Preventive Cardiology: Ayurveda View

 

Abhijit Dinkarro Shekhar¹, Gunvant H Yeola², Prasad N Kulkarni³,

Prashant Khade³, Pranesh Gaikwad³

¹Assistant Professor, Department of Kayachikitsa, Dr. D Y Patil College of Ayurved and Research Centre, Pune

Dr. D Y Patil Deemed to be University (DPU).

²Principal and HOD, Department of Kayachikitsa, Dr.D Y Patil College of Ayurved and Research Centre, Pune

Dr. D Y Patil Deemed to be University (DPU).

³Associate Professor, Department of Panchakarma, Dr.D Y Patil College of Ayurved and Research Centre, Pune

Dr. D Y Patil Deemed to be University (DPU).

 

ABSTRACT:

Cardiovascular diseases are one of the leading causes of morbidity and mortality all over the world than any other aliment. The global burden of this disease is gradually increased and it’s about 25% out of the total deaths (2.3 million). The Global Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100 000 population in India is higher than the global average of 235 per 100 000 population. Ayurveda, the art of living and the science of life is serving the man kind since antiquity. However Ayurveda extends itself to accommodate prevention and cure of the diseases which are the major impediments to health, wellbeing and long life. Ayurveda has real strength in promotive and preventive health care through Ahara-Vihara^.In view of the increasing evidence of cardiac disorders in the present times this aspect assumes added importance. The present article undertakes to discuss this point in detail, based on Ayurvedic concepts as well as for primary and secondary prevention, rehabilitation and adjunct therapy complementary to conventional treatment for current knowledge.

 

 

INTRODUCTION:

Since the early 1900s, atherosclerotic cardiovascular disease (CVD), including both coronary heart disease (CHD) and stroke, has been the leading cause of death in industrialized nations¹. Atherosclerosis represents a unique public health challenge because it is a progressive, lifelong disease that is modified by behavior and yet produces few symptoms until late into its course. Unfortunately, in spite of these efforts, smoking, hypertension, and hypercholesterolemia remain unacceptably common in the general population today.

 

The global INTERHEART study suggest that nine modifiable risk factors for CVD —dyslipidemia, smoking, diabetes mellitus, hypertension, abdominal obesity, psychosocial stress, poor diet, physical inactivity, and alcohol consumption— account for more than 90% of the risk for CVD². Success in preventive cardiology is defined by reduction in rates of mortality from CVD and the prevention of nonfatal CVD events³.

 

 

The Major Levels Of Prevention Of CVD³ -

TABLE 1–		Level of Prevention
Characteristic	Primordial	Primary	Secondary
Target patients	All patients, including children	Patients at increased risk for CVD	Patients with known CVD
Setting Community	societal Outpatient Inpatient transitioning to outpatient	Setting Community	societal Outpatient Inpatient transitioning to outpatient
Delivery of care	Dietary patterns Policy decisions Education campaigns Environment	Education campaigns Behavioral intervention Medications	Environment Medications Rehabilitation
Advantages	Intervention before risk factors develop Sustainable Does not require screening	Directed at higher risk individuals Does not require screening Tailored therapy Patients motivated to implement changes	Directed at highest risk individuals Tailored therapy Patients highly motivated to implement Changes
Disadvantages	Difficult to implement Hard to quantify effect Up-front costs Individual risk reduction small	Requires screening of population May delay but not prevent disease “Medicalization” of asymptomatic individuals	Small segment of population eligible Attempts to attenuate loss of quality of life Not sustainable

 

