor chart a graded exercise programme for you . Don’t aim for a Salman Khan / SRK six-pack in a short time.
* If its really really cold and you just do not feel like going out, hop on the indoor treadmill, find inner peace on the yoga mat or hit the dance floor with some friends.
* Eat a prudent diet low in saturated fats and calories. Nuts and dry fruits can be taken in moderation if one is not overweight. Avoid fatty fried and non-vegetarian food. Drink adequate amounts of water as dehydration makes the blood thicker.
* Avoid tobacco, coffee, tea or alcohol just to “warm you up” – the additional nicotine and caffeine put a stress on the heart. Alcohol or ‘holiday spirits’ cause vasodilatation and so produce a feeling of warmth – but the body loses heat. They also increase blood pressure and rhythm irregularity.
* Stop and smell the roses. Don’t get stressed out about preparations – make time to enjoy celebrations with family and friends.
(The writer is Director , Cardio-Vascular & Thoracic Sciences at the Ivy Hospital, Mohali)
Harinder Singh Bedi