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Preventive Health Care ProgramPreventive Health Care Program

Coronary heart disease in IndiaCoronary heart disease in India

1990-CVD cause 2.386 Millions Deaths1990-CVD cause 2.386 Millions Deaths2015 CVD will cause 4.586 Millions Deaths2015 CVD will cause 4.586 Millions Deaths

60 Million in India Suffering from CAD60 Million in India Suffering from CAD

Cause of CADCause of CAD

Atheroscelorosis Atheroscelorosis SmokingSmoking ObesityObesity DiabetesDiabetes Sedentry life styleSedentry life style StressStress

CAD an EpidemicCAD an Epidemic

Is BY-Pass the Is BY-Pass the solution…? solution…?

NONO

SolutionSolution Life Style Life Style

ManagementManagement

Preventive Preventive CardiologyCardiology

Non- Invasive Non- Invasive MethodsMethods

Result of heart diseaseResult of heart diseaseNon-Speific

1%

Heart Attack35%

Angina15%

Breathless Ness & Fatigue

14%Sudden Cardiac

Death35%

Sudden Cardiac Death

Heart Attack

Angina

Breathless Ness &Fatigue

Non-Speific

Symptoms of Heart AttackSymptoms of Heart Attack

AnginaAngina Chocking FeelingChocking Feeling SweatingSweating NauseaNausea Irregular Heart BeatIrregular Heart Beat Heart BurnHeart Burn Silent AttackSilent Attack

InvestigationsInvestigations OpthalmoscopyOpthalmoscopy Lipid profileLipid profile Uric acidUric acid Heart enzymeHeart enzyme C P K – 25-130 IU/LC P K – 25-130 IU/L AST---8-20 IU/LAST---8-20 IU/L LDH----45-90 IU/LLDH----45-90 IU/L

INVESTIGATIONINVESTIGATION

ECGECG ECHOCARDIOGRAMECHOCARDIOGRAM TMTTMT THALLIUM SCANTHALLIUM SCAN CT ANGIOGRAPHYCT ANGIOGRAPHY CORONARY ANGIOGRAPHYCORONARY ANGIOGRAPHY PET SCANPET SCAN

TREATMENTTREATMENT

MEDICALMEDICAL INVASIVE METHODSINVASIVE METHODS CABGCABG PTCAPTCA NON-INVASIVE NON-INVASIVE ACTACT ECP ECP

(External Counterpulsation)(External Counterpulsation)

MedicinesMedicines NITRATESNITRATES BETA BLOCKERBETA BLOCKER CALCIUM ANTAGONISTCALCIUM ANTAGONIST BLOOD THINNERBLOOD THINNER LIPID LOWRING DRUGSLIPID LOWRING DRUGS RESINSRESINS FIBRIC ACIDSFIBRIC ACIDS HMG CoA REDUCTASE HMG CoA REDUCTASE

INHIBITORINHIBITOR NIACINNIACIN

Is By-Pass NecessaryIs By-Pass Necessary By-Pass V/s Medical TreatmentBy-Pass V/s Medical Treatment Veteran administration coperative Veteran administration coperative

study groupstudy group European Coronary surgery studyEuropean Coronary surgery study Coronary Artery surgery study Coronary Artery surgery study

(CASS)(CASS) CASS – 10years follow-up 780 peopleCASS – 10years follow-up 780 people Survival of TWO groups is not Survival of TWO groups is not

significantly differentsignificantly different

Indications of By-Pass SurgeryIndications of By-Pass Surgery

Relive angina painRelive angina pain

Prolong LifeProlong Life

When dose By-Pass When dose By-Pass Prolong LifeProlong Life

Ejection fraction <50%Ejection fraction <50%

Blockage of Left main Blockage of Left main Coronary ArteryCoronary Artery

Triple Vessel diseaseTriple Vessel disease

By-pass being over doneBy-pass being over done

JAMA study JAMA study 386 patients underwent bypass 386 patients underwent bypass

surgery 44% of the surgery surgery 44% of the surgery inappropriateinappropriate

Dr. Thomas Graboys MD-JAMADr. Thomas Graboys MD-JAMA 50% of by pass can be avoided50% of by pass can be avoided

Side effects of By-Pass SurgerySide effects of By-Pass Surgery

Mortality 1-3%Mortality 1-3%

Brain damage 15-40%Brain damage 15-40%

InfectionInfection

Internal bleedingInternal bleeding

Can Heart Diseases Be ReversedCan Heart Diseases Be Reversed

Dr. Dean OrnieshDr. Dean Orniesh Rice University at HoustonRice University at Houston 1983 JAMA reversal of Heart Diseases 1983 JAMA reversal of Heart Diseases

in 82% of Patientsin 82% of Patients 1995 Showed Reversal of Heart 1995 Showed Reversal of Heart

