Prevent Heart Attacks & Strokes Before They Happen

Understanding Cardiovascular Prevention in the Indian Context

Indians face a cardiovascular disease epidemic—heart attacks strike a decade earlier (age 40-50) compared to Western populations, and stroke is the leading cause of death in India. Yet 80% of premature cardiovascular events are preventable through aggressive risk factor modification. At Ajuda Hospitals, our Heart Attack & Stroke Prevention Program combines evidence-based risk assessment, intensive medical therapy, and lifestyle coaching to slash your cardiovascular risk.

The root causes are clear: high prevalence of diabetes (11% of adults), hypertension (30%), dyslipidemia (25-35%), central obesity, sedentary lifestyles, and smoking. Indians develop atherosclerosis earlier and more aggressively due to genetic predisposition (high Lp(a), metabolic syndrome). Traditional risk calculators underestimate Indian risk—we use enhanced ASCVD scores calibrated for South Asian populations and advanced imaging (coronary calcium, carotid ultrasound) for precision risk stratification.

Our protocols follow ACC/AHA Primary Prevention Guidelines, European Society of Cardiology Prevention Guidelines, and Indian consensus statements for lipid, BP, and glycemic targets.

When to Consult Our Prevention Specialists

Even without symptoms, comprehensive risk assessment guides preventive interventions that can add 10-15 healthy years to your life.

Our Diagnostic Approach

Comprehensive Clinical Risk Assessment

First visit (60 minutes) with preventive cardiologist covers:

• Family History: First-degree relatives with premature cardiovascular disease—strongest predictor of genetic risk
• Personal Risk Factors: Smoking (current/past), diet (high salt, saturated fat, trans fats), physical activity, stress, sleep quality
• Medical History: Diabetes, hypertension, high cholesterol, chronic kidney disease, autoimmune disease
• Physical Exam: BP (both arms), BMI, waist circumference (central obesity >90 cm in men, >80 cm in women), fundoscopy, peripheral pulses

10-Year ASCVD Risk Score calculated using Pooled Cohort Equations—estimates probability of heart attack or stroke in next decade. Risk categories:

• Low risk: <5%
• Borderline: 5-7.5%
• Intermediate: 7.5-20%
• High risk: >20%

Comprehensive Laboratory Panel

Fasting (12-hour) blood tests:

• Lipid Profile: Total cholesterol, LDL ("bad"), HDL ("good"), triglycerides, non-HDL cholesterol
• Glycemic Panel: Fasting glucose, HbA1c (3-month average sugar)
• Kidney Function: Creatinine, eGFR, urine albumin (detects early kidney damage)
• Liver Enzymes: ALT, AST (baseline before starting statins)
• Inflammatory Markers: High-sensitivity CRP (predicts cardiovascular events independent of cholesterol)
• Advanced Lipids (if indicated): Apolipoprotein B (better predictor than LDL), lipoprotein(a)—genetic risk factor, homocysteine

Non-Invasive Cardiovascular Imaging

Coronary Artery Calcium (CAC) Score (non-contrast CT scan):

• Quantifies calcified atherosclerotic plaque in coronary arteries
• Score 0 = very low risk (no detectable plaque)
• Score 1-100 = mild plaque
• Score 100-400 = moderate plaque—high risk
• Score >400 = severe plaque—very high risk

Indicated for: Intermediate ASCVD risk (7.5-20%) to guide statin decision. Reclassifies 30% of patients—some upward (start statin), some downward (defer therapy).

Carotid Intima-Media Thickness (CIMT) ultrasound:

• Measures artery wall thickness in neck—thickening indicates early atherosclerosis
• Detects disease years before symptoms or events
• Useful if calcium score unavailable or patient wants non-radiation option

Ankle-Brachial Index (ABI):

• BP in ankles vs arms—ratio <0.9 indicates peripheral artery disease (blocked leg arteries)
• PAD is marker of systemic atherosclerosis—10x risk of heart attack/stroke

Additional Screening

• Sleep Apnea: Questionnaire (STOP-BANG); referral for polysomnography if high risk—untreated apnea doubles cardiovascular risk
• Microalbumin Urine: Detects early kidney damage from diabetes or hypertension—marker of systemic vascular disease
• ECG & Echo: If hypertension or diabetes >10 years—screen for left ventricular hypertrophy, silent ischemia

Treatment Pathways

Intensive Lipid Management: The Foundation of Prevention

LDL cholesterol is #1 modifiable risk factor—directly causes atherosclerosis. Our targets:

