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Coronary heart disease (CHD) is caused by poor oxygen supply to the heart muscle. This result from atherosclerosis (a thickening or hardening of walls of blood vessels) of coronary arteries, which supply the heart with blood. The manifestation of CHD can include episodic chest pain (Angina), acute myocardial infarction (heart attack), heart failure and sudden cardiac death. In some cases, there may not be any manifestations of symptoms (NIH, 2015). At the turn of the century, cardiovascular diseases (CVDS) become the leading cause of mortality in India. This epidemiological transition is largely because of the incurables in the prevalence of CVDS and CVD risk factors in India. In 2016, the estimated prevalence of CVDs in India was estimated to be 54.5 million. One is four deaths in India are now because of CVDs with ischemic heart disease and stroke responsible for >80% of this burden. Diet and healthy lifestyle are the best tool to have good cardiovascular health. This relation is so direct because the majority of cardiovascular diseases have their origin in atherosclerotic plague, hypertension and obesity. These three cardiovascular risk factors are directly related to dietary habits and lifestyle. It is widely demonstrated from the scientific point of view that dietary habits influence cardiovascular health. Cardiovascular disease (CVD) is also caused due to abnormal increase of cholesterol in blood and is major underlying cause of worldwide deaths, loading to 17.9 million death rates in 2016, representing 31 percent of total worldwide mortality (WHO 2017) Keeping in view the prevalence of heart diseases, role of diet and abnormal lipid levels, the present study was planned to see the causative risk factors, food habits and lipid profile of selected heart patients.

Cardiovascular disease (CVD) is a general term that describes a disease of the heart or blood vessels. Coronary heart disease (CHD) occurs when the flow of oxygen-rich blood to heart is blocked or reduced by a build-up of fatty material (atheroma) in the coronary arteries. Blood flow to the heart, brain or body can be reduced as the result of a blood clot (thrombosis), or by a build-up of fatty deposits inside an artery that cause the artery to harden and narrow (atherosclerosis).
CVDs are the number one cause of death globally more people die annually from CVDs than from any other cause. An estimated 17.5 million people died from CVDs in 2012, representing 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to coronary heart disease and 6.7 million were due to stroke. Over three quarters of CVD deaths take place in low-and middle-income countries. Out of the 16 million deaths under the age of 70 due to non communicable diseases, 82% are in low and middle income countries and 37% are caused by CVDs (WHO, 2015).
Over the past few decades, non-communicable diseases (NCDs) have emerged as the leading cause of death globally, killing more people each year than all other cause combined. As per the International Diabetes federation, the number of people with type 2 diabetes is increasing in every country. Morbidity and mortality due to diabetes occur as a result of lack of health care facilities for early screening, diagnoses of disease and initiation of therapy, as well as poor management of disease and its associated complication.
Wild et al (2004) the prevalence of diabetes is predicted to double globally from 171 million in 2000 to 366 million in 2030. It will be seen that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in India. china with 42.3 millon and The United State ( 30.3 million) will also see significant increases in those affected by the  disease.     (Whiting et al, 2011)
The literature related to the present study has been reviewed under the following heading.
2.1       Prevalence of Heart diseases.
2.2       Risk factors of Heart disease
2.3       Life style modifications for prevention and treatment of Heart disease

A list of heart patients coming to Tulip Hospital, Vivekanand Chowk Delhi Road Sonipat (Haryana) at OPD time was prepared. One hundred heart patients willing to cooperate in the study were selected for the present study. The general information regarding their age, marital status, education and income level etc. was obtained. Information regarding medical history i.e. age of onset of disease, causative factors, and food habits was also collected with the help of pre structured interview schedule. Theinformation about their blood and lipid profile was obtained from their medical record. The data was analyzed statistically using standard method.

The general information of heart patient is presented in Table 4.1. The data revealed that most of patients (48%) belonged to age group of 51-60 years whereas 26 percent were above 60 years of age and 22 percent of patient were in the age group of 41-50 years.

