Heart attack: Who is at risk?

Dr. Turin Chowdhury

Heart is the main blood pumping organ of our body. Heart pumps and initiates circulation of blood through the blood vessels all over the body. This blood carries the needed oxygen and nutrients to our body cells for their functioning. To function properly our heart muscles also needs blood to be supplied to them properly. If blood flow to the heart gets obstructed due to any reason, heart cells are deprived of oxygen and nutrients. As a result they start dying quickly. The dying heart cells causes loss of heart function. This creates a medical emergency which is commonly known as heart attack. A heart attack is an injury to the heart muscle caused by a loss of blood supply. Interrupted blood flow to the heart can damage or destroy a part of the heart muscle. Heart attack in known as "Myocardial Infarction" or MI.
   
   Risk factors and triggers
   The risks related to heart attack should be considered in a couple of perspective.
   1. Coronary risk factors
   2. Triggering factor
   We can think of forest fire to understand the inter relation among the different types of heart attack risk factors. Some factors sets up the stage of a forest fire or bush fire to take place. Such a presence of very dry weather, suitable dryness of the forest or bushes to catch and spread fire, very little or no rain during that time, absence of surface water in that area, etc. Presence of these things does not cause the forest fire or bush fire by themselves, but they prepare the stage for the occurrence.
   Presence of these factors increases the chance of a forest or bush fire in comparison to the absence of these factors. Now in these given circumstances any uncontrolled camp fires, sudden shoot-up of the environmental temperature, human mistakes with combustion related activities in that place will initiate the forest fire or bush fire. These things will act as the triggering factor for the event. This situation can be compared with the coronary risk factors. The presence of coronary risk factor sets up the stage for the heart attack to happen. And the triggering factors will initiate the acute onset of a heart attack.
   
