Musings of a Cardiologist

Dr Jaideep das Gupta MD (Medicine), DM (Cardiology) (AIIMS)

Consultant Interventional Cardiologist

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I prefer to call myself a Cardiologist with inclination towards interventions.

  • Benefits of Omega 3 Fatty Acids for Heart Health

    Omega 3 fatty acids have gained immense attention in the field of cardiovascular health due to their potential benefits in reducing the risk of heart disease. This critical essay delves into the relationship between omega 3 fatty acids and heart health, examining the scientific evidence supporting their impact on various aspects of cardiac function.

    Research indicates that omega 3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found in fatty fish, play a crucial role in reducing inflammation, improving blood vessel function, and lowering triglyceride levels. These effects are believed to contribute to the prevention of atherosclerosis, a primary cause of heart disease. Furthermore, omega 3 fatty acids have been shown to have antiarrhythmic properties, potentially reducing the risk of irregular heartbeats and sudden cardiac death.

    Several large-scale studies, including the landmark GISSI-Prevenzione trial, have demonstrated the beneficial effects of omega 3 fatty acids in reducing the incidence of cardiovascular events such as heart attacks and strokes. These findings have led to recommendations by major health organizations, including the American Heart Association, to consume fatty fish or fish oil supplements rich in omega 3s for cardiovascular health.

    Despite the compelling evidence supporting the cardiovascular benefits of omega 3 fatty acids, some studies have yielded conflicting results, leading to ongoing debates in the scientific community. Questions remain regarding optimal dosages, sources of omega 3s, and individual variations in response to supplementation. Additionally, concerns have been raised about the potential risks of high-dose omega 3 supplements, such as gastrointestinal issues and interactions with blood-thinning medications.

    In conclusion, omega 3 fatty acids have emerged as promising nutrients in the realm of heart health, offering potential benefits in reducing inflammation, improving lipid profiles, and enhancing cardiac function. While further research is needed to elucidate the optimal use of omega 3s for cardiovascular protection, current evidence supports their inclusion as part of a heart-healthy diet. By understanding the mechanisms through which omega 3 fatty acids influence heart health, we can continue to advance our knowledge and strategies for preventing cardiovascular disease.

  • The Importance of protein in a balanced Diet

    Protein is an essential macronutrient that plays a pivotal role in maintaining overall health and well-being. As a fundamental component of tissues in both animals and humans, dietary protein is crucial for growth, development, and the maintenance of bodily functions (Wu, 2016). The body requires protein for the synthesis of enzymes, hormones, and various other molecules vital for physiological processes, such as muscle contraction, immune response, and cellular repair. This becomes even more significant considering the varied lifestyles and dietary patterns across populations. In many cultures, including India, the traditional diet has often been protein-deficient while being calorie-dense, which has resulted in an increased need for protein intake among Indians. The rise in awareness about nutrition and health also highlights the importance of protein in preventing lifestyle-related diseases and promoting overall vitality, making it imperative for individuals to prioritize their protein consumption not just for physical health but also for mental and emotional well-being.

    One of the most significant advantages of consuming sufficient protein is its ability to regulate food intake and support weight management. Research indicates that protein suppresses appetite more effectively than fats or carbohydrates, leading to increased feelings of fullness (Anderson, 2004). This heightened satiety can help individuals control their caloric intake more effectively than diets high in other macronutrients. Furthermore, high-protein diets are associated with the preservation of lean body mass during periods of energy restriction. This means that when individuals seek to lose weight, a diet rich in protein can promote fat loss while minimizing muscle loss—an important factor for long-term health.

    The quality and source of dietary protein also matter significantly. According to nutritional guidelines from the National Academy of Medicine, adults should aim for a minimum intake of 0.8 grams per kilogram of body weight daily (Konz, 2025). While deficiencies are rare in developed nations, it is crucial to focus on high-quality sources such as lean meats, fish, eggs, dairy products, legumes, nuts, and seeds to complete the daily quota of protein requirement.

    References:

    Wu, G., (2016). Dietary protein intake and human health – RSC Publishing. Retrieved from https://pubs.rsc.org/en/content/articlehtml/2016/fo/c5fo01530h.

