Recent global figures on heart diseases have revealed a disturbing upward spiral in heart diseases the world over.
Although coronary procedures such as angioplasty/stent and bypass surgery are varied out here the costs of such procedures plus the cocktail of medications are far too expensive for the average Lankan. Medications. In addition certain thrombolytic drugs are also available only in a few teaching and state hospitals. However, the good news is that preventive measures that cost little or nothing such as regular exercise, healthy eating habits and abstaining from smoking can prevent CVD - an aspect which has not been given much emphasis in our country’s health system.
With World Heart Day being observed on September 29, The Sunday Observer sought the views of Cardiothoracic Surgeon, Teaching Hospital Karapitiya, Dr. Namal Gamage ahead of this annual event to get more insights into symptoms of heart diseases to look out for, and affordable practical preventive measures to prevent a further spike in heart diseases, now affecting younger Sri Lankans in the prime of their lives.
Excerpts
Q: Cardiovascular diseases (CVD) have taken a sharp upward curve in the recent past globally and in Sri Lanka. Since many of our readers are still uncertain what cardiovascular disease is, tell us what is Cardiovascular Disease?
A. Cardio means something related to the heart and vascular refers to all the blood vessels which carry blood to and from the heart to and from the body. Blood vessels are of two types - arteries and veins. So diseases involving blood vessels and the heart are called cardiovascular diseases.
Q: Are there different types of heart diseases?
A. There are two types of heart diseases. The congenital or inborn heart diseases where the baby is born with a diseased heart is the first variety. The second is the acquired heart diseases where a person acquires heart diseases later in the life due to causes that person goes through during the journey of life. These could be mere environmental, lifestyle related or could be genetic expression of a disease in one’s own family.
Q: Of these diseases, what are the most common in Sri Lanka?
A. Congenital or inborn heart diseases are more or less static in numbers i.e. about 3 to 5 for every 1000 live births. Acquired heart diseases are commoner and of them coronary heart diseases remain very high causing 120 to 150 coronary deaths every day in Sri Lanka.
Q: Is High blood sugar a major risk for heart disease?
A. Yes diabetes especially when not properly controlled is a very big risk for heart disease. In fact 70 to 80 percent of patients who come for bypass surgery are diabetics.
Q: What about those with cholesterol?
A. Cholesterol is an important contributor to heart disease The main cause for coronary heart disease is related to cholesterol metabolism in the body. Most of the other primary causative factors like diabetes, hypertension, smoking, bad food habits, bad lifestyle patterns and familial tendency act through cholesterol metabolism making cholesterol to deposit in the walls of the blood vessels.
Q: So how does a person with high cholesterol lower it?
A. Cholesterol lowering starts always with a diet which is high in fiber, low in saturated fats and high in unsaturated fats. But you cannot treat high cholesterol blood levels with the diet itself. Sometimes you may need to take treatment in addition to dietary control.
Q: What are the adverse effects of ingesting unhealthy diets on the human body ?
A. High fat diets can cause obesity and hypercholesterolemia. Obesity in turn can lead to diabetes mellitus. Obesity invites numerous bodily problems like aches and pains, hernia and hiatus hernia, osteoporosis and joint problems like arthritis.
Q: Is stress also a contributory cause?
A. Certainly stress is a big reason to develop heart problems. Stress could act directly on the heart and can act indirectly through other illnesses caused by stress like hypertension, diabetes and insomnia.
Q: If a close relative/s has a long history of cardiac problems what is the risk of developing it even if you are physically fit?
A. Closer the relationship higher will be the risk. If your parents or siblings are affected the risk you run is more than four folds compared to the normal population. If too many close relatives are affected them the risk may reach 100 percent.
Q: Can heart disease lead to strokes?
A. There are some congenital and acquired heart diseases as a secondary complication gets blood clots inside the heart and these clots can get detached and can block blood vessels inside the brain in turn causing strokes. Generally most of the strokes are caused by narrowing or ulceration of the blood vessels running to the brain. That is also due to deposition of cholesterol in their lumen. Therefore, heart disease and strokes have similar or the same origin.
Q: Are heart diseases preventable? If so, which of them can be prevented with proper, timely ,interventional measures?
A. Acquired heart diseases in particular can be prevented as they are caused by avoiding factors like smoking, alcohol ,unhealthy diets, and poor control of pre-existing contributory diseases like diabetes and cholesterol.
Congenital heart diseases are difficult to prevent but if those causative factors like consanguinity, use of some drugs and some viral infections like Rubella during pregnancy, active or passive smoking and malnutrition could be prevented, congenital types of heart diseases may be controlled to some extent.
