"HEALTHY HEART : IN A HOLISTIC WAY"
(PREVENTIVE CARDIOLOGY IS THE ONLY HOPE IN THE FUTURE)
RELEASED ON THE OCCASION OF WORLD HEART DAY

Dr. H. K. Chopra
Chief Cardiologist, Moolchand Medcity
Organising Chairman, WCCPC & WPCHC 2007
Vice President, CSI Delhi Branch
Secretary General, IMSA World HQ

The prevalence of coronary artery disease is rising rather steeply in our country, in general, and Delhi, in particular. Cardiovascular Disease (CVD) is assuming epidemic proportions in India. To a very large extent, heart attack is self-inflicted by our faulty lifestyle, which we adopt right from the childhood. The prevalence of Coronary Artery Disease in adults was 1% in 1960,11% in 2003, 14% in 2007 in India in the urban population. CAD is four times higher in Indian in all age groups. To be an Indian is itself a risk factor for premature CAD. Risk for CAD is twenty times higher than Japanese. CAD is more extensive, more diffuse and multivessel and more premature in Indians as compared to its counterparts in Western and European World. CVD mortality is decreased by 60% in Japan and Finland, by 50% in Australia, Canada and USA and by 25% in Europe. According to WHO Projections there will be 100% rise in mortality from CAD in India by year 2015 if drastic step for lifestyle optimization are undertaken. Rapid urbanization, globalization, industrialization and health transition are the main factors for premature CAD in our country. Dr. Dudley White Johnson, from San Francisco once said, "Anybody getting a heart attack below the age of 80, it is his or her own fault; after the age of 80, it is God's wilf. One should not have heart attack in the prime of his/her life when he/she is important not only to the family, but also to the community, society and nation. In fact, we are the cause and we are the cure of this malady of Coronary Artery Disease by the lifestyle we have, which should be in accordance with the laws of nature. A healthy heart is an expression of our own perception, thoughts, interpretations and choice making. Thus, a healthy heart is not a matter of chance, but it is a matter of choice. We should know the fact that wisdom is what we are, and not what we have. Women are fortunate to have lower prevalence of coronary artery disease before the age of 45 i.e. menopause. After menopause, the prevalence of CAD is same as men. Over 25 Lac people die of Heart Attack in our country every year. Out of these, 16 lac die within an hour of Heart Attack before even the medical aid is available.

What is Heart?

Heart is a hollow organ of the size of a fist, situated in the center of the chest behind the breastbone. It beats 60-80 times/minute and almost one lac times in a day and pumps about 5 liters of blood/minute to different parts of the body including brain, kidney, lungs and other tissues. Infact it works like a double pump. The right cell of the heart pumps blood into the lungs where it is filled with oxygen and the left side of the heart pumps this oxygen rich blood throughout the body providing oxygen to 60 trillion cells in human beings. It has four chambers named as right atrium and left atrium, right ventricle and left ventricle. The blood ejected from the left side of the heart from left ventricle goes to different organs and tissue of the body through the major artery of the heart called as aorta and its branches. The blood from the left side of the heart is purified and oxygenated while the blood from the right side of the heart from the right ventricle goes to the lung and is not purified and is deoxygenated and gets purified in the lung before going into left atrium through pulmonary veins. The right atrium of the heart receives deoxygenated blood from the veins, which drain into two major veins called as inferior venacava, and superior venacava, which opens into right atrium. The heart has four valves named as (a)mitral valve has two leaflets and is situated between the left atrium and left ventricle (b)aortic valve has three leaflets and is situated between the left ventricle and aorta (c)tricuspid valve has three leaflets and is situated between right atrium and right ventricle d)pulmonary valve has three leaflets and is situated between right ventricle and pulmonary artery. Heart has two major arteries namely right coronary artery (RCA) and left coronary artery (LCA). They arise from aorta and supplies blood to the heart muscle. The two major branches of left coronary artery are named as left anterior descending artery (LAD) and circumflex artery (CX). Besides these there are many branches of right coronary artery, LAD and CX. Heart has its own physiological pacemaker, the electrical impulses originate from SA node (Sinoatrial node), this node is the "heart's brain" which is the center and sources of its neural energy and then propagates to AV node (Aterio ventricular node) and then propagates to right and left bundle and the perkinje fibers etc. like a bank cashier the heart handles vast sum and earns relatively a very small salary for its survival.

