On World Heart Day, which will be observed on September 29, heart specialists from around the world will come together to discuss and pool their resources to drastically reduce the upward surge in heart diseases around the globe.
The Sunday Observer spoke to Consultant Cardiologist Teaching Hospital, Kuliyapitiya, Dr. Wasantha K. Abeywickrama to find out more about these diseases, what had caused this frightening health trend once a disease of the elderly, but now affecting younger persons, and how they can be prevented. We also raised the questions as to why a separate day was needed to discuss these issues amidst so many other equally important and serious health topics.
Excerpts.
Q: Cardiovascular disease (CVDs) is now on the increase. How far should we be concerned about this unhealthy trend?
A: Cardiovascular diseases (CVDs) are the leading cause of death globally, taking an estimated 17.9million lives each year worldwide. It is the leading cause of death in most developed countries and with a prevalence that is rapidly increasing in resource limited developing countries as well. The majority of CVD deaths are due to heart attacks and strokes, and one third of these deaths occur prematurely in people who are under 70 years of age.
Dr. Wasantha K Abeywickrama
Consultant cardiologist,
Teaching Hospital Kuliyapitiya
Healthy lifestyle habits lower the heart disease risk by 50 percent. The awareness of this number one killer is unsatisfactory globally. That’s why it is necessary to increase awareness among people worldwide. Although we cannot limit it to a single day, it is still necessary to set aside a special day for it.
Q: What is its significance to the Sri Lankan community as a whole?
A: On par with the world, in Sri Lanka too, coronary artery disease is the leading cause of death and strokes are the third cause of death. More than 20 percent of deaths are due to cardiovascular diseases.
These deaths are increasing as result of increasing ageing population in Sri Lanka. These days we noticed an increasing trend of having heart attacks and strokes among young people as well.
Therefore, it is very important to increase the awareness among our community amidst the economic crisis and unavailability of adequate resources.
Q: How close is Sri Lanka to achieving the goal of World Health Day 2024 in educating the people on abstaining from unhealthy lifestyles and diets that lead to untimely deaths caused from heart attacks and related diseases like strokes?
A: I feel that this is not satisfactory and we need to do more on educating the general public and even our health workers.
Q: Since awareness-raising is the key as you rightly pointed out, and many people are still ignorant of even some of the basic facts about heart disease explain to us what Cardiovascular disease is.
A: Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include:
Coronary artery disease – diseases of the blood vessels supplying the heart muscle. Cerebrovascular disease – diseases of the blood vessels supplying the brain. Peripheral arterial disease- disease of blood vessels supplying arms and legs. Other than that, it includes rheumatic heart disease and congenital heart diseases. Out of these, our main concern is coronary artery disease/ coronary heart disease, as it is a condition affecting your coronary arteries which supplies blood to your heart.
Q: How does it occur?
A: It occurs when a coronary artery blocks or narrows because of a build up plaque. Plaque is made up of fat, cholesterol, and other materials.
Q: So who is most at risk of developing a heart disease?
A: People who are aged 65 years or older are much more likely than younger people to suffer a heart attack,stroke. We as south Asians have a greater risk for it. And also, people who are having diabetes, hypertension (high blood pressure), high cholesterol, obesity and people who are smokers.
Q: Is this something that has happened overnight, or over a period of time?
A: Actually, this process happens over a period of time (20 years) and this process of coronary artery narrowing is called atherosclerosis. In this process, plaques are built up in the walls of coronary arteries as well as other vessels. This plaque is made up of deposits of cholesterol and other substances in the artery. Plaque buildup causes narrowing of the lumen of the arteries over time which in turn can partially or totally block the blood flow.
Q: How could increased high blood pressure, increased blood sugar levels, being obese or overweight also lead to heart damage?
