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ischaemic heart disease

There are families in which ischaemic heart disease is common and heart attacks occur at an early age. It is important to know why this happens and what can be done to help prevent the disease in unaffected younger members of these families.

What is the usual age after which a heart attack is not unexpected?
As age advances, fatty deposits occur in the coronary arteries and by the age of about 60 almost everyone is presumed to have some atheromatous lesions in his/her coronary arteries. Hence myocardial infarction occurring after the age of about 55 is not an unexpected event, but one occurring before that is.

What happens in families prone to have heart attacks?
The attacks occur at an early age when the members of these families are still in their thirties or forties. Younger the age, severer the attack.

Why do attacks occur at an early age?
Many factors can be responsible. Their lipid profile may be faulty; total and LDH - Cholesterol may be high and/or the beneficial HDL - cholesterol too low. Triglycerides too may be high. Their blood may be more easily coagulable. Obesity in these families is common. While the lipid abnormalities may be genetic in origin, their diet is usually faulty and rich in animal fat, and overeating is common. In some families, diabetes is common and may be the factor responsible for early IHD.

Why are the heart attacks in these families very severe?
I have explained in chapter 4 that collateral circulation which bypasses the atheromatous obstructions takes time to develop under natural conditions. If a heart attack occurs at an early age, there has not been enough time available for them to develop. The result is that in the event of complete obstruction occurring, say due to thrombosis in the artery, there is no alternative source of blood supply to the affected part of the heart and the attack becomes massive.

There can be another reason. The number of the fine intercommunicating channels, which become anastomotic channels, is genetically determined. In some families their number may be too small, so that effective collateral circulation does not develop.

What should be done by members of these families?
It is important for you to know your family history. In case some of the other members of your family have had heart attack or met with sudden unexpected death before the age of 55, it becomes important for the younger members to start taking precautions early in life. They should get their blood pressure, blood sugar and lipid profile checked regularly, say twice a year, and keep their blood pressure and/or diabetes under good control with the help of their physicians if any of these conditions is present in them. secondly, they must not add any more risk factors to their lifestyle because their heredity is against them. in effect, lifestyle of the whole family should be changed to one of simple life in which smoking has no place, drinking is in strict moderation, there is no overeating, animal fats are avoided and a diet which is well balanced and generally vegetarian. The life should be physically active and obesity should be avoided these precautions are the same as for anyone else but they should be strictly enforced, not on an individual but on the whole family, so that children learn and get used to such a life from a tender age. With these precautions, the members of these families can substantially reduce their risk of getting heart attacks.

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