The survival of the heart and the life of its owner depend on the patency of these coronary arteries. According to Ayurvedic teaching healthy human body is like freely flowing river. Whenever there is stagnation of blood flow what we call as stasis then the healthy circulation is replaced by accumulation what we call as atherosclerosis (hardening of the arteries with plaque formation, ulceration leading to plaque rupture and thrombus formation leading to angina (heart pain) or heart attack.

What are the Risk Factors for Heart Attack?

The major risk factors responsible for heart attack can be classified as modifiable and non-modifiable. The modifiable risk factors are smoking, high cholesterol, unmanaged negative stress, obesity central obesity (pot-belly), lack of physical activity, faulty diet, uncontrolled high blood pressure, uncontrolled diabetes, excessive homocysteine levels in the blood, etc. The non-modifiable risk factors, on the other hand, are advancing age, male sex, post-menopause state in women and a strong family history of Coronary Artery Disease in the first-degree blood relatives of the person.

Tobacco,in any form, chewable or non-chewable, such as cigarette, bidi, hookah, cigars and passive smoking are equally injurious, and are major predisposing factors for a premature heart attack and sudden death. Smoking, by virtue of various chemicals such as nicotine, carbon monoxide and various other chemicals, narrows the coronary arteries, thereby reducing the blood flow to the heart muscle. This hardens the coronary arteries and oxidizes the cholesterol Low Density Lipoprotein (LDL Bad Cholesterol). It also increases the stickiness of the blood by increasing platelet aggregation and adhesiveness, thus increasing clot formation. Coronary Artery Disease has been seen in 80 percent of smokers.

Today, if we smoke cigarettes, then tomorrow, cigarettes will smoke us. Today, if we chew tobacco, then tomorrow tobacco will chew us. If we really want to bypass the bypass surgery, tobacco crops should be replaced by vegetable crops. We can halt the menace of heart attack by eradicating the habit of tobacco consumption from our society. From mind body perspective smoking is vata related activity and use smoking as an attempt to reduce anxiety or stress.

Elevated levels of total cholesterol, LDL (Bad Cholesterol) and triglycerides are associated with high risk of premature Coronary Artery Disease. The risk is especially high when elevated triglyceride levels are more than 150 mg%, cholesterol levels of more than 150 mg%, high LDL (Low Density Lipoprotein) of more than 70 mg% and low HDL (High Density Lipoprotein Good Cholesterol) of less than 40 mg% in males and less than 50 mg% in females. Oxidation of LDL cholesterol is also one of the crux of premature hardening of coronary arteries. Total cholesterol and high density cholesterol ratio of more than 4.5 is a powerful predictor of Coronary Artery Disease. Doctor Larry Sherwitz of the University of California at San Francisco has shown in a study Multiple Risk Factor Intervention Trial, that men aged 35-57 with cholesterol counts over 300 over more than four times as likely to die from coronary heart disease as compared to men with the cholesterol levels of less than 180 mg%. It has been documented in one of the studies done in Finland, where the heart attack rates are highest amongst the people in the world. It is due to their faulty lifestyle. Remain cholesterol fit, if you really want to prevent Coronary Artery Disease.

Behavioral patterns, including negative emotions such as aggression, competitiveness, hostility, jealousy, anger, cynicism and other negative emotions multiply the risk of Coronary Artery Disease by many folds. Acute unmanageable negative emotional stress can precipitate plaque rupture in coronary arteries due to sudden release of catecholamine, which may cause a massive heart attack. Our thoughts have a tremendous influence on the health of our heart. Tranquility of mind and positive emotions such as love, compassion, humility, harmony, peace, altruism and magnanimity can prevent Coronary Artery Disease. Yoga and Primordial Sound Meditation also play a tremendous role in preventing Coronary Artery Disease.

