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Your heart beats

for you ...it’s time
you did.

A Cardiovascular Disease Management Program for

Hypertension • Angina • Dyslipidemia

Here’s how you benefit from the ‘Healthy Heart’ Program. Akhilesh Verma, 54, Company Director

• Knowledge about your condition and • Education material on cardiovascular

cardiovascular disease management. risk factors.
• Access to the Healthy Heart Team • BP monitoring instrument
I’m winning against
– aids co-ordination and follow-up. (subsidised price) and training.
• Lifestyle advice by professionals
(diet, physiotherapy and yoga).
•
•
Invitations to select Group Sessions.
Access to ATM (Any Time Medicine)

A joint initiative by Pfizer and Apollo Hospitals

heart disease
because I understand my condition.

Indraprastha Apollo Hospitals PFIZER LIMITED

Delhi-Mathura Road, Jasola Vihar Pfizer Centre, Patel Estate Off S.V. Road,
New Delhi-110044 Ph: 011- 2682 5604 Jogeshwari (W), Mumbai 400 102
 contents welcome!
hypertension 2 Cardiovascular disease burden in India is on the rise with changing lifestyles. In
our country, nearly 50% of CVD-related deaths occur below the age of 70,
compared with just 22% in the West. That trend is particularly alarming and
heart attack 8 thus warrants aggressive therapy that aims to drive treatment goals to lower
levels, which are often difficult to attain and maintain.
angina 10 ‘The Healthy Heart Program’ identifies the people who are at
risk or have past history for hypertension, Coronary Artery Disease and
diabetes 15 dyslipidemia and sets up a lifelong preventive and promotive healthcare
program by using medical intervention and lifestyle management. This
taking care 20 program is the first of its kind in India, and through it PFIZER and APOLLO
hospital group will treat such patients through the application of medical care
and lifestyle management. This cardiovascular disease management program
has been reviewed and approved by the Apollo Hospital Ethics Committee.
Your voluntary enrolment in this program will be documented through the
signing of an informed consent form.

To know more about the "Healthy Heart" program and for details of
enrollment you can mail us on healthyheart@apollohospitals.com or call us on
1800 345 1066 "or" +91-40-60601066.

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hypertension
Hypertension is synonymous with high blood pressure. Blood
pressure is a measure of the force of blood against the walls of
the arteries, which are the conduits that carry blood from the
heart to other parts of the body. In some people, the blood
cannot flow easily through these arteries. For example, if the
arteries are narrowed for some reason, the pressure will go up
to keep the blood flowing. This is high blood pressure. If you
have it, you are not alone. Hypertension is a very common
condition; however, if left untreated, it can become serious.
silent killer
If you have hypertension, chances are that you may not have any symptoms at
all. Hypertension is often called the “silent killer” because most people who
have it do not feel sick, but if left uncontrolled, it can lead to a heart attack or
kidney disease. This is why it is so important to treat hypertension even if you
feel fine.
changes
Many people can keep their hypertension under control by making some
changes in their daily activities, such as increasing exercise and eating a
healthier diet. Other people may need to take medicine in addition to diet
and/or exercise.
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what is considered high blood pressure?
The pressures are measured in millimeters of mercury.
Healthy blood pressure is less than 120/80.
Pre-high blood pressure (prehypertension) is from 120/80 to 139/90.
Stage I high blood pressure ranges from 140/90 to 159/99.
Stage II high blood pressure is over 160/100.
why is high blood pressure a problem?
When your blood pressure is high, your heart has to work harder just to pump a
normal amount of blood through your body. The higher pressure in your arteries
may cause them to weaken and bleed, resulting in a stroke. Over time, blood
vessels may become hardened. This often occurs as people age. High blood
pressure speeds this process. Blood vessel damage is bad because hardened
or narrowed arteries may be unable to supply the amount of blood the body's
organs need. The higher artery pressure may lead to atherosclerosis, in which
deposits of cholesterol, fatty substances, and blood cells clog up an artery.
Atherosclerosis is the leading cause of heart attacks. It can also cause strokes.
The added workload on the heart causes thickening of the heart muscle. Over
time, the thickening damages the heart muscle so that it can no longer pump
normally. This can lead to a disease called heart failure.
Your kidneys or eyes may also be damaged.
The longer you have high blood pressure and
the higher it is, the more likely it is you
will develop problems.
cholesterol deposited on the insides of an artery