   Coronary risk factors
   These are the factors which contribute to increased risk of having a heart attack. These factors contribute to the unwanted buildup of deposits (atherosclerosis) that narrows arteries throughout your body, including arteries to your heart. Coronary risk factors are categorized by two characteristic:
   1. Uncontrollable risk factor
   2. Modifiable risk factor.
   Uncontrollable coronary risk factor: These are the coronary risk factors which increase possibility of having a heart attack but are inevitable. They are part of our life process, such as;
   Increasing age: The risk of heart attack increases as we grow older. This is especially true for women. Old age heart attack results in more fatal outcome.
   Gender: Men have a greater risk of heart attack than women. Men have a higher risk of heart attacks during the earlier ages in life in comparison to women.
   Family history of heart attack: Offspring of parents with heart disease are more likely to develop it themselves. Most people with a strong family history of heart disease have one or more other risk factors present among them. In addition, families may contribute to heart disease by practising or upholding poor health habits, such as smoking or eating high-fat diets.
   Modifiable coronary risk factor:
   These certain factors increase the risk of a heart attack but they can be controlled. As a result the chance of developing heart attack can be reduced to significant extent. One can modify or eliminate many of these risk factors to reduce the danger of having a heart attack. Modifiable coronary risk factors include:
   Tobacco smoking: Smoking and long-term exposure to secondhand smoke damage the interior walls of arteries, including arteries to the heart. This allows deposits of cholesterol to occur and ultimately hamper blood flow. This is called arthrosclerosis which increases the chance of heart attack. Smoking also enhances the risk of lethal blood clots forming which may lead to causing a heart attack.
   High blood pressure: Sustained long-term high blood pressure can damage arteries, including the ones that supply to the heart, by causing injury to the interior walls of the arteries accelerating atherosclerosis condition. Arthrosclerosis increases the risk of heart attack.
   High blood LDL-cholesterol or triglyceride levels: Increased level of blood LDL-cholesterol has been associated with the build-up of plaques that can narrow or even block blood vessels, including those that supply the heart. A high LDL-cholesterol level is undesirable and is often a byproduct of a diet high in saturated fats and cholesterol. A high level of triglycerides, a type of blood fat related to our diet, also contributes to atherosclerosis thus increasing risk of heart attack..
   Sedentary physical activity: A physically inactive lifestyle contributes to bad cardiovascular fitness. Inactive lifestyle worsens the risk factors like high blood cholesterol levels and obesity. On the contrary, people who get regular moderate amount of physical exercise have better cardiovascular fitness. This decreases overall risk of heart attack not only in people with other heart risk factor but also for people apparently relatively free from heart risk.
   Overweight and obesity: Obesity is the condition of having a high proportion of body fat. Being overweight or obese is one of the most common risk factors for heart attack. Obesity raises the risk of heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. The part of the body where one carries body fat is as important as how much extra weight one has. Someone who carries too much fat around the middle of the body, rather than the extremities, is more likely to have heart health problems.
   Diabetes problem: Diabetes is caused by too little insulin, resistance to insulin, or both in our response to blood glucose. Insulin, a hormone secreted by the pancreas, allows the body to use glucose, which is a form of sugar from foods. In diabetes body cells are deprived of the very essential glucose, even if plenty of glucose is available in the blood. Diabetes greatly increases the risk of a heart attack by speeding up atherosclerosis and negatively affecting blood cholesterol levels.
   Alcohol: Excessive drinking contributes to the worsening risk profile of heart attack. Drinking leads to the raise in blood pressure and triglyceride levels, thus increasing the risk of heart attack.
   Triggering factor: These factors act as supplementary cause of the existing risk factors. In general heart attack episodes have higher chance of being triggered in a person having coronary risk factors already existing in him or her. The factor which influences this initiation of the heart attack event is considered as triggering factor.
   The mechanism of the triggers is not that clearly understood yet. The possible triggers for hear attack are:
   Stress: Sudden overwhelming stress can trigger a heart attack. Individual response to stress may be a contributing factor. Scientists have noted a relationship between heart disease risk and stress in a person's life, their health behaviours and socioeconomic status. These factors may affect the established risk factors. For example, people under stress may overeat, start smoking or smoke more than their usual habit.
   Emotional outburst: Too much emotional outburst such as anger can act as a trigger to heart attack. These emotional eruptions contribute to the sudden raise in blood pressure which may kick off heart attack.
   Caffeine: Research suggests coffee can trigger a heart attack within an hour in some people. It is already known that caffeine causes transient increases in blood pressure. But the relation of caffeine and heart attack has not been yet established fully.
   Binge drinking: Too much drinking may act as a trigger of heart attack in the background of deteriorating heart risk profile. This may act as leading to the abrupt raise in blood pressure, thus increasing the immediate risk of heart attack.
   Heavy meals: People at risk for heart attack should be careful about the size of individual meals. Normally it is advised to people that they should keep check on the total caloric intake they eat every day, but apart from that uncontrolled heavy meal can trigger the heart attack event.
   Infections: Infections can trigger heart attacks among the people who are already at risk. Getting the flu could increase ones risk of having a heart attack. In a study it has been observed that heart attack risk rose sharply among research subjects during the first few days following the diagnosis of influenza, pneumonia, bronchitis, and other respiratory tract infections.
   Pollution: Air pollutants specially the tiny ones have been linked to heart attacks. Smoke from diesel vehicles is a major source of fine particle air pollution in urban areas. Researches have shown that long term exposure to air particulates can initiate a chain of events that trigger a heart attack in individuals with cardiovascular disease or cardiovascular risk factors.
   Risk evaluations by risk factor screening and risk estimation: Knowing our risk factors, uncontrollable or modifiable both, will equip us with the necessary knowledge in regards to living healthfully against the risk of hear attack. This will be helpful not only in the fight against the heart attack but also the fight against other chronic illness like stroke, diabetes, hypertension, abnormal lipid condition, etc. All people, especially with presence with any of the risk factors, should undergo risk factor screening that includes recording blood pressure, body mass index, waist circumference, cholesterol and glucose testing regularly. And doctors will estimate each person's percentage risk of developing cardiovascular disease based on the risk factor screening. In addition to that the risk factor modification strategy and processes to avoid the triggers should be sought out by the patient and the consulting physician.