    J.W., A., (2004). Dietary Proteins in the Regulation of Food Intake and Body Weight …. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022316623027451.

    E.C., K., (2025). Protein • The Nutrition Source. Retrieved from https://nutritionsource.hsph.harvard.edu/what-should-you-eat/protein/.

  • How Sleep Affects Your Heart

    The quality of sleep is a critical yet often overlooked factor in the maintenance of cardiovascular health. Research indicates that both sleep duration and quality are intricately linked to the risk of developing cardiovascular diseases (CVD). According to Slipczuk (2024), disturbances in sleep can lead to conditions such as hypertension, coronary artery disease, heart failure, and arrhythmias. Conversely, existing cardiovascular issues can disrupt sleep patterns, creating a bidirectional relationship that underscores the importance of addressing sleep quality in CVD prevention strategies. A significant study by Lao (2018) involving over 60,000 adults revealed alarming statistics regarding the association between poor sleep and coronary heart disease. The findings indicated that individuals who slept less than six hours per night faced a 13% increased risk of developing coronary heart disease. More strikingly, those experiencing difficulty falling asleep or relying on sleeping pills exhibited a hazard ratio of 1.40 for coronary heart disease (Lao, 2018). This data highlights the necessity for healthcare providers to consider both sleep duration and quality when assessing cardiovascular health risks. Furthermore, Liu (2022) advocates for redefining cardiovascular health metrics to include various aspects of sleep health. By incorporating measures such as sleep duration into assessments of cardiovascular wellness, researchers found a notable decrease in CVD risk among older adults. This approach suggests that improving public awareness about the importance of good sleep hygiene could be instrumental in enhancing overall cardiovascular health outcomes (Liu, 2022). Ultimately, prioritizing high-quality sleep should be an essential component of any comprehensive strategy aimed at reducing the burden of cardiovascular diseases.

    References:

    Slipczuk, Leandro (2024). The Role of Sleep in Cardiovascular Disease. Retrieved from https://link.springer.com/article/10.1007/s11883-024-01207-5.

    Lao, X. Q. (2018). Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease. Retrieved from https://jcsm.aasm.org/doi/10.5664/jcsm.6894.

    Liu, X. (2022). Redefining Cardiovascular Health to Include Sleep. Retrieved from https://www.ahajournals.org/doi/10.1161/JAHA.122.025252.

  • The impact of 10,000 Steps on Daily Health Habits

    The impact of 10,000 Steps on Daily Health Habits

    The concept of achieving 10,000 steps per day as a health benchmark has garnered significant attention in recent years. Proponents argue that this goal promotes physical activity, leading to improved health outcomes. A study by Agusala (2016) reveals that participants who adhered to the 10,000-step regimen experienced notable enhancements in both physical and mental health, including reductions in anxiety and depression alongside better mood states. This evidence suggests that setting a clear target like 10,000 steps can effectively motivate individuals to increase their daily activity levels, which is critical for sedentary populations struggling with weight management and mental well-being.

    However, some scholars contend that the emphasis on 10,000 steps may be misguided. Noble (2022) points out that the origin of this figure was largely arbitrary, created for marketing purposes rather than scientific validation. Research indicates that individuals aged 60 and older may experience significant health benefits from as few as 7,000 steps daily. Furthermore, it appears that for younger adults, the advantages plateau around 9,000 steps. These findings imply a more nuanced understanding of physical activity needs across different age groups rather than adhering strictly to a single step count goal.

    Ultimately, while aiming for 10,000 steps can serve as an effective motivational tool for many individuals seeking healthier lifestyles, it is essential to recognize the variability in individual needs and circumstances. Increased step counts—regardless of whether they reach the mythical threshold—are associated with lower risks of chronic diseases such as heart disease and obesity. Thus, fostering an environment where any increase in physical activity is celebrated may yield broader public health benefits than fixating solely on a numerical target.

  • Relevance of Beta Blockers in 2024

    Relevance of Beta Blockers in 2024

    In the latest annual scientific sessions at the ACC 24, the results from the REDUCE AMI trial have put the spotlight back on beta blockers, the age-old drug which has conventionally been used to treat post acute coronary syndrome patients. This registry-based randomized clinical trial, conducted among 5020 subjects, 95% of them being Swedish, led to the conclusion that long-term beta blocker therapy in subjects with acute coronary syndrome and a normal ejection fraction did not contribute to a reduced incidence of all-cause mortality and heart failure hospitalization.