• Primary prevention, low-intermediate risk: LDL <100 mg/dL
• Primary prevention, high risk (10-year ASCVD >20% or calcium score >100): LDL <70 mg/dL
• Secondary prevention (prior heart attack/stroke): LDL <55 mg/dL
• Very high-risk secondary prevention (recurrent events): LDL <40 mg/dL

Statin Therapy:

• High-intensity: Atorvastatin 40-80mg or rosuvastatin 20-40mg—reduces LDL by 50%+
• Side effects rare (muscle aches 5%, elevated liver enzymes 1%)—benefits far outweigh risks
• Monitoring: Lipid panel at 6 weeks, 3 months, then every 6 months; liver enzymes at baseline and 3 months

Add-on Therapies if LDL not at goal on maximum statin:

• Ezetimibe: Blocks cholesterol absorption—additional 20% LDL reduction
• PCSK9 Inhibitors (evolocumab, alirocumab): Injections every 2 weeks—reduce LDL by 60%—reserved for very high-risk patients or statin-intolerant (expensive, ₹25,000-40,000/month)
• Bempedoic Acid: Oral alternative for statin-intolerant patients

Triglyceride Management (if >150 mg/dL):

• Lifestyle: Reduce refined carbs, sugar, alcohol
• Omega-3 Fatty Acids (EPA/DHA) 2-4g daily if triglycerides >200
• Fibrates (fenofibrate) if triglycerides >500—prevent pancreatitis

Optimal Blood Pressure Control

Targets:

• Standard: <130/80 mmHg (all hypertensives)
• High cardiovascular risk: <120/70 mmHg (diabetes + CAD, prior stroke)
• Elderly (>65): <140/90 mmHg (gentler to avoid orthostatic hypotension)

Medication Strategy:

• First-line: ACE inhibitors or ARBs (protect kidneys in diabetes), calcium channel blockers, thiazide diuretics
• Combination therapy needed in 70%—fixed-dose combos improve adherence
• Resistant hypertension (uncontrolled on 3+ drugs): Add spironolactone, screen for secondary causes

Home BP Monitoring: Patients measure twice daily—validates clinic readings, detects masked hypertension, ensures 24-hour control.

Diabetes & Glycemic Optimization

HbA1c target: <7% (or <6.5% if early disease, no hypoglycemia risk)

Medications with Cardiovascular Benefit:

• Metformin: First-line—reduces heart attack risk independent of glucose lowering
• GLP-1 Receptor Agonists (liraglutide, semaglutide): Injections—reduce cardiovascular events by 15-25% in trials (LEADER, SUSTAIN-6)
• SGLT2 Inhibitors (empagliflozin, dapagliflozin): Pills—reduce heart failure hospitalization by 30-40%, slow kidney disease progression

Avoid: Sulfonylureas, insulin—cause hypoglycemia and weight gain without cardiovascular benefit.

Antiplatelet Therapy: Aspirin Decision

Secondary Prevention (prior heart attack, stroke, peripheral artery disease):

• Aspirin 75-150mg daily is mandatory—reduces recurrent events by 25%
• Continue lifelong unless major bleeding occurs

Primary Prevention (no prior events):

• Controversial—bleeding risk vs benefit
• Consider aspirin if 10-year ASCVD risk >10% AND:
  • Age 50-70
  • No bleeding history (no ulcers, GI bleeding)
  • Not on anticoagulants
  • Patient understands trade-offs
• Net benefit modest—prevent 1 heart attack per 300 treated, cause 1 major bleed per 300

Lifestyle Transformation Program (12-Week Intensive)

Nutrition:

• DASH or Mediterranean Diet: Rich in vegetables, fruits, whole grains, fish, nuts, olive oil. Limit red meat, processed foods, trans fats.
• Sodium <5g/day (reduce pickles, papad, restaurant food)
• Saturated fat <7% of calories; eliminate trans fats
• Dietitian-led cooking classes with Telugu/Hindi recipes adapted for South Indian/North Indian palates

Exercise:

• Aerobic: 150 min/week moderate (brisk walking, cycling) or 75 min vigorous (jogging, swimming)
• Resistance Training: 2 days/week (weights, resistance bands)—builds muscle, improves insulin sensitivity
• Supervised sessions with physiotherapist—safe progression for cardiac patients

Smoking Cessation:

• #1 modifiable risk factor—quitting reduces heart attack risk by 50% within 1 year
• Nicotine replacement (patches, gum), varenicline, bupropion
• Behavioral counseling, support groups

Stress Management:

• Yoga, Meditation, Pranayama—proven to lower BP, improve lipid profile
• Sleep hygiene counseling—aim 7-8 hours; screen for sleep apnea