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Bush at Yale

Rayyan Kamal

Yale College has produced a total of three U.S. presidents: William Taft, George Bush Sr., and George Bush Jr. If you include Yale Law School, that figure jumps up to five with the addition of Gerald Ford and Bill Clinton. If we add presidential candidates to this amount, the number increases to at least six with John Kerry. Wondering if it was at all possible that Dubya got into Yale solely based on merit, I decided to do some research. My findings merely corroborated the belief held by most - that Bush was admitted because his father was an alumnus, and a powerful one at that.
   President Bush walked away from the SAT's with mediocre scores: 566 verbal and 640 math (out of a possible 800 on each). His SAT scores were used against him when he expressed discontent with the way in which University of Michigan (UM) used affirmative action to give a boost to applicants from minority groups. UM ranks applicants using a scoring system. Based on their achievements, students get "points" out of a maximum of 150. What bothers President Bush is that students of African-American, Hispanic, and Native American receive an extra 20 points merely by virtue of their race. Supporters of the system were quick to point out that when Bush was applying to college, he, himself, benefited from affirmative action, albeit a different sort - he received extra points simply because his father was an alumnus.
   It is not surprising that Bush's cumulative numerical grade average after three years at Yale was a 77. Although I would never say that a future president's lack of academic achievement in college heralds a bad presidency - I don't think the two are necessarily related - this statement sadly seems to hold true in the case of Mr. Bush.
   Bush Sr. is a different story. In high school, he was not only a good student, but was also highly involved in extracurricular activities. He was president of the senior class, secretary of the student council, president of the community fund-raising group the Society of Inquiry, a member of the editorial board of the school newspaper, the Phillipian, and captain of both the varsity baseball and soccer teams. It is rumored that he was part of an elite fraternity, A.U.V., or "Auctoritas, Unitas, Veritas" (Latin for "Authority, Unity, Truth"). His membership at A.U.V. was a precursor to his being "tapped" as a junior at Yale into the (in)famous Skull and Bones, arguably America's most elite and controversial secret society. It is unclear whether Bush Sr. was tapped by Skull and Bones based on his own merit or whether it was because his father, Prescott Bush, had also been a member while at Yale.
   However, when considering Bush Jr.'s induction into Skull and Bones, it is clear that the reason he got tapped was the same reason he got into Yale, and most probably the same reason he is now president of America: he has an extraordinary man for a father.
   Rayyan Kamal is a sophomore at Yale University.

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Geographical Misplacement out of Ignorance

Saad Quasem

I have long been enraged at the Americans, for their ignorance of the existence of the world outside the fifty states that are united. Apparently a survey said 70% of American high schoolers could not locate the Atlantic Ocean on a blank map. We as foreigners are enthralled at such statistics and it is a daily routine to be questioned about our origins. Americans are least ignored about the rest of the planet. They are very satisfied with their lives in the US and that gives them justifications to remain ignorant.
   However, certain instances always circle around and bring back laughter. When I was a student at the University of the Arts, I had to introduce myself to a certain advisor. I started of my name, my field of interest and study and then I said I am originally from Bangladesh. Although the University lacked a sustainable number of international students and most people were amazed to hear off international representation, the advisor seemed rather calm and not surprised at all. After five minutes of speaking to him, he asked me "Bangladesh, isn't upstate is it?" Did, I respect him after he told me about his confusion of world geography? I don't remember even if I was a little upset at his performance, he is quite knowledgeable in his own realm. Now, I have decided to forgive the ignorance as most of the country is like this.
   Very recently, there was a multicultural seminar being held to raise awareness on women's rights. Women from all walks of life joined hands and since I am such an activist as well, I was asked to speak at one of the workshops. The introductory session introduced the participants to make themselves familiar with the Bangladeshi, Australian, British, Kenyan and Vietnamese speakers. One of my colleagues and I were standing adjacent to each other as the work shop rooms labeled "Australia" and "Bangladesh" were neighboring. We stood there, chit chatting and waiting for the participants to enter. One lady notices us speaking and comments "Benladesh and Australia, together. Indeed a very nice blend." There is really no retort, basically. I mistake her pronunciation as an accentual trend. Then she continues "My husband and I are planning to go to Benladesh, the next time I visit him. He lives quite nearby." I ask "really, where nearby?" I thought she would mention India, Nepal, Thailand or Burma or some other Asian country, instead she says "Bucks County, Pennsylvania." I look at my Australian colleague in awe and wonder and utter "madam, Bangladesh is in Asia about thousands of miles away from Pennsylvania. It's a country, by itself." I asked if she was mistaking with Ben Salem, Pennsylvania and she replies, most probably. She does though apologise.
   Then we involve ourselves in small talk again. My colleague describes her hometown in the coral beaches of Australia. The lady remarks that she has heard so much about Australia that she wants to visit the country. However, she is reluctant to visit a "non-English" speaking country. My colleague and I exchange looks and laugh and faithfully reply "Australia is the only non-western country to speak English."
   After the seminar was over, all the speakers rounded up together. We exchanged our stories. The speaker from Vietnam added that a young gentleman commented: "I thought Vietnam was a war, not a country." With such comments, we decided to accept the ignorance and start to "ask not what one can do for your country, ask what you can do for your country." I could generally educate the ignorant.
   Saad Quasem lives in Philadelphia, USA.