Mind Body concept and Heart attack

According to Mind Body concept we exist on many levels such as physical, mental, emotional and spiritual. Positively based lifestyle changes have a positive influence on the health of the heart. Mind body medicine teaches us that the healthy heart is an expression of dynamic stream of intelligence and the consciousness give rise to this reality. By changing your perception in the presence you can change your life for tomorrow. You can experience in the beating of your heart, in your breathing, in your digestion, in your thinking and flow of energy in your muscles etc. The quantum mechanical body is comprised of our existence in three ways. Mind body refers to these as the physical body, the subtle body and the causal body. These are all software of our existence. Matter and energy are components of physical body. It is born, lives and then disappears at our death, when the atoms and molecules disperse. Infact the atoms of our bodies are constantly dispersing and are being replaced. The subtle body comprises of thoughts and feelings that exist beyond the limits of physical body. This is also a space and time event and its self life is little longer. Beyond the subtle body is the causal body, which is a unit of perfect order, and it encompasses all the space time events. In a way it is analogous to the genetic programming from which the nature of each individual derived. It is a greater field of energy and intelligence from where everything begins. It is both subjective and objective. It is the knower, the process of knowing and the known. Mind body calls this as a vast interconnecting network of energy and information, which is constantly flowing and changing. The heart is not just a pump whose welbeing depends on the fuel that is put into it. Every aspect of your perception, thoughts, interpretation and experience and choices have their influence on the health of the heart. It is therefore necessary to have the self awareness to maintain a healthy heart and recognize heart disease in early stages so that they can be reversed. Diagnosing a coronary artery disease to an Ayurvedic Physician means knowing and understanding the patient and not the disease. When the true nature of the patient is know and only then and illness can be understood and treated at the most fundamental level. Thus understanding of patient's mind body system can prevent imbalance from ever reaching the point where symptoms become manifest. Thus mind body intervention for a healthy heart is such an approach so that illness of coronary artery disease is prevented at a primary level first and then at secondary level. It also help us in analyzing the unique physical, emotional and spiritual makeup of an individual, so that an individualistic approach of a lifestyle such as work plan, exercise plan, diet plan, stress management protocol, sleeping profile, meditation, massage therapy and other modes of therapy can be instituted according to individuals mind body constitution.

According to Mind Body Medicine each of us is born with a unique proportion of three doshas, which creates us physical, intellectually and emotionally. If an individual has balance in these doshas then they remain healthy. Any fluctuation in the proportion of doshas because of the negative stress may increase the vulnerability to physical illness and emotional instability. These threes dosahs are know as vata, pitta and Khapha. Vata dominant persons mind body system if in balance then he or she may be creative, vibrant and enthusiastic and if the vata imbalance exceeds the normal then and individual is very anxious, sleepless, restless, irritable with lot of negative emotions which directly influence the health of the heart and increase the tendency for palpitation and arrhythmia and has less significant coronary artery disease than pitta and kapha imbalance. On the contrary if a person is pitta dominant then imbafance when exceeds the normal give rise to jealousy, negative competition, resentfulness, revengefulness, anger impatience and irritability which may influence the health of the heart by premature athersclerosis of coronary arteries and by inflammation of the arterial wall producing premature heart attack. Kapha imbalance when exceeds the normal give rise the lethargy and overweight and thereby affecting the heart by increasing the tendency for hypertension dyslipidemia and wide range of destructive emotion such depression procrastination and self pity. Our heart both literally and figuratively if congested with anger doubt, fear hostility, cynicism, irritability, repression due to dosha imbalance may produce premature coronary artery disease. It is therefore necessary that all the doshas should remain in balance to have a healthy heart. One should identify the emotion, be mindful of the physical sensation in your body, take the responsibility of what your experiencing, express what you have feeling in private and let go of the negative emotion through some personal ritual and then share your feeling with another persona and celebrate and rejuvenate.

Mind Heart Connections:

The mind and the heart both are directly and indirectly connected. Direct connections exist through the autonomic nervous system, which can influence the heart rate and rhythm as well as blood pressure. Indirectly, negative emotions such as fear, jealousy, hostility, cynicism, negative competition, hard driving person, dead line oriented, highly demanding individuals, frequently angry individual so called type A personality release hormones such as adrenaline and nor-adrenaline and increase the vulnerability to heart attacks. This causes aggregation of platelets and activates clot formation. Every thought in the mind, either pain or pleasure, hope or fear, love or hate, influence the heart. A four years study of middle aged men who expressed hopelessness about their future had 20% greater increase in narrowing of the coronary arteries as compared to those who were more optimistic. Negative psychological factors produce stress hormones, which precipitate pre mature angina and heart attack. Loss of social support such as divorce, death of the spouse, loss of job or retirement, loneliness and frustration may all precipitate heart attack has been well documented in the research data.

