Know your risk!
Heart disease and stroke is the world's largest killer, claiming 17.5 million lives a year. The good news is that heart disease is largely preventable and that simple, affordable steps can be taken to reduce the major risk factors, says cardiac surgeon Alex Manché.
"... how much happier our society would feel if we practised and lived a long and healthy lifestyle!"
We have all tensed our abdominal muscles when parading on the beach in a vain effort to draw in that growing waistline. We all know how tiring this manoeuvre is. Now stop to think for a while: our heart, an incredibly strong muscular pump, deep within our body, is contracting every second of our life, tirelessly, continuously. It works while we sleep, it works even harder when called upon during exercise or heightened emotion. It is a truly incredible thing, deserving our respect and our utmost care.
Serious malfunction of the heart is still the leading cause of premature death in our society in spite of great advances in medicine and surgery. Perhaps this relentless loss of life is the result of our increasing dependence on doctors and technology at the cost of personal initiative in caring for our health. As keepers of our body, we have a duty to be informed and educated as to how best to behave, and to put this knowledge into practice. Information and awareness on health issues are certainly not lacking in this day and age. The known risk factors of heart disease, until a few years ago the domain of the medical student's curriculum, are now common knowledge to us all.
We are bombarded in the media with green and healthy debates. Yet many of us flout the basic principles as if there were no tomorrow. Sadly we are responsible for our deteriorating health at an early age, and at a time of our lives when we believe we are indestructible and practically immortal. By middle age, when we have accepted the notion of bodily deterioration, the damage has been done and we are forced to resort to drastic, often emergency, measures to bring about a health rally. With progression of heart disease these drastic measures result in diminishing returns. How can we, as individuals, work alongside the medical profession to bring about a significant improvement in our longevity and quality of life? The answer lies in informed choices we make every day of our lives coupled with a sound relationship with a trusted medical practitioner who is there to treat and advise. Beyond this is specialist intervention. This last resort option, often life saving, very expensive and many a time the result of failure of the above measures, is still on the increase in Malta.
As one of these specialists, I am dealing daily with patients who have reached a critical stage of disease, where life expectancy is often a matter of months. I am saddened at the breakdown in the system and the predicament of the person before me. I always ask myself how a once healthy baby has reached this state of extremely poor health, often in the short space of 40 years or so. Thankfully medicine and surgery have much to offer, even at this eleventh hour, but how much happier our society would feel if we practised and lived a long and healthy lifestyle!
World Heart Day, being celebrated tomorrow, has come round again to remind us of an extremely important health issue. It would be a very sad state of affairs if we only loved our mum on Mother's Day. Likewise, making a healthy effort on World Heart Day would be inconsequential. We should resolve to make this year's event a meaningful one with lifestyle changes over the long term. The theme today is "know your risk" and this implies continuing education in a plethora of evolving health theories.
Amid this jungle of health information overload there are salient and undeniable facts that are borne out of large clinical trials.
Two such trials, the Monica Project and the Interheart Study between them recruited over 150,000 people and hence the statistics are robust and approximate the truth.
Published more than 10 years ago, also on World Heart Day, they confirmed the contemporary clinical opinion that smoking, high cholesterol, stress, high blood pressure, diabetes, lack of exercise and an unhealthy diet all contribute significantly to heart disease. Many of these, so-called, risk factors can be responsibly curtailed if we are self-disciplined.
Ten years down the line young people are taking up smoking more than ever before. This habit kills more than one person per day on our tiny island and is incredibly still legal all over the planet except in Bhutan. Smokers have become immune to anti-smoking campaigns and only tend to quit after a medical catastrophe. The success of smoking cessation programmes, which today include group sessions, medication and nicotine replacement therapy, is low. And we are all aware of the potent carcinogenic effects of tobacco in addition to its damaging effects on the heart. Obviously education in this field is depressingly lacking.
Stress is also now recognised as an important contributor to heart disease, coming third in importance as a risk factor in the Interheart Study. Stress is not easy to quantify but we all feel its effects when we are passing through a particularly difficult patch. A rapidly changing world causes stress in each and every one of us. Stress is unavoidable unless we choose to take up monastic life, an option not open to most of us. There exist internet questionnaires that can give a fairly accurate assessment of our stress levels. When stress becomes chronic it causes serious health problems, and may even precipitate a fatal complication in a person suffering from chronic, but stable, heart disease.
Managing stress is part of life and involves such daily activities as outdoor walking or swimming and periodic interventions such as vacations or simply getting away from a routine. The key factor is winding down.
Medicine is still in its infancy and prevention is still far better than cure. Today the emphasis is on a particular facet of heart disease, ischaemic heart disease, meaning that due to a lack of blood supply consequent upon narrowed vessels feeding blood to the heart muscle. Our concept of the jeopardised heart as a sophisticated mechanical pump with a faulty fuel supply may be far too simplistic. There are some who believe that the heart thinks, feels, remembers, loves and hates, that it communicates the information and memory stored throughout its life to every cell in the human body.