A: Compared with people without diabetes, those with diabetes have a higher prevalence of coronary heart disease (CHD), have a greater extent of coronary ischemia, and are more likely to have a myocardial infarction (MI) and silent myocardial ischemia. Both type I and type II diabetes are powerful and independent risk factors for coronary artery disease (CAD), stroke, and peripheral arterial disease.
Atherosclerosis accounts for virtually 80 percent of all deaths among diabetic patients. Prolonged exposure to hyperglycemia is now recognised as a major factor in the pathogenesis of atherosclerosis in diabetes. Hyperglycemia induces a large number of alterations at cellular level of vascular tissue that potentially accelerate the atherosclerotic process.
The physical stress of hypertension on the arterial wall also results in the aggravation and acceleration of atherosclerosis, particularly of the coronary and cerebral vessels. Moreover, hypertension appears to increase the susceptibility of the small and large arteries to atherosclerose.
Q: I have heard that many risk factors to heart diseases can be controlled or modified. What do you consider as the main risk factors for heart disease and which of them can be controlled? If so, how? Through modifying lifestyle?
A: There are risk factors for heart disease that you have control over and others that you don’t.
Uncontrollable risk factors for heart disease include
Being male
Older age
Family history of heart disease
Being postmenopausal
Heart disease risk factors that you can control revolve around lifestyle. These include
Smoking
Unhealthy cholesterol numbers (see below)
Uncontrolled high blood pressure
Physical inactivity
Obesity (having a BMI greater than 25)
Uncontrolled diabetes
Uncontrolled stress, depression, and anger
Poor diet
Alcohol use
The most important behavioural risk factors for heart diseases and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioral risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity.
Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular diseases.
Q: You mentioned that obesity is a risk factor. In Sri Lanka we now see a sharp rise in obesity among young and old alike. So could you please tell readers how being overweight can affect them.
A: Overweight and obesity are defined by the World Health Organization as abnormal or excessive fat that accumulate and present a risk to health.
Q: Can obesity be measured? If so, how?
A: It is measured in body mass index (BMI), which is a person’s weight (in kilograms) divided by the square of his or her height (in meters). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.
Cardiovascular disease (CVD) mortality and morbidity has been shown to be elevated in those who are overweight, particularly with central deposition of adipose tissues. Obesity may be associated with hypertension, dyslipidemia, diabetes, or insulin resistance, and elevated levels of fibrinogen and C-reactive protein, all of which increase the risk of CVD events.
Here are three ways that obesity contributes to heart disease.
It changes our cholesterol levels while it increases bad cholesterol (LDL), decreases the good high density lipoproteins and it leads to high blood pressure and poor glycemic control.
Q: How does high cholesterol lead to heart disease?
A: With high cholesterol, you can develop fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for blood to flow through your arteries. Sometimes, those deposits can break suddenly and form a clot that causes a heart attack or stroke.
Factors that increase the risk of developing high cholesterol levels include too much fat in the diet, obesity,and insufficient exercise. A genetic form of high cholesterol known as familial hyperlipidemia is often difficult to control, even through diet and medication. Excessive alcohol intake can raise LDL cholesterol and also contribute to heart disease. Smoking can lower the HDL cholesterol and modify other types of cholesterol to bad forms.
Q: Can medicinal drugs also lead to heart disease?
A: Some drugs can increase cholesterol, including estrogen and birth control pills and antidepressants. Some diseases, including diabetes, hypothyroidism, kidney disorders, and polycystic ovarian syndrome, are associated with high cholesterol.
Q: Smoking cigarettes and other tobacco related items is said to be the main or one of the leading causes for heart disease according to new studies. What do you say?
A: Smoking has a large impact on heart disease and stroke. Smoking causes these effects by several mechanisms such as causing long term increase in blood pressure, increasing the heart rate , increasing the process of atherosclerosis and damaging the blood vessels and also by reducing the amount of oxygen that reaches the tissues.
Passive smoking can cause coronary artery disease and stroke. Also, it poses health hazards to pregnant women, infants and young children as well.