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Barrister Harun ur Rashid

The Communist Party of India-Marxist (CPI-M) has held the political power in West Bengal since 1977. This is unprecedented in West Bengal's volatile political scene. It has been a party for the welfare of people.
   This is the party that railed and ranted against capitalists, often branding them as "class enemies". It is an irony that today the same party has been charged with advancing the interests of those it regarded as "anti-people."
   My recent visit to Calcutta after almost 26 years (I was Deputy High Commissioner for Bangladesh in late 70s) left me in no doubt that there is an undercurrent tension between the former Chief Minister Jyoti Basu and the current Chief Minister Buddhadeb Bhattacharaya. Even a proxy war is going on between them in the coming election of the Cricket Board and this news has dominated in the media.
   As a result, the party is not united as before. It is a pity the continuing simmering tension between the two leaders has undermined its dominant role in West Bengal. Ordinary people perceive that policies of government are not anymore people- oriented.
   Ever since the Marxists decided that the route to prosperity in the state rests on industrialisation and agricultural reform only cannot alleviate poverty, they are wooing industrialists to invest in West Bengal. Tata's presence (small car project) is very much felt in the state.
   The recent furore has occurred when the government allocated 10,000 acres for a multi-product industrial zone in Nandigram for an Indonesian company. Its own people are angry with the CPI (M) leaders. There is a perception that the government is steamrolling opposition and is determined to take over the land through force.
   Ever since this plan of acquiring land for the industrial group, the government has been in deep trouble. The opposition has been egged on by a rainbow of coalition of opposition forces-the Congress, the Trinamool Congress, the Jamaat Ulema-e-Hind and the Naxalites, among others.
   It was the Naxalites, the Jamaat and others who silently organised the farmers and turned them against CPI(M). It has been reported that the Jamaat has given a communal dimension of the issue spreading the rumour that the government plans to acquire burial grounds, madrassas and mosques.
   Furthermore the government-owned Haldia Development Authority-announced initially the price for an acre was Rs. 8 lac but later it was notified it would be Rs. 4.3 lac. This change of price confused everyone and especially to those who would sell their lands. Furthermore confusion got more complex when HDA announced that it would acquire the entire Nandigram bloc, rather than a part of it. This has been a complete reversal of policy for affected people. The change of policies has caused damage to the government.
   Eventually there erupted violence between police and villagers. When police lathicharged them, they retaliated by hitting back. Subsequently, hundreds of CPI (M) supporters were driven out of the locality and two of them were killed after their houses were torched.
   Finally the chief Minister Bhattacharaya admitted the mistake of the government to calm tempers. He reportedly said that HDA had committed a blunder and conceded that no land would be acquired until all details were worked out and everyone including the land losers would be taken into confidence.
   His government has been placed into an awkward situation because the backbone of the CPI (M) party consists of small and marginal farmers. They have been alienated by this policy of land grabbing for industrialisation.
   Political analysts believe that the political mistake the CPI(M) government has made will not go away easily. Mistrust has been sown between the party and farmers. It is not known how long it will take to repair their relations. Meanwhile the test lies for the government to convince the landowners to give up their land voluntarily.
   CPI(M) has been put in a dilemma. They know to alleviate poverty they desperately need industrialisation and at the same they cannot afford to lose support of farmers in acquiring lands for industries. This is catch 22 situation and even the Marxists have to devise means and methods to balance these two opposing interests. German unifier Bismarck (1815-1898) once said: "Politics is the art of possible". The acid test now lies whether CPI (M) can make both parties satisfied given the present situation in Nandigram.
   Former Bangladesh Ambassador to the UN, Geneva

