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Cardio Diabetes Medicine 2017 625

fasting blood sugar (FBS). A 10% increased risk of to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg,

sudden cardiac death has been observed with each as defined in the JNC 7 identifies persons at future
1 mmol/L increase in FBS. risk of developing hypertension. Intervention at this
stage with appropriate lifestyle modifications can
Boguszewski et al reported a significantly higher avert or delay CVD. JNC 7 also recommended anti-hy-
prevalence of ASCVD in dyslipidemic patients with pertensive drug in prehypertensive individuals, who
FBS between 90 and 99 mg/dL compared to lower also have diabetes or kidney disease, if the lifestyle
levels of the blood sugar. With increase in FBS from modifications did not lower the BP to 130/80 mmHg
90 to 125 mg/dL, a corresponding increase in the or less.
prevalence of ASCVD was also seen.
Smoking
Blood pressure
Smoking increases risk of CVD. Sudden death, MI,
Hypertension (HT) is often called ‘the silent killer’ as CHD, cerebrovascular disease, PAD, HT complica-
it is usually asymptomatic in the early stages. It is tions and poor prognosis following angioplasty or
a significant risk factor for atherosclerosis and also bypass surgery are associated with smoking. Hence,
an independent predisposing factor for heart failure, patients should be encouraged and helped to quit
CAD, stroke, renal disease and peripheral arterial smoking. Quitting smoking may reduce calculated

disease (PAD).
CVD risk almost to the same levels as never-smok-
As per the National Family Health Survey 4 (NFHS- ers.
4) 2015-16, 13.6% men and 8.8% women in India in
the age group of 15-49 years are hypertensive. The Smoking is associated with insulin resistance, in-

prevalence of hypertension is increasing in both rural flammation and dyslipidemia. It increases the risk of
and urban areas in India. Nearly 25% of urban and 10- developing diabetes, and aggravates the micro- and
15% of rural adults are hypertensive, corresponding macrovascular complications of diabetes. Although
to a 12-fold and 7-fold increase in urban and rural smoking is known to decrease body weight, it is as-
hypertensive population, respectively. Hypertension sociated with central obesity. Smoking also increases

accounts for 57% of deaths due to stroke and 24% inflammation and oxidative stress and has direct ad-
of deaths due to CHD and around 11% of all deaths verse impact on beta-cell function and also impairs

in India. endothelial function.
The hypertensive population in India is estimated to Diet
double from 118 million in 2000 to 213 million by the Dietary modifications can prevent many of the life-
year 2025.
style diseases.
This rising trend is multifactorial due to factors such Replacing saturated fats with unsaturated fats re-
as increased life expectancy, life style changes, in- duces the risk of CAD. Diets rich in fiber and com-

creased salt intake and also due to the increased plex carbohydrate and low in fat improve glycemic
awareness and detection of hypertension. A signifi- control, delay absorption of glucose, lower insulin
cant association was found between high salt intake requirement, decrease serum cholesterol and tri-
(>10gms/day) and HT in a study, where 55.46% of glycerides, help to control body weight and also lower
hypertensive study participants had >10gm of daily BP in patients with type 2 diabetes. There is an in-
salt intake.
verse association between fruit, vegetable and fibre
As per the Seventh Report of the Joint National Com- consumption and risk for CHD and stroke.
mittee (JNC 7) on prevention, detection, evaluation, Cereal products should be eaten in a whole-grain,
and treatment of high BP, the risk of CVD doubles high-fiber form. High consumption of refined car-
with each increment of 20/10 mm Hg in the BP from bohydrates is associated with type 2 diabetes, CAD
a baseline of 115/75 mm Hg.

and metabolic syndrome. Intake of sugar and sug-

In a meta-analysis of individual data for one million ar-based beverages should be restricted. Sugar in-
adults in 61 prospective studies published in The Lan- take leads to hypertriglyceridemia, insulin resistance,
cet, mortality from both ischemic heart disease (IHD) metabolic syndrome, diabetes and fatty liver, and
and stroke increased more than 2-folds with every 20 hyperuricemia mostly by increasing body fat and in-
mmHg increase in systolic BP or 10 mmHg increase tra-abdominal fat.
in diastolic BP between ages 40 and 69 years.
Excessive intake of energy from any source should
The category of prehypertension, systolic BP of 120 be avoided to prevent avoid obesity and overweight.

Cardio Diabetes Medicine