    The findings of the trial have, I daresay, limited the use of beta blockers in the patients with acute coronary syndrome and normal ejection fraction. This challenges the conventional wisdom of prescribing beta blockers in patients with no heart failure symptoms post-acute coronary syndrome. However, the importance of the beta blocker as a drug to prevent adverse ventricular remodeling in patients with low ejection fraction still holds true, and there are multiple trials to prove its efficacy. My chief concerns with the findings of the trial are, first and foremost, that this trial was conducted mainly among an ethnic population recruited from the SWEDEHEART registry. How much of this is applicable to other ethnicities still needs to be found out. Second, the study sample of 2508 patients undergoing beta blocker therapy is rather small to definitively derive any positive conclusions from it. Third, there was a significant crossover between the beta blocker and the non-beta blocker therapy group beyond 1 year, thus making it difficult to monitor drug adherence, which may have affected the final outcomes.

    What this trial does prove is that more drugs are not usually better in the case of patients with acute coronary syndrome with preserved ejection fraction. Even though the drug may have been a cornerstone of heart failure therapy for years.

  • THE FOUR PILLARS OF RHEUMATIC HEART DISEASE MANAGEMENT

    The ACC/AHA/ESC, in its latest guidelines on the management of heart failure with reduced ejection fraction (HFrEF), highlights the importance of quadruple drug therapy for effective heart failure management. This comprehensive approach involves the use of a beta blocker, mineralocorticoid receptor antagonist, SGLT2 inhibitor, and RAS antagonist or ARNI. Notably, a similar combination therapy is available for patients with rheumatic heart disease, emphasizing the need for tailored treatment strategies for specific cardiac conditions.

    Rheumatic heart disease (RHD) holds significant relevance in developing countries like India, where its impact cannot be understated. The incidence of Acute Rheumatic Fever (ARF) is approximately 8-7 persons per 100,000 among 5 to 14-year-olds, further emphasizing the need for proactive management and early diagnosis. Additionally, the prevalence of RHD in India is estimated to be around 0.5 – 1 person per 1000, shedding light on the substantial burden of this condition within the population. Early diagnosis and effective management play a pivotal role in preventing the long-term complications associated with RHD, such as cerebrovascular accidents and valvular cardiomyopathy.

    In the context of established rheumatic valvular heart disease, medical therapy aims to alleviate symptoms and enhance overall quality of life. The pillars of medical therapy for RHD encompass various interventions, including beta blockers for rate control, diuretics to reduce preload and relieve congestion, oral anticoagulants for preventing cerebral thromboembolism, and penicillin therapy for the prevention of recurrent carditis.

    This comprehensive approach to medical management can be likened to the “four-pillar therapy” for established rheumatic heart disease, highlighting the multifaceted nature of treatment for this complex cardiac condition. By acknowledging the specific nuances of RHD and tailoring therapeutic strategies accordingly, healthcare professionals can strive to enhance patient outcomes and mitigate the long-term impact of this disease.

  • Why heart failure may be more malignant than malignancy itself

    The above graph shows the 5 year survival of heart failure patients compared to the most common types of cancer among Scottish patients in 1991. Its clear from the above diagram that the mortality of heart failure is clearly worse than that of the most common types of cancer. In the Framingham study it was found that only 25% of the men and 32% of the women survived more than 5 years from the diagnosis of heart failure. Hence this fact should be a somber reminder of the importance of early diagnosis and treatment initiation for all patients experiencing symptoms of heart failure. On a brighter note the mortality from heart failure has seen a decreasing trend recently with the advent of new device or medical therapies.

  • Increase steps as a way to decrease cardiac disease

    In this generation of fast paced life with multiple options available all at the click of a button the risk of cardiovascular disease is increasing at an alarming rate especially among the young individuals. In my clinic I am seeing more of 20 and 30 years olds with coronary artery disease and many of them do not even have any of the usual risk factors for cardiac disease but still end up with multiple blocks in heart.