active partner
It is important that you become an active partner with your doctor in taking care
of yourself. At first, as you adjust your daily habits to the treatment program
advised to you, making these changes may seem difficult. After a while, these
changes will become routine. So the sooner you begin to make these changes,
the better.
Most treatments include a combination of diet, exercise and medication. Here
are some important suggestions to consider
shed weight
If you weigh too much, your heart may have to work harder to pump blood.
Find out what your ideal weight range should be. This is important to know
because as you gain weight, your blood pressure sometimes increases. Losing
extra weight is often the best way to lower blood pressure.
If you are overweight, you may have to reduce the amount of food you eat.
Once you lose weight, it is important to keep it off.
medication
Keep appointments with your doctor and have your blood pressure checked
regularly. By doing so, you will know if your blood pressure is under control.
Tell your doctor about the progress you are making or any problems you
having. Further, be sure to ask any questions you may have concerning your
diet, exercise, or medication.
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compliance
Patient compliance can be defined as the extent to which a
person’s behaviour, in terms of taking prescribed medication,
following dietary regimens, or executing recommended
lifestyle changes, is consistent with medical or health advice.
Research has shown that patients can have clinically significant
increases in blood pressure within 24-48 hours of missing a
dose of a calcium-channel blocker or beta-blocker, and that
even patients taking their blood pressure medications 80-99%
of the time can experience up to a two-fold increase in risk for a
cardiovascular event as a result of the occasional missed dose.
Cramer, Am J Managed Care, 1998
medication
In the treatment of heart disease alone, noncompliance with drug regimens is
believed to cause as many as 125,000 avoidable deaths every year.†
Compliance with antihypertensive drug regimens is cost-effective, because the
cost of treating cardiovascular disease that may arise from untreated
hypertension is substantially higher than the cost of treating hypertension before
it progresses to disease.‡ † McCarthy, Business Health, 1998 ‡ Rizzo and Simons, Clin Ther, 1997
 lifestyle
It is best to limit or avoid certain foods to help control your blood pressure:
• Limit the amount of salt you eat. Avoid foods high in salt.
• Read food labels to check the amount of salt in prepared foods.
• Avoid eating foods high in fat like bacon, egg yolks. Avoid cooking
with excess butter.
• Cigarette smoking is damaging to the heart and blood vessels.
Stopping will lower your risk of a heart attack or stroke over time.
• Alcohol can also raise your blood pressure. Avoid or limit drinking.
• Exercise can help lower your blood pressure and reduce your weight.
It will only help, however, if you exercise on a regular basis. Consult
your doctor for an exercise plan that is right for you.
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family
Let your family know that you have high blood pressure. This is important
because high blood pressure tends to run in the family. It is a good idea for other
members of your family, age 20 and older, to get their blood pressure checked
as well. Your family can help you follow your doctor’s advice and remind you to
take your medication.
cholesterol
Cholesterol is a type of fat in the blood that plays an important role in some
essential body functions. Too much cholesterol in the blood, however, can lead
to atherosclerosis, a common disease characterized by plaque formation in the
arteries.
Most cholesterol is produced by the liver, but the foods you eat can also affect
your cholesterol levels. Your physician can measure the cholesterol in your
blood with a simple blood test.
reduce it!
Reducing your cholesterol level can help lower your risk of atherosclerosis and
heart disease. Try these simple lifestyle changes:
• Talk to your physician about a regular exercise program that is right
for you.
• Your physician may prescribe a medicine to help lower your blood
cholesterol level.
• Reduce your intake of foods high in cholesterol and saturated fats, and
add more fruits, vegetables, and breads to your diet.