Risk Factor	Goal	Recommendation
Smoking	Complete smoking cessation	Assessment, counseling, and pharmacotherapy
Blood pressure*	<140/90 mm Hg <130/85 mm Hg if patient has CRI or CHF <130/80 mm Hg if patient has diabetes	Lifestyle therapy, then individualized pharmacotherapy based on patient characteristics
Diet	Overall healthy eating pattern	Consistent with AHA Diet and Lifestyle Guidelines
Aspirin	Low-dose aspirin in patients with ≥10% 10-year risk	Doses 75-162 mg/day Contraindicated if patient has risk of GI or otherhemorrhage
Lipid management	Primary Goal LDL-C level <160 mg/dL if ≤1 RF LDL-C level <130 mg/dL if ≥2 RFs LDL-C level <100 mg/dL if 10-year CHD risk >20% Secondary Goal If triglyceride levels ≥200 mg/dL, then Non–HDL-C level <190 mg/dL if ≤1 RF Non–HDL-C level <160 mg/dL if ≥2 RFs Non–HDL-C level <130 mg/dL if 10-year CHD risk >20% Other Targets Triglyceride levels <150 mg/dL HDL-C level >40 mg/dL in men HDL-C level >50 mg/dL in women NCEP Optional Goals: LDL-C level <100 mg/dL if ≥2 RFs LDL-C level <70 mg/dL if 10-year risk >20% Non–HDL-C level <130 mg/dL if ≥2 RFs Non–HDL-C level <100 mg/dL if 10-year CHD risk >20%	Lifestyle change, including dietary plant stanols/sterols, viscous fiber, and omega-3 fatty acids Then add statin therapy
Physical activity	≥30 min activity of moderate intensity per day most days of week	Additional benefits are obtained from vigorous intensity activity
Weight management	Primary Goal Achieve BMI of 18.5-24.9 kg/m2 Secondary Goal Waist circumference: <40 inches in men <35 inches in women	Reduce body weight by 10% in first year of therapy
Diabetes	Normal fasting glucose HbA1c level < 7%	·                      Lifestyle therapy ·                      Oral hypoglycemic agents ·                      Then insulin therapy
Chronic atrial fibrillation	Normal sinus rhythm or INR of 2.0-3.0	Aspirin, 325 mg, can be alternative if patient has high risk of Bleeding

 

 

The current management scenario have its own limitations and drugs which are used they have adverse effects on continuous use. Hence, there is need to detect safe and effective management for CVD’s. Ayurveda science having a major role to play. In samhitagranthas, Hridroga with its aetiopathogenesis as well as management is explained in detail⁴. Various factors such as dietary,  lack of exercise, various psychological factors, krimi etc are the etiological which play important role in the development of these disease.

 

Hridroga

 

NIDANA of Hridroga- Hridroga(heart diseae) is caused by following factors-

1) Aahar- Usna, Guru, Kasaya, Tiktasevana, Advasana

2) Somatic factors- Srama, Vegadharana, Abhigata, Ativerechana

3) Psychological factors - Cinta, Bhava, Trasa, Mada

 

Vagbhata states that the etiological factors of Hridroga are similar to that of Gulma. Modern medicine on the other hand, based on clinical and experimental evidence puts the blame on food containing large amounts of saturated fat,cholesterol, smoking, alcohol consumption, mental stress, lack of exercise, obesity and present sedentarylife style. But Ayurveda describes guru ahara but not singdhaahara i.e. fat containg diet among the causativefactors. ButAcharya describes number of preparations are made with ghrita.

 

Ahara-It is the most important pillar of human health anddiseaseIn preventive cardiology, the aim of a healthy diet is to provide adequate calories and provide essential nutrients for the individual body requirements. The energy intake should be limited up to maintain BMI 25 kg/m2. For intake of fats, recommendation is that they should account for 30%< of total energy intake, of which saturated fats should contribute 10%< (up to one-third of total fat intake) with remainder being met by intake of polyunsaturated (sunflower oil, soya oil, walnuts, fish oils, etc.) or mono-unsaturated fats (olive,rapeseed oil, nuts and seeds). However, the relationship of saturated fats with CVD is still debated, and there is emerging evidence that those from dairy products may be beneficial.Trans unsaturatedfats, particularly industrially hydrogenated oils (Vanaspati ghee, margarine, etc.) are strongly linked with CVD and should be best avoided or account for 10% < of energy intake. Daily intake of 5-6 portionsof fruitand vegetables (each portion  of  about  8  gm) is highly  recommended. Consumption  of  3 -45  gm  of fiber  is  recommended  mainly  from  wholegrain products besides  fruit  and  vegetables.  Daily salt intake  of   6 gm/ day  is recommended.

 

Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India New Delhi suggested diet chart according to the prakruti of persons,There are three dosha, mixed prakrutis. Following are diet charts to avoids CVD risks⁵.

