Heart surgeon Alexander Manché argues that both nature and nurture are leading to the high prevalence of heart disease in our society. But while we have little to no control over nature, we can and have to regulate our lifestyles better.

World Heart Day, being celebrated on Monday, helps us evaluate our present cardiovascular status another year down our lifeline. For most of us, primary prevention remains the goal: the indefinite delay of a cardiovascular event by means of a healthy lifestyle, with medications to address any specific problems such as hypertension.

For some who have already experienced a heart attack or an intervention such as a bypass operation or a stent implantation, secondary prevention goes a step further and includes medications that address risk factors that have led to the event as well as others that help to mitigate any complications that may arise from the event, such as heart failure or rhythm disturbances.

All disease results from the genes we are dealt at birth, our nature, and the way we subsequently live our lives, our nurture. Both are important, and it would be wrong to dismiss the latter and blame destiny for all our woes.

When it comes to heart disease we lump nature and nurture into one group of risk factors that are known to increase our chances of premature death. Some of these risk factors are easily categorised as nature, and, as yet, we are unable to alter them. I am referring to gender, age and family history.

Others are clearly within the realm of nurture, such as smoking, exercise and diet. One would expect to have a handle on these and do the right thing at will. We refer to these as modifiable risk factors. Still others like hypertension, diabetes and high cholesterol fall into a grey area, with contributions from both nature and nurture.

In this day and age we are all well aware of the three major healthy lifestyle requirements of smoking abstention, exercise and a healthy diet. There is no mystery about the first: no smoking, active or passive, ‘social’ or otherwise.

Exercise need not involve sophisticated machines or regular gym classes. One only need imagine life before the motorcar and the computer: walk to your destination or walk for pleasure, live the experience rather than visualising it on a screen. Use the stairs, swim and travel abroad. These are activities we are all capable of accomplishing.

Diet is more complex. Major industries have been built around distancing us from simple, freshly prepared foods, and into packaged, addictive foods and drinks for our convenient consumption, and for the companies’ enrichment.

Moreover, even when one makes a serious effort to steer away from processed foods, one never knows what pesticides, antibiotics, steroids, etc have been injected into the food chain along the way. Nevertheless, there is dubious food and outright junk food, and we should strive to minimise the damage whenever we eat.

We have paid a high price with stress-related disease, which alas includes heart disease, our number-one killer

When it comes to stress, matters become more complex. Is stress a lifestyle factor? Is it modifiable? Stress is certainly part of, as well as a response to lifestyle, a response with negative connotations, and an entity that is certainly not easily managed. We experience the patho-physiological effects of stress on our body when we develop symptoms such as palpitations, headaches, rashes, nervous ticks, runny tummy and a whole host of other complaints.

We can explain many of these responses in terms of stress hormones which are secreted in surges whenever we encounter a difficult situation, be it real or perceived. We may have developed simple techniques such as deep breathing and relaxation to deal with the acute events.

We may also have learnt to package this stress into manageable bites and to escape it artificially for short periods on a daily basis and for longer stretches on holidays. But in the end why indeed are we stressed?

Simply put, it is change that stresses us – anything that makes us venture from our ancestral world of simplicity, where survival depended on hunting and gathering, with intervening periods of rest. Although this very change is what helped us evolve into the dominant species we are, individually we have paid a high price with stress-related disease, which alas includes heart disease, our number-one killer.

So, each time you wake up in the dark hours, drive through congested traffic, inhale ubiquitous pollutants, put up with constant noise, deal with complex work-related frustrations, hunt for that elusive parking spot, attempt to keep abreast of technology, and possibly come home to yet more worries, you are contributing to the evolution of the species and killing yourself in the process.

This year’s World Heart Day focus is on heart-friendly environment. Let us all make a unified effort to address these long-standing issues of modern life before stress grinds us to a halt. It may seem like an impossible agenda, but if we had to leave it to the next generation it would certainly grow and fester.

Rome was not built in a day. Our concerted efforts will steer us towards a future heart-friendlier Rome, hopefully one conducive to a longer and happier life.

Mr Manché is senior surgeon and chairman of the cardiothoracic department at Mater Dei Hospital, and a founder member of the Malta Heart Foundation.