heart attack
Acute myocardial infarction, more commonly known as a heart
attack, occurs when the blood supply to a part of the heart is
interrupted. The resulting ischemia, or oxygen shortage, causes
damage and potential death of heart tissue. It is a medical
emergency, and the leading cause of death for both men and
women all over the world. Source: en.wikipedia.org/wiki/heart_attack
A blood clot is the most common cause of a blocked coronary artery. Usually,
the artery is already partially narrowed by atheromas. An antheromatous
plaque may rupture or tear and create more blockage through clot formation.
This complete blockage stops the flow of oxygen-rich blood to the heart.
Without oxygen, the cells of the heart begin to die. This death of heart tissue is
called a heart attack, or myocardial infarction.
plaque
blood clot
complete blockage
The most common cause of a heart attack is atherosclerosis, a cardiovascular
disease in which fatty materials in the blood form sticky plaques in the arteries,
as described earlier in this booklet. These plaques can get larger and larger,
until they completely block the flow of blood to the heart muscle.
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signs and symptoms
Unlike angina, the chest pains caused by a heart attack do not diminish with
rest. The following symptoms are noticeable in case of heart attack:
• Uncomfortable pressure, fullness, squeezing or pain in the center of
the chest lasting more than a few minutes.
• Pain spreading to the shoulders, neck or arms. The pain may be mild
to intense. It may feel like pressure, tightness, burning, or heavy
weight. It may be located in the chest, upper abdomen, neck, jaw, or
inside the arms or shoulders.
• Chest discomfort with lightheadedness, fainting, sweating, nausea or
shortness of breath.
• Anxiety, nervousness and/or cold, sweaty skin.
• Nausea, vomiting, dizziness, fainting.
• Increased or irregular heart rate.
cardiac rehabilitation
If there is adequate blood flow following a
heart attack, then the damaged heart tissue
begins to heal. Dead heart tissue is replaced
with scar tissue, which does not function
normally.
When you are ready to leave the hospital,
your doctor will usually perform a series of
test, including an ECG stress test, a coronary
angiogram and an echocardiogram
Your recovery will depend on many factors,
especially your physical condition, age, and
the severity of your heart attack. A low-fat
diet, a supervised exercise program, stress
reduction, and medication will all help you
prevent further heart attacks and reduce the
progression of heart disease.
 when could it occur?
angina You are more likely to have angina when your heart is working harder, for
example, when:
• You are exercising, such as walking.
• You are upset.
Angina pectoris is a feeling of tightness, squeezing, or pain in
• You are in cold air.
the chest. It happens when the heart does not get enough
• You are digesting a big meal.
oxygen-rich blood. Angina can occur in men and women of
However, you can also have angina when you are resting or sleeping.
any age, but it is more common among the middle-aged and
elderly.
signs and symptoms
how does it occur? The symptoms of angina may include:
• Heavy, strangling chest pain
Angina may be caused by any condition that affects the blood flow to your
heart, such as: • Pain that starts in the chest and spreads to the throat, arms (usually the
left arm), and jaws, and between the shoulder blades; the pain can
• Coronary artery disease: The walls of the arteries that carry blood to also spread to the stomach and feel like an ulcer or indigestion.
the heart develop atherosclerosis (fatty deposits). This restricts the flow
of blood, so less oxygen reaches the heart muscle. This is by far the • A feeling of tightness or heaviness in the chest with no pain.
most common cause of angina. • Nausea
• Coronary artery spasm: A temporary narrowing of a coronary artery • Sweating
causes blood to slow or stop flowing through the artery. When the • Trouble breathing
spasm stops, the artery and blood flow return to normal.
• Abnormal heart valves
• Abnormal heart rhythms
• Anemia: The levels of red blood cells or hemoglobin (the oxygen-
carrying chemical in the blood) are too low.
• Polycythemia: The blood has too many red blood cells, which causes
the blood to thicken.
• A thyroid problem

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 diagnosis of angina treatment
Your doctor will ask about your Often the symptoms of angina can be controlled with medicine. Nitrates such
symptoms and medical history. You as nitroglycerin increase the blood flow to the heart. They reduce the workload
will have a physical exam. You may on the heart by dilating (expanding) the coronary blood vessels and lowering
have one or more of these tests: blood pressure slightly. Drugs called beta blockers and calcium channel
• Electrocardiogram (ECG) and blockers are also effective. Other medicines your doctor may prescribe are
treadmill electrocardiogram ACE (angiotensin-converting enzyme) inhibitors, aspirin, and cholesterol-
(TME): These tests show lowering medicines. Your doctor will determine which type of medicine is right
electrical changes in heart for you based on your test results and any other medical problems you have.
muscle getting too little oxygen.
• Nuclear heart scan: This scan
measures blood flow in the
heart. surgery
• Stress echocardiogram: This test Angina caused by blocked arteries can be treated with two types of surgery:
shows how a lack of blood balloon angioplasty and coronary bypass graft surgery.
oxygen affects the heart's
ability to squeeze (contract). Balloon angioplasty is a simpler
procedure than coronary bypass inflated
surgery. A tube with a balloon tip is angioplasty
baloon
placed in your artery. The balloon is

lifestyle changes inflated where the artery is blocked. This

When angina is caused by coronary artery disease, treatment often involves
changes in your lifestyle. This may include:
• Quitting smoking.
• Losing weight.
• Getting more regular exercise, as prescribed by your doctor.
• Lowering your blood pressure (if high).
• Lowering your blood cholesterol (if high).
• Lowering your blood sugar (if high).
expands the artery enough to let blood
flow normally. Most people have a stent
inserted as part of this procedure to help
keep the artery open. With stents, your
risk of having the artery become blocked
again is only 10% to 15%. The balloon athero-
sclerotic
is then deflated and removed with the deposites
tube from your artery. If you have this
surgery, you may need to stay at the
hospital just a day or two.
In coronary bypass graft surgery, blood vessels are taken from other parts of
your body and attached to the blocked coronary arteries beyond the
blockage. The blood is then able to flow around, or bypass, the blockages.
This procedure usually requires a stay in the hospital of at least 1 week,
followed by several weeks of recovery.

