BEWARE OF SILENT KILLER DEADLIER THAN COVID

The virus has claimed 4.6m lives in 20 months, but cardiovascular disease kills an average of 17.9m annually. Worse, CVD is a risk factor for Covid and cholesterol levels are high in UAE

Cardiovascular disease (CVD) is a key risk factor for Covid-19. But by itself, CVD is far deadlier — with nearly 400% more deaths each year, compared to Covid.

For context, the deadly pandemic has so far claimed 4.55 million lives in nearly 20 months (from January 2020 to September 13, 2021), according to a Johns Hopkins University figures.

Fact: CVD kills an average of 17.9 million per year (3.93 times more than Covid), making it the leading cause of deaths globally, according to WHO data.

Amid reports cholesterol levels are dangerously high among UAE patients, three cardiologists weigh in:

What is the main cause of cardiovascular disease?

There are many causes, instead of just one. Dr Anil Prahalada Rao Kumar, consultant cardiologist, Aster Jubilee Medical Centre in Bur Dubai, describes CVD as a “range of disorders” that affect the heart and blood vessels.

Major causes include:

■ Hypertension

■ Stroke

■ Atherosclerosis

■ Peripheral artery disease

■ Vein diseases

What are the biggest contributor to CVD?

Dr Srinivasan Kandasamy, Cardiologist at Zulekha Hospital, point to “fatty plaques” (or atherosclerosis) as the key driver behind CVD. Doctors point to the usual suspects behind cardiovascular disease:

■ Unhealthy lifestyle

■ Unhealthy diet

■ Lack of exercise

■ Obesity

■ High cholesterol, high blood pressure

■ Excessive alcohol consumption

■ Smoking

■ Stress

“Unhealthy lifestyle ranges from smoking, unhealthy diet, intake of salt-rich food or excess-calorie food, leading to obesity. These are the biggest contributors to increased fatality due to cardiovascular diseases,” said Dr. Kandasamy.

What CVD risk factors are beyond control?

Two factors — age and heredity — are out of your control.

From what age does heart diseases typically start?

The risk of heart disease increases around the age 45 in men and 55 in women.

Does heredity play a part in risk factors for CVD?

Yes. Your risk may be greater if you have close family members who have a history of heart disease.

How does CVD start?

Current scientific evidence shows that chronic inflammation is a starting point of CVD, said Dr Kumar. Chronic inflammation plays a key role in the “pathogenesis” (disease development) of CVD and coronary artery disease. This chronic inflammation, also known as “atherosclerosis”, is a major contributor to CVD incidence and deaths.

What does ‘atherosclerosis’ lead to?

Inflammatory processes involve the sub-endothelial area of the arterial wall, accumulating fat and fat-laden macrophages, among other cell types, said Dr Kumar. Inflammation is only a response, said Dr. Kumar. “What promotes inflammation is the disruption of the endothelial function. Inflammation also leads to thrombus formation, and multiple pathological consequences such as calcification, stenosis, rupture, or haemorrhage.”

In its advanced form, atherosclerosis is a major risk factor for coronary heart disease, stroke, peripheral artery disease, heart failure — or sudden death.

Is there something we can do about stress?

There’s good stress and bad stress. “Stress is a part of life for just about everyone,” said Dr Kumar. “Sometimes it is not easy to recognise stress because we are caught up in the flow of life.”

Is diet high in fat/meat increase CVD risk factor?

“Eating foods rich in trans fats increases the amount of harmful LDL cholesterol in the bloodstream,” Dr Kumar said.

Dr Brajesh Mittal, Consultant Cardiologist, Medcare Hospital Al Safa, said: “A diet rich in fatty food and meats definitely increases the risk of CVD. These (types of the food) lead to higher blood levels of bad cholesterol deposited in the arteries — causing blockages.”

Trans fat can be found in:

■ Baked goods, such as cakes, cookies and pies.

■Shortening.

■ Microwave popcorn.

■ Frozen pizza.

■ Refrigerated dough, such as biscuits and rolls.

Fried foods, including French fries, doughnuts and fried chicken. Non-dairy coffee creamer. Stick margarine.

What’s the problem with red meat?

“There is some evidence that red meat alters the gut microbiome, leading to higher levels of certain metabolites and proinflammatory cytokines in the blood, which have in turn been linked to greater risk of heart disease,” he added.

Dr Kandasamy said studies show that “high-fat, high-calorie, high red meat-containing food, fried items — in whatever form, whether veg or non-veg — do contribute to heart disease.”

What processes are behind red meat intake that contributes to higher CVD risk?

High-fat, highcalorie, high red meat-containing food, fried items — in whatever form, whether veg or non-veg — do contribute to heart disease.”

Several mechanisms contribute to an adverse effect of red meat intake on risk of CVD, said Dr Kumar.

■ Increased blood levels of low density lipoprotein (LDL) cholesterol.

■ Red meat is low in polyunsaturated fat.

■ Excessive iron intake might catalyse several cellular reactions involved in the production of reactive oxygen species, thus increasing the levels of oxidative stress.

■ High-sodium content of processed meats is likely to increase the risk of coronary heart disease — by increasing blood pressure and vascular resistance.tO

Dr Srinivasan Kandasamy | Cardiologist, Zulekha Hospital

A diet rich in fatty food and meats definitely increases the risk of CVD.”

To reduce CVD risk, what advice do you give to people?

Dr Kumar: “Heart disease is a leading cause of death, but it’s not inevitable. While you can’t change some risk factors — such as family history, gender or age — there are plenty of other ways you can reduce your risk.”

Dr Mittal: “Maintain a healthy lifestyle — healthy food, low-fat, low-calorie foods, with fruits and salads, regular exercise, weight maintenance, yoga/meditation, adequate sleep, periodic checkups after 40 years. Also monitor blood pressure, diabetes and cholesterol.”

Dr Kandasamy: “As a cardiologist, I advise people to maintain a healthy lifestyle, avoid smoking, take less calorie, less fatty food and less salt. Take sugar/sweets, carbohydrates. Consume more protein-related diet, consume foods rich in dietary fibre, try to control your risk factors including diabetes, hypertension or any other risk associated with chronic morbidities.”

Dr Brajesh Mittal | Consultant Cardiologist, Medcare Hospital Al Safa