If you have read articles on our blog, you will be well aware that heart disease in India is on the rise, with frightening number of people expected to suffer from the condition in the coming decades.

Traditional risk factors include high blood pressure, diabetes, smoking, obesity, high cholesterol and a family history of heart disease, all of which either occur singularly or in combination with each other. A good diet and exercise can prevent the development of these risk factors and could reduce your chance of heart attacks.

While these risk factors have now become common knowledge, we thought we would talk about some of the ‘odd’ factors that have been linked to heart disease. These actually might surprise you…. or not. Let’s take a look at a few.

1. Your hand grip

Did you know that how you shake another person’s hand could indicate whether you could develop heart disease? Yes, hand grip strength may provide clues to your heart health.

In a study that looked at over 140,000 individuals, grip strength was assessed and measured in ‘kg’ using a Jamar Dynamometer. Study subjects were between the ages of 35 years to 70 years, and hailed from 17 different countries. The study was conducted to assess if the strength of a person’s grip was one of the risk factors for heart disease.

The study revealed that with every 5 kg decrease in grip strength, the risk of developing a heart attack increased by 7% and stroke by 6%. Interestingly, there was a 17% higher chance of dying from heart disease or heart related causes. In fact, the paper goes on to suggest that hand grip strength is a stronger predictor of heart disease than the systolic blood pressure.

Another revelation from the study was that men from developed countries had a better grip strength than those from developing countries. But in the case of women, those from middle-income countries seemed to have a stronger grip when compared to those from higher income countries.

However, the study group, led by Dr Darryl Leong, clearly state that more research is needed to determine to what extent muscle strength plays a role. Furthermore, treating ‘poor hand grip’ would be hard. How would it be possible to reduce risk? Would someone need to undergo weight training or purchase a hand grip? Treating risk factors such as high blood pressure and high cholesterol can be done easily through medication, but it is not that easy to increase grip strength.

2. Menopause

Recent studies have now shown that women who have been through menopause are at a higher risk of heart disease.

The reason for this is believed to be the excess deposition of fat around the heart muscle. However, this concept of fat deposition around the heart being linked to heart disease is not new. Research has shown that the deposition of adipose tissue around the heart is linked to clogging up of heart arteries (a phenomenon called atherosclerosis). Fat releases certain compounds that increase the level of inflammation; the basic underlying process in atherosclerosis.

This deposition of fat is irrespective of whether the individual smokes, has diabetes or high blood pressure.

The primary reason for fat deposition is lowered levels of estrogen in the blood after menopause. Taking hormone replacement therapy (HRT) seems to increase HDL (good cholesterol), reduce LDL (bad cholesterol) and reduce the chances of developing type 2 diabetes. In fact, studies have shown that post menopausal women who take hormone replacement therapy reduce their risk of heart disease by 50%. Estrogen + progestin pills have better results than just estrogen alone.

3. Erectile dysfunction

Men! Problems with sex? You may have a broken heart.

Men may be surprised to hear that an inability to achieve and sustain an erection (called erectile dysfunction) may be a sign of underlying heart disease. Erectile dysfunction, or ED, affects more than 30% of men over the age of 40 years and 60% of men over 70 years across the globe, and the incidence in India seems to be quite high.

The underlying cause for ED is atherosclerosis. Increased deposition of cholesterol in the arteries leads to reduced blood flow to the penis at times of need. The risk factors for ED are similar to those of heart disease, and include diabetes,obesity, high blood pressure, smoking and high cholesterol levels.

In a sense, if these risk factors are bad enough to cause narrowing of the arteries to the male genitalia, they are bad enough to narrow the heart arteries.

Men with ED are 8 times more likely to develop heart failure, according to one study. Furthermore, there is a 6 in 10 chance that those with erectile dysfunction will develop some form of heart disease. Admission rates with heart disease appear to be higher in men with ED compared to those who have normal erectile function.

Erectile dysfunction often appears 3 to 5 years before heart disease appears.

