With World Heart Day coming up shortly, and evidence now showing that heart disease is no longer a disease of the elderly but affecting younger patients as well, the Sunday Observer spoke to Consultant Cardiologist Base Hospital Tangalle and Base Hospital Panadura, Dr. Wasantha Abeywickrama to find out the what brought on this disturbing trend, factors that drive heart diseases in general, and most importantly how premature deaths and morbidity from heart diseases could be minimised or drastically reduced.
Excerpts
Q. World Heart Day falls on September 29. Why is it necessary to set aside a special day to discuss this specific subject amidst so many other equally pressing health issues?
 Dr. Wasantha Abeywickrama |
A. Cardiovascular diseases (CVDs) are the leading cause of death globally affecting both developed countries and developing countries as well. However, healthy lifestyle habits can lower the heart disease risk by 50% . That’s why it is necessary to increase awareness among people worldwide.
Q. What is its significance to the Lankan community as a whole?
A. In Sri Lanka coronary artery disease is the leading cause of death. These deaths are increasing as a result of the increasing ageing population in Sri Lanka but we notice a disturbing trend where young people are also becoming victims of heart attacks. Hence it is very important to increase awareness among our community especially today as they face an unprecedented economic crisis that has drastically limited their resources.
Q. How close is Sri Lanka to achieving the goal of World Health Day 2023 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. Unsatisfactory/Suboptimal
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 - a disease of blood vessels supplying arms and legs.
There are rheumatic heart disease and congenital heart disease. Out of these our main concern is coronary artery disease/ coronary heart disease, and it is a condition affecting your coronary arteries which supplies blood to your heart. It occurs when a coronary artery blocks or narrows because of a buildup of plaque. Plaque is made up of fat, cholesterol, and other materials.
Q. So who are most at risk of developing heart diseases?
A. People aged 65 years or older are much more likely than younger people to suffer a heart attack, stroke or develop coronary artery disease. We as South Asians have a greater risk for it. We define coronary artery disease occurring in less than 45 years of age as young CAD and recent studies show an increasing trend of it. We as South Asians are especially vulnerable to CAD in the young age group. Risk factors such as smoking, diabetes, hypertension, obesity, and family history seem to be important. The most associated risk factor in young CAD is smoking and other than that unhealthy food habits and lack of exercise play a role.
Q. Is this something that has happened overnight, or over a period of several years?
A. No. it happened over a period of time (more than 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 the inside of the arteries to narrow over time which can partially or totally block the blood flow.
Q. Could Increased high blood pressure, increased blood sugar levels, being obese or overweight also lead to heart damage? If so, how?
A. Compared with individuals 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% of all deaths among diabetic patients. Prolonged exposure to hyperglycemia is now recognized as a major factor in the pathogenesis of atherosclerosis in diabetes. Hyperglycemia induces a large number of alterations at the 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 atherosclerosis.
Obesity is also closely related to coronary atherosclerosis causing coronary artery disease as well as heart failure, rhythm abnormalities and even sudden cardiac deaths. Obesity increases hypertension and diabetes as well. These factors together cause a huge impact on the cardiovascular system.
Q. What do you consider as the main risk factors for heart disease and which of them can be controlled or modified through correct lifestyle habits?
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
* Uncontrolled high blood pressure
* Physical inactivity
* Obesity (having a BMI greater than 25)
* Uncontrolled diabetes
* Uncontrolled stress, depression, and anger
* Poor diet
* Alcohol use
Q. You said that being overweight is a risk factor? In what way does obesity impact our body?
A. There 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 leads to high blood pressure and diabetes.
Q. How is it measured?
A. Obesity 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 metres). 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 individuals who are overweight, particularly with central deposition of adipose tissues. Obesity is also 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.
Q. Please comment on the impact of High cholesterol in our body and risk factors that contribute to it?
A. With high cholesterol, you can develop fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for enough 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 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 smoking can lower HDL cholesterol. 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. What about uncontrolled Diabetes?
A. Coronary artery disease is a leading macrovascular complication of diabetes.
Q. Could stress lead to a heart attack?
A. Yes. High levels of cortisol from long-term stress can increase blood cholesterol, triglycerides, blood sugar, and blood pressure. These are common risk factors for heart disease. This stress can also cause changes that promote the buildup of plaque deposits in the arteries.
Q. Smoking?
A. Smoking has a large impact on heart disease and stroke through several mechanisms : It causes long-term increases in blood pressure, increasing heart rate, increasing the process of atherosclerosis damaging the blood vessels and also by reducing the amount of oxygen that reaches the tissues. These risks extend to second hand ( passive smoking) as well which are particularly dangerous to pregnant women infants and young children..
Q. Alcohol?
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 (Atrial fibrillation).
Q.. How important is a healthy nutritious diet to laying the foundation for healthy hearts?
A. Healthy food choices can extend longevity and reduce the risk of cardiovascular disease, diabetes, and hypertension and they help with weight management and improve health-related quality of life
Q. Are heart diseases preventable?
A. 50-80% of premature heart attacks and strokes are preventable. That’s why preventive measures are this important. A healthy diet, regular physical activity, and saying no to tobacco products are key to 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 reversed?
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?
A. It is a tailor-made treatment to suit individual conditions.
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. The dye flows through the catheter. The dye helps blood vessels show up better on the images and outlines any blockages. And stents are placed to the blockages to re-establish the flow. Coronary computed tomography (CT) angiography and magnetic resonance imaging (MRI) These are non-invasive methods to visualize the heart and blood vessels.
Q. What do you consider as the foundation to healthy hearts, and when should we set the stage to begin laying such a foundation?
A. Atherosclerotic vascular changes can begin in early childhood, setting the stage for cardiovascular diseases.
Q. Do you have a message for our readers on how to avoid or minimize risks of heart problems?
A. Obey the following list of Do’s and Don’ts .
Do’ s
Regular exercise as a daily routine of about 30 mins
Adequate sleep
Maintain healthy weight. Take balanced healthy diet {with adequate vegetable and fruits, less carbohydrate and fat}
Manage stress
Do regular screening tests
Don’ts
Don’t take excessive salt
Don’t smoke or use tobacco and consume alcohol
Don’t bottle up frustration and depression
Most importantly, don’t assume that you are not at risk.
Don’t underestimate/neglect Diabetes