Central obesity (pot-belly) has been documented as one of the risk factors for premature Coronary Artery Disease. A in hospital data (MMMSStudy 2007) published in Indian Heart Journal by choprahketal 2007 showed that prevalence of metabolic syndrome is 65% and it is 70% in females and 60% in males. Central Obesity or Pot-Belly is the most powerful predictor of metabolic syndrome with highest prevalence between the age of 40-60 yrs of age. A pot belly more than 36 inches in male and 32 inches in females increases the vulnerability for premature coronary artery disease (heart attack and stroke (paralysis by many folds). "Longer the waist line, shorter the lifeline and vice-versa". Morbid obesity is a higher risk for many illnesses such as heart attack, hypertension, diabetes, cancer etc. Perfect weight management may halt the menace of morbid obesity by regular exercise, yoga, dieting and meditation and mind body balance strategies.

Physical inactivity lack of exercise is also one of the risk factors for Coronary Artery Disease. It has been documented in one of the studies in U.K that the incidence of Coronary Artery Disease is higher in postmasters than in postal clerks, and it is higher in bus drivers than in bus conductors. Regular physical exercise, especially aerobic exercises such as walking, wogging, jogging, cycling, swimming, dancing and skiing, increases the myocardial efficiency, reduces blood pressure, improves cardiac output, decreases peripheral vascular resistance and produces new collateral vessels (natural bypass), thus help in bypassing the bypass surgery. Exercise, especially walking for twenty minutes every day, keeps heart attack away. Exercise also reduces bad cholesterol, increases good cholesterol and reduces obesity. One should never do any unaccustomed exercise, as it may carry a risk of premature heart attack. The best exercise after the age of 40 is brisk walking, on a daily basis, in a beautiful, lush green garden, which will energize you. One should avoid anaerobic exercises such as weightlifting, push-ups, etc. as they increase the tendency for hypertension. I firmly believe in "use your body or lose it".

Diet - A diet rich in saturated fats and cholesterol can raise blood cholesterol. These foods include oils rich in saturated fatty acids, such as palm and coconut oils, fatty foods of animal origin such as beef, pork and lamb, and high fat dairy products such as butter, whole milk, hard cheese, egg yolk, etc. It is recommended that one should consume a lot of vegetables, fruits, cereals and pulses, and for a non-vegetarian diet, one can have chicken without skin, and fish, which contains Omega-3 fatty acids, which are protective for the heart, low fat dairy products such as skim milk, and low fat yogurt, etc. Olive and Canola oils are monounsaturated oils and may be even more beneficial in reducing blood cholesterol than polyunsaturated oils. Eating the right food at the right time, in the right place, in the right manner and in the right dose, makes the heart healthy. We are what we eat! Avoid saturated fats and take more of monounsaturated fats (MUFA) and polyunsaturated fats (PUFA). Refined oils are better cooking media than saturated fatty acids. Eating healthy food at a right time, at right place can influence our body metabolism, According to Mind body medicine, eating is a holy experience in which energy and information from the environment are converted to life energy. We must eat when we are settled in our mind and we should experience not only the taste but also the sight, smell, texture of the meal." We are what we eat. What we eat is important, but what is eating us is much more important."

Uncontrolled diabetes increases the risk of Coronary Artery Disease by virtue of increasing the oxidation of low density LDL cholesterol, and hence it enhances hardening of the arteries. Adequate control of diabetes prevents Coronary Artery Disease.

Hypertension is a medical term for high blood pressure, which threatens not only coronary arteries but also brain, eye and kidney arteries. Blood pressure increases the load on the heart muscle, which has deleterious effect on the circulation in the coronary arteries. Both systolic and diastolic hypertension is equally hazardous for premature coronary artery disease. Uncontrolled high blood pressure may increase the thickness of heart muscles and reduce coronary circulation. 80 percent of uncontrolled, moderately hypertensive patients have definite Coronary Artery Disease. Thus, blood pressure, both systolic and diastolic, should be adequately controlled.

Hypertension is a silent killer

Homocysteine: Recently, it was documented that homocysteine, which is derived from a diet high in animal proteins, can increase the chances of heart attack by three folds. In 1969 Dr Kilmer McCully of Harvard first documented that homocysteine might play a key role in development of coronary artery disease. In a study of 15,000 of healthy doctors, it was determine at high levels of homocysteine corelate with three folds increase in the risk of heart attack. Other research has shown that in young women high homocysteine levels doubles the risk of heart attack. Interestingly, the rise in coronary artery disease in women coincides with the use of birth control pills, which lower vitamin B6 levels. Smoking also lowers B6 and folic acid etc. A diet high in meat protein, eggs or cheese and low in green leafy vegetables and whole grains may result in vitamin B deficiencies and high levels of homocysteine. Diet supplements rich in folic acid, vitamins B6 and B12 and antioxidants reduce homocysteine levels and help preventing heart attacks.

