WORLD HEART DAY
Obesity, lack of physical exercise and an unsuitable diet often go hand in hand. All three are discrete risk factors for heart disease
World Heart Day is observed on Sept. 29 each year. It is organised by the World Heart Federation since the year 2000. The aim is to create awareness about heart disease and stroke which are leading causes of death worldwide. The theme for this year is “My Heart, Your Heart’. According to the World Heart Federation, the theme is about saying to ourselves, the people we care about and individuals all around the world – what can I do right now to look after my heart… and your heart? The main call to action for this year’s campaign is for everyone to make a promise that will result in better heart health. The target population for the campaign is not only the individual who may, for example, pledge to give up smoking or to become more active but also healthcare personnel and health policy makers to try and make a greater difference in caring for the heart.
Cardiovascular disease (CVD) refers to diseases affecting the heart and blood vessels. They include coronary heart disease, cerebrovascular disease, rheumatic heart disease, congenital heart disease, peripheral vascular disease, etc. Heart attack and stroke account for more than 80% of deaths due to CVD. The statistics regarding CVD continue to be grim accounting for about 17.7 million deaths each year globally. This is about 31% of all deaths. The coronary arteries supply blood to the heart. When these arteries become narrowed, usually due to atherosclerosis, circulation to the heart is compromised and can present in a variety of ways. Sudden blockage of a coronary artery usually leads to an abrupt cessation of blood to part of the heart muscle and this is what constitutes a heart attack. The commonest cause of this occurring is a clot formation within the artery and is called coronary thrombosis. Death of heart muscle due to deficient blood supply is called myocardial infarction. These terms, myocardial infarction, coronary thrombosis and heart attack are thus used almost interchangeably. In other cases, the coronary arteries may be narrowed but circulation to the heart may still be adequate at rest. During exercise, however, increased metabolic demands of the heart need to be met with a corresponding increase in blood supply and the narrowed coronary arteries may not allow this. Such inadequacy in circulation to the heart causes chest pain brought on by exercise and relieved by rest and is called angina. Stroke occurs due to inadequate circulation to the brain and may be ischaemic or haemorrhagic. Ischaemic stroke is usually due to a clot formation in an artery supplying part of the brain while haemorrhagic stroke denotes bleeding into the brain and is usually due to rupture of an artery in the brain or due to a circulating clot lodging in an artery to the brain.
Less common types of CVD are also important causes of morbidity and mortality. Although making up a smaller percentage of cases of CVD, they are nonetheless important as the absolute number of cases continues to be quite large. Rheumatic heart disease is an immune disorder typically causing damage to heart valves. It arises a few weeks after an upper respiratory illness with Group A Streptococcus bacteria. With improvements in living standards and widespread utilization of antibiotics, rheumatic fever has become much less common, especially in developed countries. Congenital heart disease refers to heart problems present from birth and these unfortunately continue to occur in a percentage of births. Viral or other infective illnesses affecting the mother during pregnancy account for a small percentage of congenital heart cases in children born of these pregnancies but in the majority no specific cause can be identified. Peripheral vascular disease refers to narrowing of peripheral arteries, usually by atherosclerosis, in a manner similar to what happens to arteries supplying the heart and brain. The lower limbs are generally affected by impaired circulation in such cases as these arteries have to travel the longest distance. Heart failure refers to the inability of the heart to carry out pumping action to maintain adequate circulation. This can be due to ischaemic heart disease as well as to numerous other problems such as long-standing hypertension, rheumatic heart disease, congenital heart disease, cardiomyopathy, myocarditis, etc. Several other types of heart problems occur with a lesser frequency.
Even though the heart is subject to a vast variety of diseases, the focus of most awareness campaigns is on ischaemic heart disease and stroke because of their majority contribution to morbidity and mortality. A number of factors are known to increase risk for these diseases. Some such as genetic predisposition, racial predisposition, growing older and male sex are not modifiable. Many others are readily modifiable. Smoking or tobacco use in any form is a major risk factor. The addictive nature of nicotine and the image of it being not only socially acceptable but also fashionable (at least to some) has resulted in it still being a very widely practiced method of what can only be described as self-destruction. Health and regulatory authorities have tried to restrict use of nicotine products by prohibiting use in public places, making them expensive to use, launching major awareness campaigns regarding detriment to health, etc but have met with only limited success. World Health day is a timely opportunity to make a promise to discontinue smoking or use of other nicotine products, if one still indulges in this habit. High blood pressure or hypertension is another major modifiable risk factor and this is especially important in causing strokes. Hypertension is a very common problem and estimates of prevalence in the general adult population range between 30 to 40% or even higher. Many people are not aware that their blood pressure is elevated as symptoms are usually notable by their absence. This is the reason that it is known as a silent killer. Many people although aware of the problem neglect taking any medicine or are inadequately controlled in spite of treatment. Checking blood pressure is simple, painless and economical. Reduction of salt in diet, regular exercise and weight reduction may be all that is required to control blood pressure. If antihypertensive drugs are required to achieve control, they are generally very safe and very well tolerated. For people on a budget quite a few reasonably priced and quite good drugs are available. To check one’s blood pressure and take treatment regularly if required is another pledge worth taking.
Obesity, lack of physical exercise and an unsuitable diet often go hand in hand. All three are discrete risk factors for heart disease. Obesity is the modern pandemic and is a risk factor for a host of problems including heart disease, a number of cancers, hypertension, diabetes, sleep apnoea, musculoskeletal problems, etc. A sedentary lifestyle without physical exercise promotes not only obesity but also heart disease. It is highly recommended to exercise daily for at least 30 minutes to reduce the risk of heart disease. Even moderate activity such as a brisk walk is worthwhile. A diet with at least 5 servings of fresh fruits and vegetables is considered preventive against not only heart disease but also other lifestyle diseases. Trans fats are best avoided. These are the fats formed by hydrogenation of vegetable oils to make them solid and to increase their storage life. Various types of unsaturated fats found in heart friendly oils such as olive oil, corn oil, canola oil and sunflower oil are to be preferred. Nuts are generally beneficial for the heart but are notorious for promoting weight gain. Intake of red meats too is advised to be controlled. Fish is heart healthy while chicken (without the skin) is considered as heart neutral. Excessive alcohol intake also needs to be avoided.
Among other major risk factors for heart disease are diabetes and elevated serum lipid levels. The global prevalence of diabetes is increasing alarmingly and this is attributable partly to adoption of a sedentary lifestyle and rampant obesity. Even though the prevalence of diabetes in UAE has shown a drop in recent years, it is still an extremely common problem. Much of type 2 diabetes, the commoner type, can be prevented or deferred by attention to a healthier diet, moderate exercise and avoiding obesity. These are the very actions needed to reduce the risk for heart disease and hypertension also. Should diabetes develop, controlling it well with measures including diet control, exercise and drugs helps reduce development of heart disease. LDL cholesterol is the serum lipid which is the focus of attention with regards to risk for heart disease. Using statin drugs to maintain LDL cholesterol levels within desirable range reduces the risk.
Ideally, the promise one needs to make to oneself is to tackle all the major risk factors for heart disease. At the very least, one owes it to oneself and one’s family and friends to at least make a start with one risk factor.