Diseases by PET ScanDiseases by PET Scan

Reversal of heart diseasesReversal of heart diseases

Reduce Fat Consumption < 10%Reduce Fat Consumption < 10% Cholesterol Level < 150Cholesterol Level < 150 Reduce Stress Reduce Stress Life Style ModificationLife Style Modification Regular ExerciseRegular Exercise Open Collaterals By ECP Open Collaterals By ECP Remove Toxic Metals by ACTRemove Toxic Metals by ACT

Heart Disease ReversalHeart Disease Reversal

RecommendedRecommended ReversalReversal

Serum Cholesterols Serum Cholesterols 130-200 mg/dl130-200 mg/dl <150 mg/dl<150 mg/dl

TriglycerideTriglyceride 60-160 mg/dl60-160 mg/dl <120 mg/dl<120 mg/dl

HDLHDL 30-60 mg/dl30-60 mg/dl >40 mg/dl>40 mg/dl

LDLLDL 30-130 mg/dl30-130 mg/dl <100 mg/dl<100 mg/dl

Blood Sugar (F)Blood Sugar (F) 80-110 mg/dl80-110 mg/dl <100 mg/dl<100 mg/dl

Total Fat Total Fat 10-30% of calorie10-30% of calorie <10 % OF Calorie<10 % OF Calorie

Visible FatVisible Fat PUFA, MUFAPUFA, MUFA BANNEDBANNED

New Risk FactorsNew Risk Factors

CRP (C reactive protein)CRP (C reactive protein) Apolipo protein AApolipo protein A HomocysteineHomocysteine Heart rate variabilityHeart rate variability

Lowering CholesterolLowering Cholesterol Recommended – 100-200 mgRecommended – 100-200 mg Ideal < 150 mg/mlIdeal < 150 mg/ml Water Soluble Fibers – Oats, Water Soluble Fibers – Oats,

Barley-brown RiceBarley-brown Rice Charcoal Charcoal Garlic Garlic GugulipidGugulipid CapsaicnCapsaicn DrugsDrugs

ECP ECP (External Counterpulsation)(External Counterpulsation) A Non Invasive Treatment For Heart PatientsA Non Invasive Treatment For Heart Patients Introduction Introduction

Latest and Very Effective Treatment For Latest and Very Effective Treatment For Recurrent Angina, Myocardial Infarction, Post MI Recurrent Angina, Myocardial Infarction, Post MI Angina and CHF. Angina and CHF.

ECP (External Counter Pulsation)ECP (External Counter Pulsation) Treatment. Treatment. ECP is an Ingenious Method for Treating Angina ECP is an Ingenious Method for Treating Angina it is Non-invasive, Painless, Safe & Inexpensive. it is Non-invasive, Painless, Safe & Inexpensive. It is an Outpatient Treatment.It is an Outpatient Treatment.

How ECP WorksHow ECP Works Increases Diastolic Pressure – Diastole Increases Diastolic Pressure – Diastole

Augmentation Augmentation Decrease After Load – Decompensate Decrease After Load – Decompensate

HeartHeart Endothelial Stabilization Endothelial Stabilization VEGFVEGF Collateral Formation Collateral Formation

Indication of ECPIndication of ECP Angina and congestive heart failure.Angina and congestive heart failure. Coronary Heart Disease, Angina Pectoris, Coronary Heart Disease, Angina Pectoris,

Myocardial Infarction.Myocardial Infarction. Cerebral Arteriosclerosis, Cerebral thrombosis, Cerebral Arteriosclerosis, Cerebral thrombosis,

Cerebral Arteries Embolism, Parkinsoism, Cerebral Arteries Embolism, Parkinsoism, Cerebral Ischemic, Cerbrovascular Accident Cerebral Ischemic, Cerbrovascular Accident Sequelae.Sequelae.

Hypertension For Renal Ischemia, Oliguresis Hypertension For Renal Ischemia, Oliguresis Adnuremina.Adnuremina.

Eyeground Arteries Embolism, Centricity Serosity Eyeground Arteries Embolism, Centricity Serosity Retina Choroid Pathologic Change Optic Atrophy.Retina Choroid Pathologic Change Optic Atrophy.

Indication of ECPIndication of ECP Sudden Deafness.Sudden Deafness. Cerebral Paralysis for Children.Cerebral Paralysis for Children. Diabetes for Arteriosclerosis.Diabetes for Arteriosclerosis. Extremities Arteriosclerosis Ischemic of Pancreatic.Extremities Arteriosclerosis Ischemic of Pancreatic. Other Ischemic Pathologic Change and Sequelae Other Ischemic Pathologic Change and Sequelae

due to Arteriosclerosis and Disturbance of Blood due to Arteriosclerosis and Disturbance of Blood Circulation.Circulation.

Hepatitis.Hepatitis. Sports Fatigue.Sports Fatigue. Use for Sub-Health Care and Test Oration.Use for Sub-Health Care and Test Oration.

Results of ECPResults of ECPEfficacy of Enhanced External Counterpulsation in the Treatment of Angina Pectoris.Efficacy of Enhanced External Counterpulsation in the Treatment of Angina Pectoris.Lawson WE, Lawson WE, HuiHui JCK, JCK, SoroffSoroff HS, et al. American Journal of Cardiology 1992; 70:859-862. HS, et al. American Journal of Cardiology 1992; 70:859-862.