Various non-modifiable risk factors for Coronary Artery Disease include advancing age, which causes hardening of coronary arteries. Male sex has higher vulnerability for premature coronary artery disease because of there faulty lifestyle including sedentary habits, faulty eating habits such as consuming junk food, high levels of stress at work. Post-menopause states in women are equally at risk for a heart attack as men due to depletion of the oestrogen hormone. The higher risk group for women includes post menopausal, diabetic, smokers and obesity. Family history is also a very important factor for all people before the age of 50. However, modifiable risk factors are much more important then genetic predisposition. Fear of a coronary artery disease motivates many people to change their lifestyle but I must emphasized the fear motivated behaviour cannot be successful on long term basis. Fear of eating, exercising should not create any king of anxiety which has more deleterious effect on our system. We must always consider the physiological benefits of a lifestyle change by considering its emotional and spiritual origins.

What are the Clinical features of Heart Attack?

CAD may manifest clinically as silent myocardial ischemia, stable angina pectoris, unstable angina, heart attack and sudden cardiac death. Silent myocardial ischemia refers to blockage of coronary arteries that does not produce any symptoms. It is often diagnosed by electrocardiogram or stress test. It is common in diabetics. It is more dangerous as it does not produce any symptoms. Severe heart attacks can occur with no pain whatsoever and the damage to the heart muscle can be detected when the disease is quite advanced. Data from the long term Framingham heart study revealed that approximately 15% of all heart attacks were "silent" and equal numbers of attacks were diagnosed wrongly as indigestion, gas or atypical upper abdominal discomfort. Angina pectoris of effort is chest pain on exertion which is also produce by partial / subtotal blockage of coronary arteries due to hardening of the arteries and atherosclerotic plaque etc. any kind of exertion physical, mental or sexual may provoke angina of effort. The characteristic presentation of angina is pain in the center of the chest which is diffuse and not pin point radiates to the left arm or right arm or back or in the jaw which is usually associated with choking sensation, tightness across the chest, heaviness or sinking feeling associated with fatiquability and sweating etc. A large number of medication are prescribed for stable angina pectoris such as nitroglycerine in the form of a pill (sorbitrate), spray (nitrolingual spray) or a patch (transdermnitro) which dilate the coronary arteries and eliminate the pain. Other drugs, which are commonly used in angina effort, are beta blockers, calcium channels blocker which slows the heart and reduce the blood pressure. Other adjuvant therapy includes aspirin, clopidogrel which reduce the stickiness of platelets and prevent platelet aggregation. Besides these lipid-lowering drugs are also given to the patient of angina pectoris. It has been well documented that drugs like aspirin alone may reduce risk of heart attack by more than 40% if taken regularly 150 mg daily it not only the risk of heart attack but also reduces risk for stroke. Unstable angina is characterize by increase in frequency and worsening of intensity and duration of angina with more episodes of angina at rest, not responding adequately to the conversational treatment of angina. Usually the cause is a blood clot formation in subtotal blocked coronary arteries. These patients require hospitalization for medical treatment investigation such as EKG, Trop I, Echocardiography, 24 hours holter monitoring, angiography, angioplasty or bypass surgery and whatever is required.

Heart attack occurs with the coronary artery is completely blocked and the area of the heart muscle nourished by the coronary artery is damaged and becomes necrotic. This is what happens during heart attack. Myocardial infarction is the medical term for the same. Most of the heart attacks occur when a blood clot is lodged in a narrow coronary artery and cut off the flow of blood completed. The patient usually complains of severe unbearable pain in chest with radiation with the left arm, right arm or jaw. It is usually associated with nausea, sweating and shortness of breath. 60% of the people they die before reach the hospital in one hour before seeking any medical help. They need emergency care in the hospital.

How do we Diagnosis Coronary artery disease?