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 prevention of angina
Follow the treatment prescribed by your doctor. In addition, follow these
guidelines:
• Begin a regular exercise program under your doctor's supervision.
• If you are overweight, begin a weight-loss program under the
supervision of your doctor or a dietitian.
• Eat a healthy, well-balanced diet and avoid foods high in cholesterol
and fat (especially saturated fat).
• Have your blood pressure checked regularly. High blood pressure
increases your risk for heart disease.
• Get enough sleep each night.
• Try to avoid emotional upset and stressful situations.
• Always carry your medicine with you.
• Take nitroglycerin if stopping an activity doesn't help your pain, or if
the pain occurs when you are resting. It may be more comfortable to
take it while sitting in a chair. Some people help prevent symptoms by
taking nitroglycerin before any activity that usually causes angina.
be alert to:
See your doctor if the angina becomes worse or occurs more often. Sometimes
it's hard to tell a severe attack of angina from the beginning of a true heart
attack. Call your doctor or go to a hospital emergency room right away if:
• You have chest discomfort with light-headedness.
• You are sweating a lot during an attack of angina.
• You have chest discomfort (pressure, fullness, squeezing, or pain) that
lasts more than 10 minutes or goes away and comes back.
• You still have pain after taking 3 nitroglycerin tablets 5 minutes apart.
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diabetes
When you have type 2 diabetes, your body does not make
enough insulin or is unable to use insulin properly. This problem
with insulin causes the level of sugar in your blood to become
abnormally high.
insulin
Insulin is a hormone produced by the
pancreas. (The pancreas is the large
gland that lies behind the stomach.)
When you digest food, your body
breaks down much of the food into sugar
(glucose). Your blood carries the sugar to
the cells of your body for energy. Insulin
helps the sugar leave the bloodstream
and enter the cells. This is how insulin
lowers the level of sugar in your blood.
When your body does not have enough insulin, sugar cannot get into your
cells. As a result, you have high levels of sugar in your blood. When you have
too much sugar in your blood, many problems may begin to occur. These
problems can be life-threatening if they are not treated. However, proper
treatment can control your blood sugar level.
Type 2 diabetes occurs mostly in adults over age 40, especially overweight
adults. Overweight children and adolescents can also have this type of
diabetes. More people, including children and adolescents, are becoming
diabetic as more people become overweight. India is home to about 35
million diabetics — more than any other country in the world.* And with
Indians being more susceptible to diabetes than some, that number is only
expected to increase.* *http://www.worlddiabetesfoundation.org/composite-35.htm
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 causes of diabetes causes of diabetes
The precise cause of type 2 diabetes is not known, although age, weight, The goal of treatment is to control the level of sugar in your blood.
heredity, and lack of exercise appear to be important factors. As people You want to try to keep the sugar level in the same range as a non-diabetic
become older or overweight, they are more likely to have diabetes. Their cells person. This is done by:
become unable to use the insulin made by the pancreas.
• Measuring your blood sugar regularly • Exercise
Women who have given birth to large babies (for example, babies weighing 9
pounds or more), or who have had diabetes of pregnancy (gestational • Meal planning • Medication
diabetes), have a higher risk of developing type 2 diabetes later in life.

monitoring
symptoms and diagnosis It is best if you learn to check your blood sugar at home. You will need a
Type 2 diabetes may cause the following symptoms: glucometer, a small machine that tests your blood sugar. You will need some
lancets (little blades to prick your finger) and some test strips to put a drop of
• Increased urination • Vaginal infections blood on. Your doctor will tell you when and how often you need to be
• Excessive thirst and the • Tiredness checking your blood sugar.
drinking of a lot of fluids • Slowly healing sores When you have just been
• Increased appetite diagnosed with diabetes you will
• Abnormal feelings of prickling, need to check your blood sugar
• Weight gain or weight loss burning, or itching of the skin, more often. After you have your
• Blurred vision usually on the hands or feet diabetes under control, your
• Skin infections • Infections of the foreskin in doctor will tell you how you can
uncircumcised men. decrease your sugar checks.
Keep a record of your blood
Most people, however, have no symptoms, especially at first. sugar measurements. Your doctor
Your doctor will ask about your medical history and your symptoms and will check your record at your
examine you. Then test the level of sugar in your blood. If your morning fasting appointments to see how well
blood sugar (before breakfast) is above 126 milligrams per deciliter (mg/dL), your treatment is working.
you may be diabetic. Sometimes another test called a glucose tolerance test is A test called hemoglobin A1c
done. For this test a sample of your blood is taken when you have not eaten can show your average blood
anything since the night before. Then you drink a sugar drink and your blood is sugar control over the past 3
tested 2 hours later. If after 2 hours your blood sugar level is over 200 mg/dL, months. Your doctor may do this test every 3 months to check your overall
you are probably diabetic. control of your blood sugar level. This is the best way to see if you are keeping
your diabetes under control.