Majority of patients i.e. 82 percent were male and 18 percent were female. Most of the patient (47%) were graduate followed by 35 percent who were postgraduate and only 18 percent were educated upto matric. As regards to marital status, 79 percent were married while 14 percent were widow and 7 percent were divorced.  Majority of patients (62%) belonged to nuclear families while 38 percent belonged to joint families. Most of patients (52%) were having small family size followed by 41 percent patients who were having medium size families. Only 7 percent of patient belonged to large families. Most of patient i.e. 47 percent were in service while 37 percent were involved in business. The monthly income of majority of patients was between Rs 50000-1 lac while 21 percent were having more than 1 lac of monthly income.
                Similarly, for cardiovascular disease, American Heart Association (2005) strongly avowed the gender disparities. In heart disease and stroke statistics, the association affirmed that men manifest cardio vascular disease 10 years earlier than women do. Srilakshmi (2003) also reported that coronary artery disease is twice higher in men as compared to women. Middle-aged men in particular have a high prevalence of the major risk factors. They are more predisposed to abdominal obesity and metabolic syndrome. Framingham heart study made an important remark that the lifetime risk of developing cardiovascular disease after the age of 40 is 49 percent and 32 in men and women, respectively.
Regarding the large number (62%) from nuclear families in the present study indicated that numerous factors are accountable for this shifting from joint to nuclear, which mainly include economic burden, diminishing living space, transition for employment and speedy urbanization. It also seems to be a result of growing affluence (Lodhiet al 2021). There is also connection of family structure on children's eating habits and their health status. Children belonging to single parent family were highly indulged in detrimental eating habits like irregular consumption of breakfast, vegetables and intake of alcohol in comparison to children living with both parents (Back et al 2014).
1. General information of Selected Heart Patient 
(n=100)

Characteristics	Frequency	Percentage
Age
30-40	04	04
41-50	22	22
51-60	48	48
Above 60	26	26
Sex
Male	82	72
Female	18	28
Education level
Matric	18	18
Graduation	47	47
Post graduation	35	35
Marital status
Married	79	79
Widow	14	14
Divorced	07	07
Type of family
Nuclear	62	62
Joint	38	38
Size of family
Small (up to  4 member)	52	52
Medium ( 5-8)	41	41
Large ( 9 member)	7	7
Occupation
Business	37	37
Service	47	47
Houswife	16	16
Monthly income
<50000	17	17
50000-1 lac	62	62
>1 lac	21	21

2 Medical history of heart patients.
2.1. Frequency of age of onset of disease
Data regarding the age of onset of disease is presented in Table 2. Onset of diseases was maximum in 56-60 years while 21 percent were in the age group of 51-55 years followed by 14 percent of patient in the age of 46-50 years. Very few of the patients suffered from disease in younger age group.
Table 2 Frequency of age of onset of disease in selected heart patient    (n=100)

Age of onset (years)	Frequency	Percentage
31-35	05	05
36-40	04	04
41-45	04	04
46-50	14	14
51-55	21	21
56-60	52	52
Above 60 years	00	00

2.2 Family history of disease
It was seen that majority of the patient had family history of one or more diseases that were directly associated to cardiovascular disease (Table 3). Family history of diabetes mellitus was most common (61%) followed by heart diseases (50%) and incidence of obesity and hypertension was 44 percent and 43 percent, respectively.
Table 3 Family history of disease of selected heart patient (n=100)

Family history	Frequency	Percentage
Hypertension	43	43
Heart disease	50	50
Diabetes	61	61
Obesity	44	44

Multiple responses
2.3. Symptoms
Various symptoms observed in heart patient is presented in Table 4. Majority of patient (73%) observed pain in chest. Breathlessness on walking or slight extortion was felt by 34 percent. While 28 percent, felt weakness. Almost 1/4th of patients i.e. 24 percent felt the feelings of nausea / vomiting and 18 percent observed the feeling of acidity/ uneasiness. Almost similar percentage of 14 each having problem of sweating or acidity.
Table 4 Presence of symptoms in heart patient   (n=100)