Q: Currently we are seeing a rapid inflow of illegal hard drugs into the country. The common opinion of specialists is that using certain drugs increases risks of heart disease? If so, cite a few commonly used.
A: Some drugs and chemical substances can cause MI, and their mechanisms can be different: from a direct toxic effect on cardiomyocytes to probably the most common mechanism, which is vasospasm. There are cases of MI caused by chemotherapeutics. Also it is well known that the risk of MI after using such substances like ecstasy, methamphetamine, LSD, cocaine, heroin, cannabis and volatile substances (propane-butane).
The consumption of recreational drugs has reached epidemic proportions targeting mainly young people. Drug use is commonly associated with complications, including an increased risk of premature death. In particular, recreational drugs have profound effects on cardiovascular function.
Q: We are now living in a fast paced age driven by the pressure of performing par excellence in our work place, school. Could this stress lead to heart disease?
A: According to the studies many psychosocial factors such as anger, anxiety, depression and stress have association with coronary artery disease.
Anger cause increased production of stress hormones called catecholamines. These increase blood pressure and play a role in forming artery clogging plaque.
Q: Alcohol? Can excessive alcohol intake lead to heart disease? If so, how?
A: Heavy drinking, on the other hand, is linked to a number of poor health outcomes, including heart conditions. Excessive alcohol intake can lead to high blood pressure, heart failure or stroke. Also, it can cause cardiomyopathy, a disorder that affects heart muscle and rhythm abnormalities.
Q: How important is a healthy nutritious diet to laying the foundation for healthy hearts?
A: It’s very important. Healthy food choices can extend longevity and reduce the risk of cardiovascular disease, diabetes, hypertension and it helps with weight management and improve health related quality of life.
Q: If one wants to prevent a likelihood of heart disease what is the advice you will give? What are the key factors to preventing heart disease?
A: 50-80 percent of premature heart attacks and strokes are preventable. That’s why preventive measures are so important. Healthy diet.regular physical activity, not using tobacco products are keys for prevention. Checking and controlling risk factors for heart disease and stroke such as high blood pressure, high cholesterol and high blood sugar is also very important.
Q: If detected and treated early can their harmful impacts be reduced or eliminated?
A: If you have the gumption to make changes to your lifestyle, yes you can indeed reverse coronary artery disease.
Q: Treatment-wise how do you treat a heart patient? Is it a blanket treatment for all or tailor made for each specific need of every patient?
A: It is tailor-made treatment to suit individual conditions. We follow evidence based practice and the current recommendation which are published international guidelines.
Q: Now that we have moved towards a hi-tech age, what are the most recent interventions for diagnosis/ treatment available for Lankan heart patients?
A: Cardiac catheterisation and angiogram which is a diagnostic and therapeutic procedure.
In this procedure a catheter is gently guided to the heart. X-rays help guide it. Dye flows through the catheter. The dye helps blood vessels show up better on the images and outlines any blockages. Andstents are placed to the blockages to reestablish the flow. New technique called Drug coating balloon (DCB) used to remove the block rather than putting stent
Rotablation can be used to remove the calcium in the plaque coronary computed tomography (CT) angiography and magnetic resonance imaging (MRI) ; these are non-invasive methods to visualize the heart and blood vessels.
Q: Any do’s and Don’ts for our readers on how to avoid or minimise risks of heart problems?
A:
Do’s
Regular exercise as a daily routine about 30 minutes
Adequate sleep
Maintain healthy weight
Manage stress
Get done regular screening tests
Have good glycemic control if you are a diabetic
Attend to health care early if you have chest pain, epigastric pain or short of breath
Don’ts
Don’t smoke or use tobacco and consume alcohol
Don’t bottle up frustration and depression
Don’t neglect Diabetes
Most importantly, don’t assume that you are not at risk.
Don’t assume that you are having gastritis when you have chest pain