So does taking medication such as Viagra or Penegra reduce risk? Well, that is not clear yet, despite evidence suggesting that these drugs can help patients who suffer from high blood pressure in the lungs (pulmonary hypertension).

Suggestions have been made that reducing and treating risk factors such as high blood pressure and high cholesterol early may reduce the chance of developing ED.

4. Homocysteine

Homocysteine is an amino acid (basic protein molecule) that is derived from eating meat. Studies have shown that having high levels of homocysteine may increase the risk of developing heart disease.

High levels of homocysteine are often seen in patients who have low levels of vitamin B12 and folic acid in their blood stream.

However, the link between the heart disease and homocysteine levels has been debated. In particular, correcting the vitamin B 12 and folic acid levels does not reduce the levels of homocysteine.

So does this mean that you must check your blood homocysteine levels to assess your risk? There is no real need unless it is recommended by your doctor. Furthermore, the test can be quite expensive, and only offers limited information to the physician.

Make sure you eat plenty of fresh fruits and vegetables to get the required vitamin B12 and folic acid in your diet.

5. Gum disease

Keeping your teeth and gums healthy may keep your heart ticking for long, research has shown.

But how in the world is gum disease linked to heart health? Well, firstly, the link is only just ‘possible’, not really concrete. Secondly, the underlying process in gum disease is inflammation, which is a key component of atherosclerosis and heart disease. Inflammation may be the common denominator.

Elevated levels of C-reactive protein have been seen in gum disease. A high CRP is a well known risk factor in the development of heart disease.

Bear in mind that this is just a link between the two. Gum disease does not cause heart disease.

6. Air pollution

Delhi recently won the not-so-coveted ‘award’ of being the most polluted city in the world. While this appears to be a forgotten now, what is worthwhile remembering is that air pollution can be a risk factor in the development of heart disease.

Air pollutants are of many kinds, and the particles that measure less than 2.5 micrometers (also called particulate matter 2.5 or PM2.5) are notorious in increasing the risk of heart disease. These pollutants are released into the atmosphere from car exhausts, power plants, industries and cigarette smoke.

High concentration of these pollutants can increase the levels of fibrinogen in the blood – a component that promotes the formation of blood clots. Increased levels of inflammatory markers such as interleukins and CRP have also been seen. The function of the protective cells that line the blood vessels may be altered, which in turn changes the way the blood vessels respond to different stresses.

Pollution has also caused changes in the temperature, and extremes of hot and cold are both linked to heart disease.

Managing your risk

Remember, there are numerous risk factors in the development of heart disease, and almost all of them can be managed through lifestyle changes and a healthy diet. The above risk factors for heart disease are not very common, but are worth remembering. There is plenty of clinical research that has looked into all of the above, and ongoing research will no doubt reveal some more unknown cardiac risk factors.

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References

1. Leong, Darryl P., et al. “Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.” The Lancet (2015).

2. Nabulsi, Azmi A., et al. “Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women.” New England Journal of Medicine 328.15 (1993): 1069-1075.

3. El Khoudary, Samar R., et al. “Cardiovascular Fat, Menopause and Sex Hormones in Women: The SWAN Cardiovascular Fat Ancillary Study.” The Journal of Clinical Endocrinology & Metabolism (2015): JC-2015.

4. Schwartz, Bryan G., and Robert A. Kloner. “Cardiovascular implications of erectile dysfunction.” Circulation 123.21 (2011): e609-e611.

5. Lockhart, Peter B., et al. “Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? A scientific statement from the American Heart Association.” Circulation 125.20 (2012): 2520-2544.

6. Brook, Robert D., et al. “Air pollution and cardiovascular disease A statement for healthcare professionals from the expert panel on population and prevention science of the American Heart Association.” Circulation 109.21 (2004): 2655-2671.

7. Gold, Diane R., and Jonathan M. Samet. “Air pollution, climate, and heart disease.” Circulation 128.21 (2013): e411-e414.