Prof Upendra Kaul
Founder Director, Gauri Kaul foundation
Recipient of Padma shri and Dr B C Roy Award
Winter is here and we are waiting for a heavy snowfall. It is not only the coldest part of the year but also very wet in the snowy locales like ours. The word winter in fact in many Indo-European languages is related to wet and water.
Cold weather triggers many medical problems like influenzas, asthma, sore throat, joint pains and heart diseases in particular heart attacks. Heart attacks are the most concerning of these problems. The reasons for this fact are multi-factorial. People with underlying risk factors like, diabetes, high blood pressure (BP), smokers, high bad cholesterol levels, over weight and obese people are more prone to get heart problems in this chilly season. In general heart related problems double during these times. Winter months typically are from December to February, with 21st December to 31 January being the coldest and called the “Chilai Kalan”.
Cold temperatures lead to some adverse changes in the body. These include, shrinking of arteries in general including those of heart. There are some circadian changes leading to higher cortisol levels which can result in higher blood pressure, increased pumping action of heart to increase the circulation of blood necessary to keep body warm.
The regions which are not intensely cold see increase in pollution with worsening of the air quality indices. Pollution is an important cause of inflammation of the arteries which can lead to quiescent lesions to progress and block the arteries leading to heart attacks.
Of the 9 important risk factors which account for 90% of heart attacksas per the INTERHEART study from the Lancet 2012, many of them are adversely affected.
These risk factors are: Smoking which invariably increases in colder months, high bad cholesterol levels generally deteriorate because of more sedentary habits and increased intake of cholesterol rich foods, BP levels increasing in general, diabetics getting sugar levels out of control, gain in weight and tendency for obesity, depression and anxiety because of gloomy overcast weather and often getting stuck indoors. Reduced exercise and less intake of fruits and vegetables.
Those individuals who consume alcoholic drinks usually consume larger quantities which again is hazardous causing increasing BP, triglycerides and also irregularities of heart beats. All this can lead to heart failure and sudden death especially in patients with previous heart disease.
It is always desirable to get a general body examination done at the onset of winter. A blood pressure, blood sugar and blood cholesterol and triglycerides estimated. If abnormal, seeking a consultation with a physician is advised.
Exercise done regularly is one of the best ways to keep the heart healthy. For un accustomed persons it should be started gradually and increased steadily. Taking tea and eatables in between is not recommended. Vigorous exercises should be avoided. There have been examples of people getting heart attacks during such spurts.
For persons with risk factors like diabetes, high BP and high cholesterol levels getting an exercise test with ECG monitoring is the best way to start. Keeping a count of the pulse rate is a scientific way of monitoring the heart activity. A number of apps are available for this. In general, for an average person between 40 and 60 years a rate of 120/ minute is considered a good level. Patients with underlying heart problems should always consult their physician to guide them regarding the duration and speed etc.
Targets to be maintained
Blood pressure at rest less than 140/90, Fasting blood sugar less than 126 mgs, Total cholesterol less than 150 mgs, weight under check with a body mass index of < 25 and no use of tobacco.
Mercifully COVID is now contained and most have taken all the 3 doses of COVID vaccination. Influenza vaccine once a year before the onset of winter and Pneumonia vaccine once after 65 years of age is advocated.
Things to remember
Winter season predisposes to heart related disorders. These problems can be avoided to a large extent by healthy heart checks and timely preventive measures. Regular exercise and intake of plenty of fruits andvegetables are verycost-effectivesolutions. Patients with high BP, diabetes and underlying heart diseases should maintain their targets. Tobacco use should be avoided at all costs.