Obe­sity, lack of phys­i­cal ex­er­cise and an un­suit­able diet of­ten go hand in hand. All three are dis­crete risk fac­tors for heart dis­ease

The Gulf Today - Time Out - - TRAVEL - Dr Asheesh Me­hta In­ter­nal Medicine Spe­cial­ist

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.

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