World Heart Day 20 years down the line may have a completely new meaning. Until then we should heed the advice we have at hand. We have no other.
What are cardiovascular diseases?
Cardiovascular diseases include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, and an unhealthy diet.
Globally, cardiovascular diseases are the number-one cause of death and is projected to remain so. If current trends are allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly from heart attacks and strokes).
Heart attacks and strokes are mainly caused by a blockage that prevents blood from flowing to the heart or the brain. The most common cause is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. The blood vessels become narrower and less flexible, also known as atherosclerosis (or hardening of the arteries). The blood vessels are then more likely to become blocked by blood clots. When this happens, the blocked vessels cannot supply blood to the heart and brain, which then become damaged.
Common symptoms
• Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first warning of underlying disease.
• Symptoms of a heart attack include: pain or discomfort in the centre of the chest; pain or discomfort in the arms, the left shoulder, elbows, jaw or back. In addition the person may experience difficulty in breathing or shortness of breath; feeling sick or vomiting; feeling light-headed or faint; breaking into a cold sweat; and becoming pale.
• Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.
• The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body. Other symptoms include a sudden onset of: numbness of the face, arm or leg, especially on one side of the body; confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; and fainting or nconsciousness.
What can I do to avoid a heart attack or a stroke?
HO estimates that more than 17 million people died of cardiovascular diseases such as heart attack or stroke in 2005. Contrary to popular belief, four out of five of these deaths occurred in low- and middle-income countries, and men and women were equally affected. The good news, however, is that 80 per cent of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention.
• Eat a healthy diet
A balanced diet is crucial to a healthy heart and circulation system. This should include plenty of fruit and vegetables, whole grains, lean meat, fish and pulses, and restricted salt and sugar intake.
• Take regular physical activity
At least 30 minutes of regular physical activity every day helps to maintain cardiovascular fitness; at least 60 minutes on most days helps to maintain healthy weight.
• Avoid tobacco use
Tobacco in every form is very harmful to health - cigarettes, cigars, pipes or chewable tobacco. Exposure to second-hand tobacco smoke is also dangerous. The risk of heart attack and stroke starts to drop immediately after a person stops using tobacco products, and can drop by as much as half after one year.
Check and control your cardiovascular risk
• Know your blood pressure
High blood pressure usually has no symptoms, but can cause a sudden stroke or heart attack. Have your blood pressure checked.
• Know your blood sugar
Raised blood glucose (diabetes) increases the risk of heart attacks and strokes. If you have diabetes it is very important to control your blood pressure and blood sugar to minimise the risk.
• Know your blood lipids
Raised blood cholesterol increases the risk of heart attacks and strokes. Blood cholesterol needs to be controlled through a healthy diet and, if necessary, by appropriate medications.
Next week, on the eve of the anniversary of the world's first pacemaker implantation, we look at how these devices have changed many lives.
Serious malfunction of the heart is still the leading cause of premature death in our society in spite of great advances in medicine and surgery. Perhaps this relentless loss of life is the result of our increasing dependence on doctors and technology at the cost of personal initiative in caring for our health. As keepers of our body, we have a duty to be informed and educated as to how best to behave, and to put this knowledge into practice. Information and awareness on health issues are certainly not lacking in this day and age. The known risk factors of heart disease, until a few years ago the domain of the medical student's curriculum, are now common knowledge to us all.
We are bombarded in the media with green and healthy debates. Yet many of us flout the basic principles as if there were no tomorrow. Sadly we are responsible for our deteriorating health at an early age, and at a time of our lives when we believe we are indestructible and practically immortal. By middle age, when we have accepted the notion of bodily deterioration, the damage has been done and we are forced to resort to drastic, often emergency, measures to bring about a health rally. With progression of heart disease these drastic measures result in diminishing returns. How can we, as individuals, work alongside the medical profession to bring about a significant improvement in our longevity and quality of life? The answer lies in informed choices we make every day of our lives coupled with a sound relationship with a trusted medical practitioner who is there to treat and advise. Beyond this is specialist intervention. This last resort option, often life saving, very expensive and many a time the result of failure of the above measures, is still on the increase in Malta.
As one of these specialists, I am dealing daily with patients who have reached a critical stage of disease, where life expectancy is often a matter of months. I am saddened at the breakdown in the system and the predicament of the person before me. I always ask myself how a once healthy baby has reached this state of extremely poor health, often in the short space of 40 years or so. Thankfully medicine and surgery have much to offer, even at this eleventh hour, but how much happier our society would feel if we practised and lived a long and healthy lifestyle!
World Heart Day, being celebrated tomorrow, has come round again to remind us of an extremely important health issue. It would be a very sad state of affairs if we only loved our mum on Mother's Day. Likewise, making a healthy effort on World Heart Day would be inconsequential. We should resolve to make this year's event a meaningful one with lifestyle changes over the long term. The theme today is "know your risk" and this implies continuing education in a plethora of evolving health theories.