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Bangladesh needs a free media

Ripan Kumar Biswas in New York

In 399 BC an Athenian jury convicted Socrates, then age 70, on two counts: rejecting the gods of the city and corrupting the young. Both of these charges involved solely things he said, not any physical actions.
   Socrates mocked the Greek gods as silly and immoral. He taught that a good life, as a human, must be based not on imaginary gods but instead on inner virtues such as true knowledge, honesty, justice, and personal integrity. The real crux of the charge, however, was not his bad-mouthing the gods (many writers for decades had laughed at the Greek gods) but rather his endless attacks against the entire democratic culture as symbolized by the city gods of Athens.
   Socrates speaks to jury at his trial: 'If you offered to let me off this time on condition I am not any longer to speak my mind... I should say to you, "Men of Athens, I shall obey the Gods rather than you."' In history's first democracy renowned for freedom of speech, Socrates was convicted and executed for exercising it.
   Obviously, people of Bangladesh or the press didn't do or say anything like Socrates but both of them will have to be apart from each other.
   Everybody shocked and thundered once again to hear the order from the Bangladeshi authority that media will have been followed strictly by the emergency rules and restrictions. Although, the Information Adviser of the present interim government and the chairman of editorial board of Ittefaq news media Mainul Hosein mentioned that they did not introduce any rule or order curbing press freedom, the constitution according to emergency rules states that the freedom of newspapers and the media can be suspended.
   Whereas, the editor of the Daily Prothom Alo newspaper in Bangladesh, has given an example of Pakistan where the state is now running with 100 percent military rule and 100 percent freedom of press simultaneously.
   Like many times before, last couple of month's in Bangladesh, media is the only one reliable friend of democracy in which people can really rely on. Media saved the country and democracy from bureaucracy and politicians, strikes and sufferings, conspiracy and corruptions, faith and unfaith.
   Once again, due to the media vigilance everyone came to know about the brutality of Police at Bogra Police Station, Bangladesh on January 27, 2007. According to the report, even police head quarter of Bangladesh also agreed that the method used to interrogate the detainee was totally against the law.
   However, media in Bangladesh never forget to uphold the news about something courageous. Women from each corner of Bangladesh will be encouraged to be a cricketer after knowing the recent news about women cricketing at Dhaka.
   Everyone from any corner of the world must agree that the new interim government in Bangladesh is the fruit of professionalism of the media in Bangladesh.
   Then what's wrong with the media!!
   The state of emergency raised concern in a country with a history of military rule. Two presidents had been slain and 19 other coup attempts failed in Bangladesh since it gained independence from Pakistan in 1971. According to the article 35(b), Part-III of the constitution of Bangladesh, freedom of the press is guaranteed. Freedom of press in any country is not only a right to be guaranteed but also a way to march for a civilized society.
   Democracy fails under a variety of conditions and one of the major conditions occurs when people don't have the ability to get the kind of information they need to make up their mind.
   It may be mentioned that one of the major achievements of democracy in Bangladesh is its press. It was the press which figured out the Islamic militants in Bangladesh. Although journalists are targeted by Islamist and Maoist groups, as well as officials and politicians, Bangladesh feels proud of its media.
   Although the whole nation is plunged into an abyss of concern, instability, and uncertainty, the state of emergency shouldn't suspend the fundamental rights of citizens. As the interim chief of the people's republic of Bangladesh Dr. Fakhruddin Ahmed emphasized the country's democracy and fundamental rights in his latest address to the nation, freedom of speech should be protected as prerequisite of democracy.
   Ripan Kumar Biswas is a freelance writer based in New York.

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