Health Watch

World Heart day on September 28:

Healthy lifestyle key to prevent heart diseases

Hiran H. Senewiratne

Heart diseases are the number one killer in the world, to both male and female. But this condition could be prevented by following a moderate lifestyle, the medical experts say.

Coronary Artery Disease (CAD) (or atherosclerotic heart disease) better known as heart diseases are a serious health issue in Sri Lanka as well. But these can be prevented if detected early.

It is found that 80 percent of heart diseases could be prevented if detected and the risk factors connected to heart diseases are identified. Resident Consultant Cardiothoracic Surgeon, Nawaloka Hospital Dr Y.K.M, Lahie said.

He said coronary heart disease is the term that describes what happens when your heart’s blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries.

Over time, the walls of your arteries can become clogged with fatty deposits. This process is known as atherosclerosis, and the fatty deposits are called atheroma. If your coronary arteries become narrow due to a build up of atheroma, the blood supply to your heart will be restricted. This can cause angina (chest pains), he said.

If a coronary artery becomes completely blocked, it can cause a heart attack which could lead to death. The medical term for a heart attack is myocardial infarction. Infarction means that the tissue had died due to lack of oxygen-rich blood, he said.

The end result is the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes called Coronary Heart Disease (CHD). Although CAD is the most common cause of CHD, it is not the only cause, he said.

Risk factors of this CAD are smoking including passive smoking, un-healthy diets specially junk food, fast food, canned food containing preservatives and lack of exercise. However, patients with diabetes, high cholesterol and with a family history could also be at risk of suffering heart diseases. Stressful jobs could also lead to coronary diseases, he said.

While the symptoms and signs of coronary artery disease are noted at an advanced state of the disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a “sudden” heart attack, Dr. Lahie said.

After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting the blood flow to the heart muscle.

The disease is the most common cause of sudden death and is also the most common cause of death of men and women over 20 years.

By making simple lifestyle changes, you can reduce the risk of coronary heart disease. And if you already have heart disease, you can take steps to reduce the risk of developing further heart-related problems, Dr Lahie said. New findings have revealed that women are at a higher risk than men as their symptoms differ.

As coronary artery disease progresses, there may be a near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary artery disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.

A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia is the amount of oxygen supplied to the tissue. When the myocardium becomes ischemic, it does not function optimally.

When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. According to the Guinness Book of Records, Northern Ireland tops in CAD occurrences.

According to present trends, half of healthy 40-year-old males and one in three healthy 40-year-old women will develop CAD in the future. Dr. Lahie said main symptoms are jaw pain’ left hand pain, sweating, chest pain and palpitation. If one gets such symptoms it is advisable to consult a medical doctor immediately, he said. Dr Lahie said preventable measures are quit smoking, have a balanced diet with a lot of vegetables, fruits and fish, and regular exercise like swimming and brisk walking. Leading a less stressful life is one of the important factors to prevent heart diseases.

Treatment for the disease is available in all leading hospitals in the country. With the development of technology treatment has become simple and less complicated.

Today, operations are done in many ways including by-pass surgeries and angiongram method, he said. Dr. Lahie said that Angiogram could be done by a Cardiologist who will insert a needle into one the arteries shown in the diagram and push a thin plastic tube to reach the opening of the arteries supplying blood to the heart.

He said that normal coronary Angiogram and Normal Left Ventricular function need no active treatment. The patient could continue with the medicine and attend follow up clinics.

The most important thing is Percutaneous Transluminal Coronary Angioplasty which could be done at the same time as the angiogram or later. Using a small balloon on the tip of a plastic catheter, the cardiologist can open up the blockage.

Sometimes the opened up blockage can close again and in this case the cardiologist will place a coiled or Stent, inside the blockage to keep it open. This will then allow blood to flow to the heart muscle that did not get blood previously to allow normal function, he said. The open heart surgery procedure is a most common surgery every where, he said.

Preventing lifestyle diseases

The prevention of lifestyle related diseases such as cancer and cardiovascular complaints is a challenging task, owing to the difficulty that people have in changing their patterns of behaviour, especially their dietary choices, an addiction to smoking and drinking of alcohol, once their lifestyle is established.