Amid this jungle of health information overload there are salient and undeniable facts that are borne out of large clinical trials.
Two such trials, the Monica Project and the Interheart Study between them recruited over 150,000 people and hence the statistics are robust and approximate the truth.
Published more than 10 years ago, also on World Heart Day, they confirmed the contemporary clinical opinion that smoking, high cholesterol, stress, high blood pressure, diabetes, lack of exercise and an unhealthy diet all contribute significantly to heart disease. Many of these, so-called, risk factors can be responsibly curtailed if we are self-disciplined.
Ten years down the line young people are taking up smoking more than ever before. This habit kills more than one person per day on our tiny island and is incredibly still legal all over the planet except in Bhutan. Smokers have become immune to anti-smoking campaigns and only tend to quit after a medical catastrophe. The success of smoking cessation programmes, which today include group sessions, medication and nicotine replacement therapy, is low. And we are all aware of the potent carcinogenic effects of tobacco in addition to its damaging effects on the heart. Obviously education in this field is depressingly lacking.
Stress is also now recognised as an important contributor to heart disease, coming third in importance as a risk factor in the Interheart Study. Stress is not easy to quantify but we all feel its effects when we are passing through a particularly difficult patch. A rapidly changing world causes stress in each and every one of us. Stress is unavoidable unless we choose to take up monastic life, an option not open to most of us. There exist internet questionnaires that can give a fairly accurate assessment of our stress levels. When stress becomes chronic it causes serious health problems, and may even precipitate a fatal complication in a person suffering from chronic, but stable, heart disease.
Managing stress is part of life and involves such daily activities as outdoor walking or swimming and periodic interventions such as vacations or simply getting away from a routine. The key factor is winding down.
Medicine is still in its infancy and prevention is still far better than cure. Today the emphasis is on a particular facet of heart disease, ischaemic heart disease, meaning that due to a lack of blood supply consequent upon narrowed vessels feeding blood to the heart muscle. Our concept of the jeopardised heart as a sophisticated mechanical pump with a faulty fuel supply may be far too simplistic. There are some who believe that the heart thinks, feels, remembers, loves and hates, that it communicates the information and memory stored throughout its life to every cell in the human body.
World Heart Day 20 years down the line may have a completely new meaning. Until then we should heed the advice we have at hand. We have no other.
What are cardiovascular diseases?
Cardiovascular diseases include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, and an unhealthy diet.
Globally, cardiovascular diseases are the number-one cause of death and is projected to remain so. If current trends are allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly from heart attacks and strokes).
Heart attacks and strokes are mainly caused by a blockage that prevents blood from flowing to the heart or the brain. The most common cause is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. The blood vessels become narrower and less flexible, also known as atherosclerosis (or hardening of the arteries). The blood vessels are then more likely to become blocked by blood clots. When this happens, the blocked vessels cannot supply blood to the heart and brain, which then become damaged.
Common symptoms
• Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first warning of underlying disease.
• Symptoms of a heart attack include: pain or discomfort in the centre of the chest; pain or discomfort in the arms, the left shoulder, elbows, jaw or back. In addition the person may experience difficulty in breathing or shortness of breath; feeling sick or vomiting; feeling light-headed or faint; breaking into a cold sweat; and becoming pale.
• Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.
• The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body. Other symptoms include a sudden onset of: numbness of the face, arm or leg, especially on one side of the body; confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; and fainting or nconsciousness.
What can I do to avoid a heart attack or a stroke?
HO estimates that more than 17 million people died of cardiovascular diseases such as heart attack or stroke in 2005. Contrary to popular belief, four out of five of these deaths occurred in low- and middle-income countries, and men and women were equally affected. The good news, however, is that 80 per cent of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention.
• Eat a healthy diet
A balanced diet is crucial to a healthy heart and circulation system. This should include plenty of fruit and vegetables, whole grains, lean meat, fish and pulses, and restricted salt and sugar intake.
• Take regular physical activity
At least 30 minutes of regular physical activity every day helps to maintain cardiovascular fitness; at least 60 minutes on most days helps to maintain healthy weight.
• Avoid tobacco use
Tobacco in every form is very harmful to health - cigarettes, cigars, pipes or chewable tobacco. Exposure to second-hand tobacco smoke is also dangerous. The risk of heart attack and stroke starts to drop immediately after a person stops using tobacco products, and can drop by as much as half after one year.
Check and control your cardiovascular risk
• Know your blood pressure
High blood pressure usually has no symptoms, but can cause a sudden stroke or heart attack. Have your blood pressure checked.
• Know your blood sugar
Raised blood glucose (diabetes) increases the risk of heart attacks and strokes. If you have diabetes it is very important to control your blood pressure and blood sugar to minimise the risk.
• Know your blood lipids
Raised blood cholesterol increases the risk of heart attacks and strokes. Blood cholesterol needs to be controlled through a healthy diet and, if necessary, by appropriate medications.
Next week, on the eve of the anniversary of the world's first pacemaker implantation, we look at how these devices have changed many lives.
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