Symptoms *	Frequency	Percentage
Pain in chest	73	73
Acidity/uneasiness	18	18
Breathlessness	34	34
Sweating	14	14
Nausea/ vomiting	24	24
Weakness	28	28
Headache	14	14

*Multiple responses
2.4. Causative risk factors:
Sedentary lifestyle was observed as major culprit for the incidence of majority of disease prevalent in the patients in the present study (Table 5). Obesity in-patient (70%) was another major causative risk factor followed by hereditary factors (61%). The main cause of obesity in-patient was mainly due to sedentary life style, faulty diet and hereditary factors. Almost 49 percent of patients accepted the existence of stress as a reason for their disease while 45 percent patient observed faulty diet as the culprit. The primary reason for stress was being under lots of pressure, facing new challenges in job and home adjustments.

Table 5 Causative risk factors of the disease prevalent in heart patient (n=100)

Risk factors *	No of subject	Percentage
Sedentary lifestyle	82	82
Obesity	70	70
Hereditary factors	61	61
Stress factors	49	49
Faulty diet	45	45
Age factor	24	24

*Multiple responses
A positive family of cardiovascular disease is also a risk factor in its early onset, even after adjusting for other known risk factors. Studies suggest that risk in men with a family history of coronary heart disease in about 1.5 to 2 times greater than in men without such a history. Similar findings were reported in women. A study on 304 diabetic and 328 cardiac patient reported that 90.9 and 88.6 percent of the study population had a family history with either one parent or both being diabetic or cardiac disease respectively (Haweet al. 2003).
3 The Dietary pattern
The assessments of dietary pattern of selected heart patients (Table 6) revealed that most of the patients (48%) were vegetarian followed by 27 percent who were non-vegetarian and 25 percent were consuming eggs and their products in their diet. Regarding meal pattern, 53 percent took three meal while four meals were taken by 25 percent of patients followed by 15 percent patients who took more than four meals. Only 7 percent took two meals per day. It was observed that 20 percent patients skipped meal where skipping of breakfast was most common followed by lunch. The data revealed that 59 percent of patients consumed diet same as of their family while 41 percent consumed diet prescribed by professionals. Regarding intake of fast foods, it was observed that 74 percent were taking fast foods while 26 percent did not consume. It was further observed that 56.75 percent consume weekly while 24 percent, 16, 2.71 percent consumed on fortnightly, on special occasion and monthly bases, respectively.

Table 6 Dietary pattern of selected heart patients(n=100)

Parameters	No of patients	Percentage
Food habits
Vegetarian	48	48
Non Vegetarian	27	27
Vegetarian	25	25
Meal pattern (meals/day)
2	7	7
3	53	53
4	25	25
More than 4	15	15
Meal skipped
Yes	20	20
No	80	80
Name of meal skipped
Breakfast	12	12
Lunch	8	8
Dinner	00	00
Type of diet
Prescribed diet	41	41
Same as family	59	59
Intake of fast food
Yes	74	74
No	26	26
Frequency of fast food consumption
Weekly	42	56.75
Fortnightly	18	24.32
Monthly	2	2.71
On special occasion	12	16.22

3.1 Type of oil used
The information regarding type of cooking oils and fats used by patients is presented in Table 7. Most of the patients (39%) were using a combination of refined, mustard and desi ghee in different preparations while 27 percent of patients used refined, desi ghee and olive oil in their diet for cooking of vegetables or dahls, paratha and salads etc.
Table 7 Type and amount of visible fat consumed by heart patient

