Nourish Magazine

The human heart is a muscular organ with chambers continuously pumping approximately 7000 liters of blood every day! The continued beating of the heart provides the body tissues with freshly oxygenated blood they need to survive [1] . The cardiovascular (CV) system, also called the circulatory system, maintains the distribution of blood throughout the body and is composed of the heart and the blood vessels - arteries, capillaries, and veins [2] . Cardiovascular disease (CVDs), a group of disorders of the heart and blood vessels include coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other conditions, which are the leading cause of death globally, taking an estimated 17.9 million lives in 2019 [3] . This represents 32% of all global deaths, and of these, 85% were due to heart attack or stroke (https://www.who.int/india/health-topics /cardiovascular -diseases). In 2016, reports from India attributed 27% of total deaths due to non-communicable diseases to CVDs (https://www.who.int/india/health-topics/cardiovascular-disease s). It is indicated that the prevalence of cardiovascular diseases is high in India, even among people who are slightly older than 45 years [4] . The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health [5] . CVD risk factors such as high blood pressure, overweight, obesity, and abnormal blood lipid and glucose levels have become prevalent among men and women of all socioeconomic strata of urban and rural Indian populations too [6] . While there are risk factors that we cannot modify (eg: age, gender, genes, ethnic origin), there are habits and choices that are modifiable such as tobacco use, physical activity, and what we eat and drink to decrease one’s odds in developing heart disease.

Modes of prevention, when mentioned, are either one of the three types: secondary, primary, or primordial prevention [7] . While secondary prevention includes efforts to prevent the recurrence of clinical events in patients who have manifested the clinical disease (like a heart attack or stroke), primary prevention aims to keep an individual at risk of heart disease from having a first heart attack or stroke, or needing angioplasty/surgery, or developing some other form of heart disease. In both cases, prevention focuses on controlling the risk factors by making healthy lifestyle changes and, if needed, taking medications. The most effective means of avoiding clinical events associated with CVD during one’s lifespan is avoidance of adverse levels of risk factors in the first place. This is primordial prevention, a concept introduced by Strasser in 1978 (primordial = existing from the beginning) [8] . Primordial prevention is now the basis of the American Heart Association’s definition of ideal heart health, which is represented as Life’s Essential 8™ (Ref image) which includes key measures for improving and maintaining cardiovascular health. This comprises of ‘health behaviors’ including eating better, being more active, quitting tobacco, and getting healthy sleep, and ‘health factors’ including managing weight, blood sugar, blood pressure, and controlling cholesterol [9] (These metrics are often updated and is suggested not to be used as the sole guide for individuals to shape prevention or health promotion strategies). Population-based cohort/observational studies indicate that a higher body mass index is associated with an increased incidence of coronary heart disease [10-12] . In addition, prolonged sitting time (>8h/d) and sedentary behaviors are also found to be associated with increased CVD risk [13, 14] . While the data on physical activity in India is sparse [6] , a cross-sectional survey as a part of the ICMR-INDIAB study assessed one in every two Indians to be physically inactive [15] . These studies emphasize to need to be physically active and move away from sedentary lifestyles to prevent the risk factors associated with CVD.

Life’s Essential

11