    In a recent meta-analysis published by the European journal of preventive cardiology it was seen that the amount of steps that a person takes per day is inversely correlated with the risk of cardiovascular disorders. The authors concluded from 17 studies including almost 227000 patients that sedentary lifestyle directly accounted for higher risk of cardiovascular disease and even a 1000 step increment leads to 15% decrease in all cause mortality. For the first time the study confirmed the notion of ‘the more the better’ i.e. the more the number of steps a person takes the lower the risk of cardiovascular disease appears to be.

    This study emphasizes the inclusion of even a simple morning walk routine could be effective in adding years to your life. The American college of cardiology recommends atleast 150 minutes of moderate activity to keep heart disease at bay. This could be a good starting point for people looking to keep their hearts healthy.

  • Small habits that can change your life

    1. Show up daily irrespective of how you feel.

    2. Wake up early.

    3. Tackle high-value tasks before 12 pm.

    4. Eliminate seed oils and alcohol.

    5. Drink more water.

    6. Hit the gym atleast 3x every week.

    7. Stop watching the mainstream media.

    8. Create multiple pieces of content.

    9. Sacrifice all the sources of instant gratification.

    10. Question your beliefs.

    11. Practice intermittent fasting once a week.

    12. Spend more time in nature.

    13. Get sunlight every day.

    14. Walk 30 minutes a day.

    15. Read 30 minutes a day.

    16. Invest at least 30% of your income.

    17. Move out of your hometown.

    18. Get 7-8 hours of sleep.

    19. Develop a high-quality circle.

    20. Give back to society.

  • Advice from a 80 year old

    Recently I came across these fine points about life some of which may be applicable to improve all of our lives.

    Have a firm handshake.
    Look people in the eye.
    Sing in the shower.
    Own a great stereo system.
    If in a fight, hit hard and hit first.
    Keep secrets.
    Never give up on anybody.
    Always accept an outstretched hand.
    Be brave. Even if you’re not, pretend to be. No one can tell the difference.
    Whistle.
    Avoid sarcastic remarks.
    Choose your life’s significant other carefully. From this one decision will come 90 percent of all your happiness or misery.
    Make it a habit to do nice things for people who will never find out.
    Lend only those books that you never tend to send again.
    Never deprive someone of hope; it might be all they have.
    When playing games with children, let them win.
    Give people a second chance, but not a third.
    Be romantic.
    Become the most positive and enthusiastic person you know.
    Loosen up, Relax. Except for rare life-and-death matters, nothing is as important as it first seems.
    Don’t allow the phone to interrupt important moments. It’s there for our convenience, not the caller’s.
    Be a good loser.
    Be a good winner.
    Think twice before burdening a friend with a secret.
    When someone hugs you, let them be the first to let go.
    Be modest. A lot was accomplished before you were born.
    Keep it simple.
    Beware of the person who has nothing to lose.
    Don’t burn bridges. You’ll be surprised how many times you have to cross the same river.
    Live your life so that your obituary could read, No regrets.
    Be bold and courageous. When you look back on life, you’ll regret the things you didn’t do more than the ones you did.
    Never waste an opportunity to tell someone you love them.
    Remember no one makes it alone. Have a grateful heart and be quick to acknowledge those who helped you.
    Take charge of your attitude. Don’t let someone else choose it for you.
    Visit friends and relatives when they are in the hospital; even if it is just for a few minutes
    Begin each day with some of your favorite music.
    Once in awhile, take the scenic route.
    Send a lot of Valentine cards. Sign them, “Someone who thinks you’re terrific.”
    Answer the phone with enthusiasm and energy in your voice.
    Keep a notepad and pencil on your bed-side table. Million-dollar ideas sometimes strike at 3 a.m.
    Show respect for everyone who works for a living, regardless of how trivial their job.
    Send your loved ones flowers. Think of a reason later.
    Make someone’s day by paying the toll for the person in the car behind you.
    Become someone’s hero.
    Marry only for love.
    Count your blessings.
    Compliment the meal when you’re a guest in someone’s home.
    Wave at the children on a school bus.
    Remember that 80 percent of the success in any job is based on your ability to deal with people.
    Don’t expect life to be fair.