Visible fat	Frequency	Percentage
Type of visible fat
Refined + desi ghee	24	24
Refined+ mustard +desi ghee	39	39
Refined + olive oil	27	27
Desi ghee + mustard	4	4
Desi ghee +olive oil	6	6
Amount of visible fat
15-20g/day	24	24
More than 20g/day	76	76

3.2 Lipid profile of patients
Lipid profile of patients is presented in Table 8. Data indicated that mean triglyceride level was 206.42mg percent which was significantly higher than reference value. This triglyceride value was 137% of reference value. Triglyceride value of all patients ranged from 105-590mg percent. The mean of total cholesterol was 169.35mg, which was significantly lower than reference value and mean value of total cholesterol, was 84.5 percent of reference value. Total cholesterol value of all patients ranged from 118-370mg percent. Mean value of HDL cholesterol of heart patients ranged from 34-124.8mg percent.
Mean value of HDL cholesterol was 64.61 mg percent, which was 106 percent, and non-significantly higher than reference value... Mean observed value of VLDL cholesterol was 41.83mg percent, which was 136 percent of reference value. Mean values of VLDL cholesterol ranged from 18-65.9mg percent in heart patients.
Mean value of LDL cholesterol was 142.32mg percent, which was significantly higher than reference value, and was 142 percent of reference value. Mean LDL cholesterol value ranged from 90 to 165.8 in all heart patients.
As recommended by National Cholesterol Education Program, cardiovascular disease treatment needs to focus on reduction of LDL cholesterol levels (Bester et al 2010) diet namely high in water soluble fiber guards against heart diseases (Sahni and Shree 2018).
The optimal serum LDL cholesterol level suggested by NCEP (2001) was suggested to be <100 mg/dl. According to academy of Nutrition and Dietetics, there should be an increased intake of legumes, fruits and vegetables, nuts etc. as dietary fiber present in them is related with decreases of hyperglycemia, hyperlipidemia and pathogenic disease (Dahl and Stewart 2015).
Penetration of very low-density lip-protein in blood vessels can lead to atherosclerosis through its accumulation there (Tata et al 2018).
Table 8 Lipid profile of heart patients    (n=100)

Parameters	Range	Reference value	Mean +SD	% reference	Z value
Triglyceride mg	105-590	<150	206.42+104.01	137	5.42*
Total Cholesterol	118-370	<200	169.35+96.39	84.5	-3.19*
HDL Cholesterol mg	34-124.8	40-60	64.61+58.44	106	NS
VLDL Cholesterol mg	18-65.9	2-30	41.83+ 22.45	136	5.37*
LDL Cholesterol	90-165.8	<100	142.32+78.61	142	0.54
TC/HDL Ratio	3.1-7.07	<4.45	4.41+1.30	99.10	NS
LDL/HDL Ratio	1.4-3.97	<3.55	2.84+1.15	80	-7.1*

3.3 Blood profile of patients
          Mean systolic blood pressure of heart patients is presented in Table 9. Mean Systolic blood pressure was 152.50 ± 10.29 mgHg and 117.3 percent reference value. This was significantly (P≤ 0001) higher than reference value.
          Mean Diastolic pressure was 90.21±7.69 mmHg which was 112.76 percent of reference value and this was significantly ( P≤ 0001) higher than reference value. Mean fasting blood glucose level was 128.13±9.03 mg/dl, which was 116.48 percent of reference value. The mean fasting blood glucose value was significantly higher than reference value. Elevated fasting blood sugar level is a predictor for diabetes but it also predicts increased risk of heart disease and mortality from all cause
Table 9 Blood profile of heart patients   ( n=100)

Parameters	Reference value	Mean ± SD	% of Reference	Z value
Systolic Blood Pressure (mmHg)	< 130	152.50 ± 10.29	117.30	21.86*
Diastolic Blood pressure ( mmHg)	< 80	90.21±7.69	112.76	13.43*
Fasting Blood Glucose ( mg / dl)	<110	128.13±9.03	116.48	19.49*

 
 
 
 
 
 
 

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