Early diagnosis of coronary artery disease may reduce the morbidity and mortality. Various diagnostic tools which utilized to diagnose various coronary artery disease syndromes are electrocardiogram (ECG), enzymatic markers such as Trop I, CPK-MB, Myoglobin, SGOT, LDH etc., Echocardiography, ambulatory holter monitoring, treadmill stress test, Dobutamine stress echocardiography, Dipyradamole stress echocardiography, stress thallium scan 64 slice CT coronary angiography and conventional cath coronary and left ventricular angiography etc.

I firmly believes that 95 percent of diseases all over the world including premature heart attack, hypertension, stroke (Paralysis), metabolic syndrome, obesity, high cholesterol, diabetes mellitus, anxiety states and even cancers and recurrent infections are caused by faulty lifestyle, which is an expression of imbalance of the mind and body. Faulty lifestyle includes inability to cope with the stresses of daily life, such as meeting deadlines, work stress, negative competition, lack of productivity in the corporate world, ego, arrogance and anger, etc. He quoted recent data published by WHO report suggesting that nearly half of India suffer from anxiety giving rise to panic reactions, fit of anger, worrisome behaviour, sadness, memory disorders and frequent absentmindedness because of underlying chemical imbalance by increased levels of epinephrine, nor epinephrine, Cortisol and altered dopamine, dehydroergotamine, endorphins and serotonin levels. firmly believe that lack of exercise or no exercise, eating the wrong food, at a wrong time, at a wrong place, in a wrong manner, in a wrong dose, in a wrong environment, consumption of junk food, tobacco in any form, excess of alcohol, drugs, mental and environmental pollution, lack of communication, miscommunication or no communication, lack of understanding, misunderstanding or no understanding, false imagination, feeling of hopelessness, helplessness, suppression, repression, frustration and depression amongst fellow beings are the main components of a faulty lifestyle. My main emphasis is on the rising incidence of metabolic syndrome, which is also called as Insulin-Resistance Syndrome or New World syndrome or Chaos Syndrome or Obesity Syndrome.

The optimisation of lifestyle in a holistic way by spiritual practices is the need of the day. By spirituality I mean that act from the eye of the soul, which is the field of silence, infinite possibilities and pure potentialities, and not from the eye of the body or the eye of the mind which materialistic and full of negative stress. The spiritual practices include regular meditation 20 minutes morning and evening, regular practice of yoga including all the eight limbsyama (do's & dont's), niyama (self-discipline), asana (various yogic postures of exercise), pranayam (breathing exercises), pratihara (contemplation), dharna (concentration), dhyana (meditation) and samadhi (transcendence). This helps in stress management, anger management, anxiety management, ego management, arrogance management, sleep management, choice management such as abstinence from tobacco, excessive alcohol, excess of salt, fried food, fat-rich food such as red meat, yellow of egg, liver, kidney, brain, etc. He strongly recommends that one should consume fruits, vegetables, nuts especially almonds, which are healthy-heart nuts, on a daily basis. Almonds reduce bad cholesterol and increase magnesium levels. That is why it is called as a "superstatin", which helps in reducing premature hardening of the arteries, thereby reducing the incidence of coronary artery disease. He said, "What you eat definitely matters, but what is eating you matters much more!" He also opined that "how long you live is alright, but how well you live definitely matters". He said, "We are busy, busy, busy in earning money at the cost of losing health, and then we are busy, busy, busy in losing that money and trying to earn health!"

I am of the firm opinion that "Time has come to market Healthy Heart in a Holistic Way Now. Practice Spirituality, Optimize lifestyle, Make Perfect Choices, Act Locally and Impact Globally". Holistic Lifestyle by spiritual practice in scientific way is the need of the day to combat anxiety related problems in nearly half of India and whole of the world including heart attacks.

I firmly believe that Medical Tourism with Holistic approach has tremendous potential to attract people from all over the world to come to India for medical treatment, with a healing touch, which is missing in the Western part of the world. I believe that, "Chat Scan" is the need of the day, i.e., to devote more time to interact with the patient to understand the underlying problem and its root cause, and solve it in a very subtle manner and not unjustified CAT Scan. These days, doctors all over the world hardly give any time to chat with their patients, by the time patient starts speaking, the prescription of the doctor is ready. Prescribing a sleeping pill is not the answer! Hearing with patience with a lot of compassion and holistic approach is the need of the day.