Moreover, epidemiologic data have shown that the risk of these chronic diseases is closely related to childhood environment and lifestyles. Therefore, a preventive strategy against lifestyle related diseases should start during childhood to attain the maximum preventive effects.

Although, in recent years, people throughout the world have become aware of the importance of children’s health, health programs in schools have so far mainly targeted the control of infectious diseases and little work has been done in the promotion of a comprehensive health regime, the need for which has increasingly come to be seen as important in the preventing of non-communicable diseases. In this context, the Sri Lankan project led by Dr. Kobayashi (Professor Emeritus of Hokkaido University) is a unique model of “school-based health promotion” in developing countries.

With a review of the Sri Lankan project based on the summery report as well school visit (November 10.11.2008), I identified 7 key features of the project.

1. a child-centered approach, supported by teachers and parents;

2. periodic workshops and newsletters on health, which have driven activities at school;

3. provision of community health service, including “health camps”, where children played a role in the health assessment of residents;

4. multi-disciplinary activities, including the improvement of the home environment;

5. the well-designed procedure of the program, organised by experienced school activities;

6. provision of modest monetary support for the improvement of school environment, which has encouraged school activities;

7. mutual interactions between the participating schools.

In reaction to the third feature, I should note that during three years of the project health behaviour or its indicators have consistently shown improvement not only among schoolchildren but also among residents of the community. Similarly, welcome changes in environment have been reported not only in school but also at home.

With these elements and promising results, I would judge that the project was very successful in showing an effective model of “child-centered, community-wide, school-based health promotion.” Currently, a school is regarded as just a place where, under the existing model, children receive health service passively.

By contrast, in the Sri Lankan model, the school is a base where health promotion is planned and disseminated actively by the children themselves, who are highly motivated and fully empowered by appropriate support from relevant adults.

Though this project, practical knowledge and skills have been accumulated and human resource have been developed for the conduct of school-based health promotion. I hope that this program will be applied to schools in many developing countries and evaluated using long-term outcome measures such as the incidence of lifestyle diseases.

Tetsuya Mizoue

Director, Department of Epidemiology and International Health, Research Institute, International Medical Center of Japan.

Reinforce and organize general diabetes care in Sri Lanka

Prof. Chandrika Wijeratne

Nirogi is an initiative directed at the lay public and persons suffering with diabetes mellitus and at risk of diabetes, targeting particularly the lower socio-economic groups in the metropolitan city of Colombo and the suburban sector.

It aims to improve the quality of diabetic care and its delivery. Hence, this project is a charitable project.

The Ministry of Health of the Government of Sri Lanka (MoHGOSL) is committed towards a free health service with particular commitment to improving quality of care.

The MoHGOSL has recognised the need for targeting chronic Non Communicable Diseases (NCDs) in particular the rapidly increasing number of diabetics from the lower socio-economic groups.

This project proposal was written in concurrence with the MoHGOSL and all stakeholders in managing diabetics under the leadership of the Diabetes Prevention Task Force (DPTF) of Sri Lanka Medical Association.

The project consists of three major components that would run concurrently with active participation of relevant members of the DPTF who have the motivation, expertise and the experience to implement in carrying out each project component which are:

1. National programme - for capacity building in diabetes care by establishing a pioneer cohort of ‘diabetes nurse educators’ initially for the state health sector to be expanded later to selected private primary care services through the College of General Practitioners of Sri Lanka.

2. Improving quality of diabetes care through the development of a health care model of tertiary-primary care partnership to be initiated in the City of Colombo i.e. to provide quality care close to the homes of the affected persons.

Prevent Type 2 Diabetes by empowering the public through activities that encourage community and family participation in a defined area of Suburban area of Colombo.

Health News Summary

Following is a summary of current health news briefs.:

H1N1 has killed 2,837, but not more serious: WHO The pandemic

H1N1 flu virus continues to cause widespread infection in many parts of the world but is not becoming more serious, the World Health Organization (WHO) said. The WHO said it had counted 2,837 deaths worldwide but noted that not every case was being counted any more.

Late-night snacks could pack on the pounds

Midnight raids on the refrigerator may have worse consequences than indigestion — a study in mice boosts the theory that when you eat affects whether the calories go to your hips or get burned off. Mice fed during the daytime — when they normally would be sleeping — gained more weight than mice fed at night, Fred Turek of Northwestern University in Illinois and colleagues found.