Q: Are heart diseases reversible ? How?
A. In coronary heart disease when coronary arteries are not critically narrowed very high concentrations of cholesterol lowering drugs may be effective in reversing the disease in some people. But this is not predictable.
Q: Genderwise who is more vulnerable to heart disease? Men or women? Why ?
A. Men are more vulnerable as they more frequently go through causative factors. Females have some protection due to the hormone Oestrogen which they carry in the circulation before menopause but after menopause they become equally vulnerable.
Q: Age-wise, what is the best age to seek medical advice and get tested for heart disease as a matter of routine? Why?
A. If you have a strong family history of heart diseases then you should seek medical advice from your early teenage years. Those around 40 years should do risk factors check up as a routine .
Q: Symptoms – what are the symptoms of heart disease to look out for? Are they visible outwardly at their earliest stage?
A. Generally pain in the chest is considered as the first feature of heart disease. Angina is the chest pain coming during exercise or exertion. Recent onset tiredness, shortness of breath, heartburn, retching or belching could be early features of coronary heart disease.
Q: Are the symptoms the same in adults and in children?
A. Children generally get symptoms of congenital heart diseases such as bluish discoloration of fingernails, shortness of breath, poor growth, squatting during play. They are not the same as in adults.
Q: With so many children now categorised as pre –diabetics which could preclude early heart disease , what are the symptoms that parents should look out for?
A. Early signs of diabetes in children could be sudden loss of weight, increased hunger, passing excessive amounts of urine, increased thirst and probably vision problems.
Q: Treatment-wise how do you treat a heart patient? Is it a blanket treatment for all ? Or is the treatment tailored for the specific needs of every patient?
A. Partly it is a blanket treatment for example cholesterol lowering, controlling diabetes, hypertension, weight and diet controlling persuading regular exercises are always done. Then comes tailor-made therapeutic measures for individual patients like angioplasty and bypass surgery which suits each patient specific anatomy of the disease.
Q: Now that we have moved towards a hi tech age with blockbuster treatments,? What are the most recent interventions for diagnosis and treatment available for Lankan heart patients ?
A. Unfortunately with the economical constraints we still have a long way to go for many of these advanced techniques available in other countries. For one thing, we don’t even have at least a cardiac catheter lab in each province as yet. There is also a very high percentage of patients dying before bypass surgery in long waiting lists. Basic infrastructure facilities are not available in most outstation hospitals. Furthermore there are also shortages of various essential items, equipment and utensils.
Q: You earlier mentioned that unhealthy diets play an important part in cardiovascular risks and that daily consumption of diets laden with sugar, fats, carbohydrates, starch and oil can also lead to early development of Non Communicable Diseases ( NCD’s), including heart diseases. My question is, as parents, how early should we begin laying the foundation for healthy hearts in our children who will be the future citizens?
A. The earlier the better. Start teaching children about healthy nutritious foods and encourage them to eat such foods from the time they are very young, so that they won’t acquire a taste for sweetened high fat oily salty diets. Parents should be the role model and set an example on healthy eating themselves for children to follow.
Q: Talking of healthy meals, do you have any suggestions or guidelines to offer on how to cook a wholesome healthy meal for one’s family? For example, how safe is flying? Steaming? Baking? Microwaving?
A. Steaming, microwaving, baking and air frying are always much better than frying in oil, especially deep frying. Deep frying even in unsaturated healthier oil varieties can destroy the goodness of the oil due to very high temperatures. Always try to eat fresh vegetables and fruits (with the skin) as raw as possible to get the best benefits from them.
Q: Do you have a list of Do’s and Don’ts to prevent heart diseases?
A. Prevention is the only hope these days as cure may not be possible most of the time. Therefore as pointed out earlier proper control of risk factors like diabetes, hypertension, high cholesterol, good eating habits, proper regular exercise and quitting smoking are very important.
Q: Have you sent a message to the parents on their role in laying healthy heart foundations for their children?
A. It is easier to acquire good habits in early years than trying to acquire them in late life. Good habits acquired as a youngster remain for the rest of the life and later learned habits are very liable and non-static. Hence parents should teach children good eating habits and lifestyles from the time they are able to understand what is happening around them.
Q: Do you have a message for the Sri Lankan public in general on preventing non communicable diseases including heart disease?
A. Most of the non communicable diseases have more or less the same origin and heart diseases.
Hence if you can avoid heart diseases then you are protected against most other non communicable diseases.