The most famous "Inter-Heart Study" data conducted in 52 countries of the world and published recently, which has shown new emerging factors for the premature heart attacks in Asians because of negative stress such as hostility, cynicism and negative competition. The study has also shown that healthy heart can be enhanced by consumption of fruits and vegetables, practice of regular exercise and stress management. Indian data from my own study published in Indian Heart Journal, (MMMSStudy, chopra etal 2007) that 65 percent of Indians are suffering from Metabolic Syndrome (Pot Belly, Hypertension, Diabetes, High Bad Cholesterol and Low Good Cholesterol) which is the major cause of premature heart attack/stroke (paralysis) in our country. The Metabolic Syndrome with significant morbid obesity is touching epidemic proportions in India, due to faulty lifestyle and poor mindset. The lifestyle optimization in Holistic way from Dr. Dean Ornish (USA), Dr. S.C. Manchanda (Delhi) and Dr. Satish Gupta and Dr. W. Selvamurthy (Mt. Abu), which has shown very clearly that CAD can be prevented, regressed and reversed which has been documented by coronary angiogram and reduction of bad cholesterol, increase of good cholesterol and reduction of stress hormones such as epinephrine, norepinephrine and Cortisol levels and increase in the levels of happy chemicals such as serotonin and endorphins, etc.

"The health of the world is an expression of our own perceptions, our own thoughts, our own interpretations, our own experiences and our own choices. Thus the health of the world is not by chance, but it is by choice ".

I quote Albert Einstein who once said, "We are not the packages of flesh and bone with wisps of memory and desire, but we are a web of information and energy interwoven with intelligence and emotions." We can enliven our prana (vital force), enliven ojas (glow), enliven tejas (intelligence) by practicing perfect lifestyle in a holistic way, right from childhood and not after we fall victim to diseases.

The good news is heart attack (CVD) is preventable. If main risk factors including high blood pressure, high blood sugar, high blood cholesterol, tobacco use, over weight and obesity (metabolic syndrome), inadequate intake fruits and vegetables, physical inactivity and negative stress levels are reduced by optimization of lifestyle in a Holistic Way. The title for the World Heart Day is "Team up for Healthy Hearts". Lifestyle optimization in a Holistic Way right from childhood, timely medicalization with poly pill (containing Aspirin, Ramipiril, Atorvastatin and Betablocker such as Metoprolol or Atenolol) as secondary prevention at the age of 50 may definitely halt the rising menance of coronary artery disease, which is need of the hour and postpone the need of relatively expensive coronary mechanical intervention.

28 Point Programme for Healthy Heart

• Drink two glasses of water daily empty stomach and about 2 litres of water in a day.
• Exercise daily for 30 minutes.
• Do not smoke or chew tobacco.
• Meditate for 20 minutes in the morning and evening.
• Maintain optimum body weight.
• Take a body massage daily, only for 5 minutes 1. (Self-Massage "Abhyanga"). 2.
• Eat the right food, at the right time, at the right place, in the right manner, in the right dose, in the right environment. Eat only when you are hungry, eat freshly cooked food in a quiet relaxed atmosphere and eat slowly and don't eat when you are upset and avoid overeating.
• Have sattvic vegetarian food and not tamsic or rajsic food. All 6 tastes including sweat, sour, salty, bitter, pungent and astringent should be included in every meal. As most of the coronary artery disease are pitta or kapha imbalances.
• Eat more natural foods such as vegetables, fruits, salads and nuts -Almonds, etc. have at least four to five servings of fruits and vegetables daily.
• Do not eat junk food such as fried food or sweets, etc.
• Don't consume excess salt especially through processed food.
• Keep away from TV or Computer as much as possible and devote more time for physical activity.
• Avoid a "pot-belly" abdomen.
• Avoid unaccustomed exercise.
• Remain cholesterol-fit.
• Remain balanced in life.
• Have adequate rest for 6-8 hrs everyday.
• Don't burn both the ends of the candle at the same time.
• Avoid lust, anger, greed, ego and attachment.
• Be honest, truthful and dedicated for work.
• Have good social support system.
• Work with self-referral and not with object referral.
• Don't feel lonely.
• Have perfect choices to achieve any goal in a very peaceful manner.
• Develop intimate relationship.
• Become an embodiment of positive emotions such as love, compassion, humility, faith, confidence, peace, harmony, bless and happiness.
• Have planned daily routine and set weekly, monthly and yearly plans.
• Take antioxidants such as lycored containing lyocpene, folic acid and natural vitamins