16 17
 meal planning insulin
Your doctor or a dietitian will give If you need insulin, your doctor will teach you how to give shots to yourself. You
you clear guidelines about which may need a shot 1 to 4 times a day. Premixed insulin combines short-acting and
foods you should eat and how intermediate-acting forms in one dose (in one needle and syringe). No other
many calories you should eat insulins can be given in the syringe with insuline glargine insulin. When you are
each day. If you are using any type of diabetic medicine, you must carefully follow your health care
overweight, losing weight provider's directions for checking your blood sugar. This will not only help you
will help you decrease your achieve good blood sugar control, but it will help you prevent possibly life-
blood sugar. threatening low blood sugar (hypoglycemia).
Choosing healthy foods for
your diet will help you lose
weight. Sometimes losing just Exercising more and not overeating can
7 to 10 pounds can reduce or often help the body restore its balance
eliminate your need to take
of sugar and insulin.
medicine for diabetes.

You may or may not need to

exercise continue taking medicine.

Physical activity is important in managing type 2 diabetes. Exercise is Your improvement depends
sometimes all some diabetics need to do to control their blood sugar. Exercise on following the diet and
improves your circulation, uses up more sugar in your blood, and helps your
body use insulin more efficiently. Walking is one of the best exercises you can
exercise plans prescribed
do. Ask your health care provider for exercise recommendations. by your doctor to keep
your blood sugar in
the recommended
medication range.
If you can't control your blood sugar with diet and exercise, your doctor will
prescribe medicine to lower your blood sugar. You may need more than one
type of medicine to keep your blood sugar in the normal range.
Most of the common blood-sugar-lowering medicines taken by mouth for type 2
diabetes. Insulin is used when diet, exercise, and oral medicines are not
keeping your blood sugar levels normal or if ketones are present at the time of
diagnosis.

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 taking care
Possible diabetic complications include heart disease, stroke, I now have Being able to My Healthy Group Sessions
lifestyle advice monitor my BP Heart Team with others
blindness, kidney failure, and nerve damage, especially to
that’s relevant at home is actually makes have taught me
your feet and legs. Carefully controlling your blood sugar and to me. so convenient. house calls. so much more.
blood pressure will delay or prevent these complications.

Here’s a check-list to personal health-care

• Follow your diet plan.
• Learn how to make healthy choices when you eat out.
• Ask for diabetic meals when you travel (for instance, at hotels or on
planes).
• Drink water or other non-caloric drinks when you have the urge to eat
between meals.
group sessions
In our endeavor to help you manage your cardiovascular risk factors and to
promote better quality of life, this program provides an opportunity to
participate in select support group sessions which are presided by a Consul-
tant Cardiologist / Internal Medicine Physician. These monthly sessions also
attempt to support you on your lifestyle aspects in the presence of qualified
lifestyle / yoga experts. In a nut-shell the group session helps you in:

• Avoid compulsive eating. • Re-inforcing your understanding about the heart and associated risk
factors.
• Limit the amount of alcohol you drink.
• Providing you clarity on the treatment/therapy and management.
• Buy only the types of food included in your diet plan.
• Importance of lifestyle modification with live assistance from a
• Eat on a regular schedule. consultant physiotherapist/yoga specialist.
• Eat slowly and chew your food thoroughly. • Follow-up diet session with your dietician.
• Choose physical activities you like. • Question & Answer session with the above professionals.
• Exercise with friends.
• Stop smoking. Smoking speeds up the damage to the heart and blood
vessels.
A joint initiative by Pfizer and Apollo Hospitals
• Carefully follow the instructions your health care provider has given
you for taking any medicine he or she has prescribed.
• If you have a family history of diabetes, you should get your blood
sugar checked every year.

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