18 patients with refractory angina18 patients with refractory angina

Counterpulsation Protects Coronary Artery Disease Patients from Future Counterpulsation Protects Coronary Artery Disease Patients from Future Cardiac Events. S. Karim et alCardiac Events. S. Karim et al 1st International Congress on Heart Disease - 1st International Congress on Heart Disease - New Trends in Research, Diagnosis, and Treatment New Trends in Research, Diagnosis, and Treatment Enhanced ExternalEnhanced External. The . The

Journal of Heart Disease 1:1 May ’99Journal of Heart Disease 1:1 May ’99

Karim and associates treated 117 patients with EECP Karim and associates treated 117 patients with EECP between 1/92 and 12/97.between 1/92 and 12/97.

Drug GroupDrug Group EECP GroupEECP Group

Mean # Event Free Mean # Event Free DaysDays

958958 10101010

Cardiac Death Cardiac Death 9.6%9.6% 4.3%4.3%

Heart Attack Heart Attack 4.5%4.5% 1.7%1.7%

Revascularization Revascularization . 5%. 5% 1.7%1.7%

Total Effective Rate - Symptoms Total Effective Rate - Symptoms Long-term results were measured in 102 EECP patients;Long-term results were measured in 102 EECP patients; 23, 39, & 53 were followed for 7, 6, & 5 years post EECP 23, 39, & 53 were followed for 7, 6, & 5 years post EECP

respectively. 19, 32, & 52 patients treated solely with respectively. 19, 32, & 52 patients treated solely with medication were followed over the same time periodsmedication were followed over the same time periods. .

Long-term:  Long-term:  Symptoms Symptoms

EECP Group EECP Group Drug Group Drug Group

5 year follow-up5 year follow-up 55.8%55.8% 33.3%33.3%

6 year follow-up6 year follow-up 67.9%67.9% 48.1%48.1%

7 year follow-up7 year follow-up 73.9%73.9% 21.3%21.3%

Cardiac Death RateCardiac Death Rate

Cardiac DeathCardiac Death EECPEECP Drug GroupDrug Group

First YearFirst Year Group4.9%Group4.9% 13.5%13.5%

By Eighth YearBy Eighth Year 7.7%7.7% 30.3%30.3%

OverallOverall 8.8%8.8% 30.3%30.3%

Does Prior Myocardial Revascularization Predict Does Prior Myocardial Revascularization Predict Therapeutic Benefit From Enhanced External Therapeutic Benefit From Enhanced External

Counterpulsation?Counterpulsation?

Lawson WE et al. Biomedicine ’97; April 25-27 1997, Washington DC - Poster #44Lawson WE et al. Biomedicine ’97; April 25-27 1997, Washington DC - Poster #44Dr. Lawson and his colleagues at Stony Brook Medical Center provided EECP to 25 Dr. Lawson and his colleagues at Stony Brook Medical Center provided EECP to 25 patientspatients with angina due to clogged bypass grafts, and compared their response with angina due to clogged bypass grafts, and compared their response to that of 35 never bypassed angina patients. Pre-EECP coronary angiograms to that of 35 never bypassed angina patients. Pre-EECP coronary angiograms

were carried out in both groupswere carried out in both groups

Psychosocial Effects of Enhanced External Psychosocial Effects of Enhanced External Counterpulsation in the Angina Patient.Counterpulsation in the Angina Patient.

Fricchione GL, et al. Psychosomatics 1995;36:494-97.Fricchione GL, et al. Psychosomatics 1995;36:494-97.

Parameter   Parameter    WorsenedWorsened UnchangedUnchanged ImprovedImproved

Sexual activity   Sexual activity    0%0% 67%67% 33%33%

Family life Family life  0%0% 33%33% 67%67%

Health condition Health condition  0%0% 0%0% 100%100%

Sense of well-Sense of well-being being 

0%0% 0%0% 100%100%

Social lifeSocial life 0%0% 33%33% 67%67%

Ability to work Ability to work  0%0% 0%0% 100%100%

Energy levelEnergy level 0%0% 0%0% 100%100%

Stress ManagementStress Management

Bio-YogaBio-Yoga Reduces heart rateReduces heart rate Lowers breath rateLowers breath rate Decrease cardiac stressDecrease cardiac stress Improve heart rate Improve heart rate

variability (HRV)variability (HRV)

Reverse Heart Disease/Reverse Heart Disease/By-Pass SurgeryBy-Pass Surgery

Choice is yoursChoice is yours

Ours programmeOurs programme2 days educational programme on 2 days educational programme on

reversing heart disease reversing heart disease Age rejuvenationAge rejuvenationHealthy agingHealthy agingDiet counselingDiet counseling Bio yogaBio yogaLowing cholesterolLowing cholesterol

Thanks a LotThanks a Lot