Study finds potential way to make an AIDS vaccine

The discovery of immune system particles that attack the AIDS virus may finally open a way to make a vaccine that could protect people against the deadly and incurable infection, U.S. researchers said.

They used new technology to troll through the blood of 1,800 people infected with the AIDS virus and identified two immune system compounds called antibodies that could neutralize the virus.

How broccoli can protect your arteries

It’s long been thought that broccoli is good for your heart, and now British scientists think they know why. Researchers at Imperial College London have found evidence a chemical in broccoli and other green leafy vegetables could boost a natural defense mechanism that protects arteries from the clogging that can cause heart attacks.

Thin thighs - maybe not your heart’s desire

People who have agonized over their fat thighs might be able to relax a bit — Danish doctors said they found patients with the thinnest thighs died sooner than the more endowed. Obesity, age, smoking and other factors did not reduce the effect, the researchers reported in the British Medical Journal.

Ethnically dense neighborhood good for health

Living in a neighborhood with a lot of people of similar ethnic background may have some health benefit, hints a new study from the United Kingdom.

In the study, fewer activity-limiting long-term illnesses were reported by people who lived in neighborhoods they felt were more than half made up of people with whom they shared a common ethnicity.

Antioxidant pills do not prevent metabolic syndrome

People who want to forestall heart disease and diabetes may do better by choosing antioxidant-rich foods instead of antioxidant supplements, a new study suggests. Researchers found that among more than 5,200 middle-aged adults, antioxidant supplements had no effect on the risk of developing metabolic syndrome over seven-plus years.

REUTERS

Aspirin and heart attacks

D.P. Atukorale

“Heart disease before the age of 80 is not God’s will but due to our own faults” Paul Duddly White, the father of modern cardiology.

Today heart disease remains by far the main avenue to the grave in our country.

Aspirin is the wonder drug of the century and is one of the cheapest drugs you can buy over the counter.

Aspirin may be the largest selling drug in the world and could prevent hundreds of thousands of premature deaths all over the world.

When aspirin was invented in 1897 in Germany, it was the world’s first synthetic drug and aspirin was the first drug ever to be tested in clinical trials before registration. It is believed that over 50,000 tonnes of aspirin are consumed globally every year.

Should I be taking an Aspirin a day?

Taking a low dose (75mg to 150mg) of aspirin a day seems to lower the risk of blood clots forming inside the coronary arteries (blood vessels taking oxygen and other nutrients to heart muscle) narrowed by fat plaques.

(a) If you have high blood fats (bad cholesterol or LDL over 100mg percent);

(b) Any person with overweight or obesity;

(c) If you have high blood pressure;

(d) If you are a diabetic and

(e) If you are a smoker

It is noteworthy that aspirin does not reduce you cholesterol and that aspirin does not help you clear out your atheromatous plaques inside the coronary arteries.

Although some doctors prescribe aspirin to all persons above 50 years, there is no scientific evidence to prove that all persons above 50 years benefit by taking an aspirin a day, if you do not have any coronary risk factors such as smoking, high blood cholesterol, diabetes, obesity, hypertension and lack of exercise.

Physicians do not prescribe aspirin to;

(a) Those who are allergic to aspirin

(b) And those who have bleeding diseases or to those with gastric bleeds or gastric ulcers or intestinal bleeds.

There are some people who get too much of thinning of blood even with low dose aspirin and these people get bleeds into the intestine or have epistaxis (nose bleeds).

Rarely low dose aspirin can cause small haemorrhages in the brain resulting in haemorrhagic strokes. Because aspirin can cause above side-effects, it is always advisable to get advice from your doctor before starting to take an aspirin a day to prevent a heart attack.

Your doctor will advise you to withhold aspirin 7 to 10 days prior to any type of surgery e.g. prior to tooth extraction and other minor and major surgery as you are prone to have excessive bleeding during surgery.

As mentioned earlier, there is no residence that aspirin is useful in preventing a heart attack if you have no coronary risk factors.

Aspirin does not influence atherosclerosis (thickening of arteries). In addition to taking a low dose aspirin a day, you have to control your high blood pressure, obesity, high cholesterol level and your blood sugar (if you are a diabatic) and take regular exercise and make other lifestyle modifications if you want to prevent getting a heart attack.