Weight Loss:

• Target BMI <25 or 5-10% weight loss if obese
• Every 1 kg lost → 1 mmHg BP reduction, improved insulin sensitivity, better lipid profile

Advanced Risk Modifier Therapy

High Lipoprotein(a) (>50 mg/dL):

• Genetic risk factor—not affected by diet or statins
• Compensate with aggressive LDL lowering (<40 mg/dL if possible)
• Emerging therapies in trials—RNA-silencing drugs (pelacarsen) reduce Lp(a) by 80%

Elevated Homocysteine:

• Folic acid, vitamin B6, B12 supplementation—controversial cardiovascular benefit but safe

Chronic Inflammation (high-sensitivity CRP >2 mg/L):

• Statins reduce CRP independent of LDL
• Weight loss, exercise, omega-3s have anti-inflammatory effects

Sleep Apnea:

• CPAP therapy reduces BP by 5-10 mmHg, improves daytime alertness, lowers cardiovascular risk

What to Expect: Your Care Journey

Initial Consultation (Week 1)

• 60-minute visit with preventive cardiologist
• Detailed history, physical exam, BP measurement
• ASCVD risk score calculated
• Labs ordered (lipid, HbA1c, kidney, liver)
• Calcium score or CIMT scheduled if indicated
• Preliminary lifestyle counseling

Follow-Up Visit (Week 3-4)

• Review all test results—lipids, glucose, calcium score
• Discuss absolute cardiovascular risk and treatment plan
• Start medications if indicated (statin, BP meds, aspirin)
• Refer to dietitian (30-min consult—personalized meal plan)
• Enroll in exercise program (2x/week supervised sessions)

3-Month Review

• Repeat lipid panel, HbA1c if diabetic
• BP log review—adjust medications if not at target
• Side effect assessment (statin muscle aches, BP med dizziness)
• Dietitian follow-up—reinforce adherence, troubleshoot barriers
• Exercise progress review—increase intensity if safe

6-Month Milestone

• Comprehensive re-assessment—lipids, HbA1c, BP, weight, BMI
• Goal check: 90% of patients achieve LDL <70, BP <130/80, HbA1c <7% by this point
• Recalculate ASCVD risk score—document improvement
• Transition to maintenance phase

Lifelong Maintenance

• Quarterly visits: BP, weight, medication adherence, side effects
• Annual comprehensive: Full lipid panel, HbA1c, kidney function, ECG
• Repeat calcium score: Every 3-5 years—track plaque progression or stabilization
• Lifestyle reinforcement: Many patients regain weight, relapse—ongoing coaching essential

Technology & Innovation

Coronary Calcium Scoring: Game-Changer in Risk Assessment

Why it matters: 30-40% of intermediate-risk patients are reclassified after calcium scoring—some upward (start aggressive therapy), some downward (defer medications).

Case example: 50-year-old male with borderline cholesterol, no symptoms. ASCVD risk 10% (intermediate). Calcium score 200 (high)—reclassified to high-risk → started high-intensity statin immediately. May have prevented heart attack.

Serial calcium scoring: Repeat every 3-5 years. If stable or decreasing—therapy working. If increasing rapidly—intensify treatment.

Carotid Ultrasound: Window to Systemic Atherosclerosis

CIMT >0.9 mm = increased risk. Plaques visible = even higher risk. Advantage over calcium score: No radiation, visualizes plaque morphology (soft vs calcified).

Preventing Complications

Without prevention, high-risk individuals face:

• Heart Attack: Chest pain, sudden death—permanent heart muscle damage
• Stroke: Paralysis, speech loss, dependency—devastating disability
• Heart Failure: Breathlessness, fluid retention—poor quality of life
• Kidney Failure: Dialysis—from uncontrolled diabetes + hypertension
• Peripheral Artery Disease: Leg pain, gangrene, amputations

With comprehensive prevention:

• 40-60% reduction in actual cardiovascular events
• 10-15 years of healthy life gained
• Preserved quality of life—active, independent, symptom-free

Why Ajuda for Cardiovascular Prevention?

Take the First Step

Heart attacks and strokes are largely preventable—but prevention requires action today, not after symptoms appear. If you have risk factors or family history, don't wait for a cardiovascular event to take charge of your health.

Schedule Your Prevention Consultation: Call 9010550550 or WhatsApp for comprehensive risk assessment. We'll calculate your 10-year risk, order appropriate tests, and build a personalized prevention plan.

Every year of delay increases plaque burden. Early, aggressive intervention can add a decade of healthy life. Let Ajuda Hospitals be your partner in cardiovascular wellness.