 

 

Diet Chart for Vata Prakriti Purush –

 

Meal/ time	Menu	Quantity
Early morning	Nuts - Almond            Walnuts Lemon tea / Green Tea/ Light tea with milk	6-7 1-2 1 cup (200 ml.approx.)
Breakfast	Fruits- Apple/Anar/ Banana Daliya /Cornflakes / poha / upma / oat meal Milk and milk products Idli / dosa	1 nos. 1 bowl 250 ml 2-3 nos.
Lunch	Roti Boiled Brown rice with starch Lunch Green vegetable (Lauki,Tinda, Torai, cabbage, Spinach etc.) Mudga Dal (Preferably whole legume) Takra (Butter milk) or Skimmed Curd Apple/Anar/ any citrus fruit	2-3 nos 1 bowl   1 bowl   1bowl
Evening	Fruits-,Papaya, Guava ,Pineapple Roasted chana /Dhokala	1 nos./ bowl 1 bowl
Dinner	Roti /Green vegetable (Lauki, Tinda, Torai, Cabbage, Methi, Cauliflower, Spinach etc.) Paneer /Dal Salad (Carrot, Tomato, cucumber, Ginger, Amalakietc).	1-2 nos 1 bowl
Bed Time	Milk	250ml

 

Diet Chart for Pitta Prakriti Purush-

 

Meal/ time	Menu	Quantity
Early morning	Nuts -  Almond Kharjura Milk and coconut water.	6-7 1-2 1 cup (200 ml.approx.)
Breakfast	Fruits- Apple/Anar/ Banana Daliya / poha / upma / Idli / dosa	1 nos. 1 bowl 2-3 nos.
Lunch	Roti Boiled Brown rice with starch Green vegetable (Lauki,Tinda, Torai, cabbage, Spinach etc.Mudga Dal (Preferably whole legume) Takra (Butter milk) or Skimmed Curd	2-3 nos 1 bowl 1 bowl 1bowl
Evening	Fruits-Apple/ Papaya/ Anar/ Guava /Citrus Fruit/ Pineapple Roasted  chana /corn Dhokala / murmurachat	1 nos./ bowl 1 Bowl
Dinner	Roti / Green vegetable (Lauki,Tinda, Torai, cabbage,  Spinach etc.) Paneer /Dal	1-2 nos 1 bowl 1 bowl 1 bowl
Bed Time	Milk	250 ml

 

Diet Chart for Kapha Prakriti Purush-

Meal/ time	Menu	Quantity
Early morning	Nuts - Almond or  Walnuts Honey Lemon with warm water / coffee / lemon tea	6-7 1-2 1 cup (200 ml.approx.)
Breakfast	Fruits- Apple/Anar/ any citrus fruit Besancheela / Vegetable stuffed Roti / Cornflakes with milk / poha/ upama Idali/ dosa	1 nos. 1 bowl 2-3 nos.
Lunch	Roti / multi grain roti Boiled Brown rice with starch Green vegetable (Lauki,Tinda, Torai, cabbage, Methi, Bathua,Spinach etc.) Paneer /Dal - Chana and mudga dal (Preferably whole legume)	2-3 nos 1 bowl 1 bowl 1bowl
Evening	Fruits- Apple, Anar, any citrus fruit, Papaya, Guava, Pineapple Roasted chana	1 nos./ bowl 1 Bowl
Dinner	Roti / Green vegetable (Lauki,Tinda, Torai, cabbage, Methi, Spinach etc.) Paneer /Dal	1-2 nos 1 bowl
Bed Time	Milk	250 ml

 

 

Psychosocial factors:

Ayurveda recognisedthe  close  relationship between heart  and psychological stress. Anxiety, depression, stress at work place, low  socio-economic status are the risk  of  developing and worsening CVD,Above factors also impact on life style of the persons so avoid this simple questionnaires in the form of cognitive-behaviour therapy methods is encouraged which makes a friendly and  positive  interaction  with  the  patient, understanding their  worries  and  concerns, Ayurved and alternate sciences suggested yoga and Pranayam to avoid the risk of CVD

 

Yoga And Pranayama- following asanas will be suggested

Asanas		Asanas
1.Tadasana (Mountain pose)	2.Vrikshasana (Tree pose)	3. UtthitaHastapadasana (Extended hands and feet pose)
4. Trikonasana (Triangle pose)	5. Veerabhadrasana (Warrior pose)	6. Utkatasana (Chair pose)
7. Marjariasana (Cat pose)	8. AdhoMukhoSvanasana	9. Bhujangasana (Cobra pose)
10. Dhanurasana (Bow pose)	11. ArdhaMatsyendrasana (Sitting half spinal twist pose)	12. Shavasana (Corpse pose)

 

Pranayama- Useful in cardiac diseases.

Sr.no	Name	Duration-
1	Bhastrika Pranayama	Practice daily for 5-6 minutes.
2	Kapalbhati Pranayama	Practice daily for 5-6 minutes.
3	AnulomVilom Pranayama	Practice daily for 5-6 minutes.
4	NadiShodhan	Practice daily for 5-6 minutes
5	Bhramari Pranayama	Practice daily for 3 to 5 minutes.

 

1. Meditation- daily Pray for 15-20 minutes in the morning between 4am-8am along with proper instructions.

 

2. Exercise-45 minutes per day walk for 5days per week

 

CONCLUSION:

With  the  rapidly  increasing  incidence  of  CVD  in developing  countries  such  as  India  with  worsening profile  of  risk factors, Ayurveda has much to contribute to  the  prevention  of  these  conditions.  A simplified  guideline combining Ayurveda and Yoga with a message for a healthy diet, exercise, and mental health for  the  population  would  go  a  long  way  in  CVD prevention. Atherosclerotic CVD is an ideal scenario for prevention efforts because  it is a common disease;  it is modifiable by behavior;  the disease latency is long;  the time between symptom onset and severe disability or sudden cardiac death is short; and no cure exists for systemic atherosclerosis once it is present. The majority of improvement in rates of mortality from CVD since the 1960s is the result of prevention, not treatment, of acute CVD. Preventive cardiology must continue across all three levels (primordial, primary, and secondary) with a balance between the two main approaches to prevention (population-based and individual-based). Despite available guidelines, there is a wide gap between the burden of CVD and current preventive efforts⁶.

 

ACKNOWLEDGEMENTS:

I would like to thank, Dr YeolaGunvant Principal and professor of Kayachikitsa Department, Dr.D.Y.Paril College of Ayurveda research center,Pimpri Pune and Dr Amit Sinkar Senior Cardiologist in Pune for his help and guidance, particularly with reference to Ayurvedic and Yoga viwes in cardiovascular disease.

 

REFERENCES:

1.     Prof. (Dr.) Abhimanyu Kumar Director General Dr. M. M. Padhi Deputy Director (Technical) Dr. A. Narayana Director, NIIMH Working Group Dr. N. Srikanth Assistant Director (Ayurveda) Dr. B. Venkateshwarlu Research Officer (Ayurveda) Dr. V. Sridevi Research Officer (Ayurveda) Dr. T. Saketh Ram Research Officer (Ayurveda) Dr. K. Bharathi Research Officer (Ayurveda) Dr. G. P. Prasad Research Officer (Ayurveda) Dr. Sobaran Singh Research Officer (Ayurveda) Dr. Shruti Khanduri Research Officer (Ayurveda) Dr. S. C. Verma Research Officer (Chemistry) Central Council for Research in Ayurvedic Sciences Ministry of AYUSH Government of India New Delhi 2015 Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India New Delhi. ISBN : 978-93-83864-31-7

2.     WHO. World Health Organization NCD and Global Monitoring Framework. 2 11(1E 1E2 14).

3.     JBS3. Joint British Societies consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart 1 (Suppl 2):ii1-ii67 (2 14).

4.     Sharma, R.K, Dash, B, Carak Samhita Sutra-sthana, a critical exposition based on Cakrapani Dattas Ayurveda Dipika. English translation,Chapter ( 3-13), Chowkhamba Sanskrit Series ,Varanasi, 2 4

5.     Rastogi, S. Ayurvedic Science of Food and Nutrition 3-14 (Springer, 2 14).

6.     Perk, Jet al. J european and guidelines on cardiovascular disease prevention in clinical practice (version 2 12). The Fifth joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Our Heart j33:1635-17 1 (2 12).

 

 

 

Accepted on 25.03.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(11):5368-5372.