A new joint scientific statement from the American Heart Association and World Heart Federation shows that cardiovascular diseases (CVDs) are responsible for six million premature deaths per year. This could rise to eight million by 2025 worldwide. World’s leading experts in heart health converged on WCC 2016 in Mexico City to debate on how to reverse this trend and inspire action. OYEYEMI GBENGA-MUSTAPHA was there.
Your heart beats about 100,000 times a day. This is about 70 times per minute. The heart is a hollow, muscular organ; its major purpose is to circulate blood, which carries oxygen and nutrients around the body, including itself. For it to maintain this optimal function, four things must be avoided: High salt intake, hypertension, tobacco, and overweight/obesity.
A new scientific statement, “The Heart of 25 by 25: achieving the goal of reducing global and regional premature deaths from cardiovascular diseases and stroke” has warned that premature deaths from cardiovascular diseases (CVDs), which is already the number one cause of death around the world with a global cost of nearly US $863billion, could rise by up to 30 percent in women and 34 percent in men in the next decade if the risk factors are not ‘aggressively addressed’ by health practitioners and policymakers worldwide.
The joint statement from the America Heart Association (AHA) and World Heart Federation (WHF) studied global data on premature deaths from CVD in 30 to 70-year-olds. The research found that CVDs are responsible for almost six million premature deaths per year, but concluded that this could rise to nearly eight million by 2025. Breaking this figure down by region this represents considerable increases in premature deaths by 2025 including: Sub-Saharan Africa – 48 percent increase in women and 52 percent increase in men.
According to Director, Nigerian Heart Foundation, Dr Kingsley Akinroye, Cost-effective measures to reduce CVD risk factors such as obesity, tobacco use, salt regulation, and hypertension already exist, but they’ve not been widely implemented. He said governments at all levels have a vital role to play in ensuring improved heart-healthy environments in the county, by providing opportunities for people to make heart-healthy choices, through a combination of public education and national regulations such as salt targets.
He said the World Heart Federation and its members are putting a spotlight on creating heart-healthy environments and calling for a world where people do not face overwhelming displays of unhealthy fast food or unwholesome school meals, all of which often contain high levels of salt. Too much salt is a hidden killer. Excess salt leads to higher blood pressure, which is one of the main risk factors for cardiovascular disease, which poses a large economic burden to society.
“Limiting sodium, or salt, to 2,000mg a day is an important part of maintaining a healthy heart and treating heart failure. With a low Ejection Fraction (EF), your kidneys get less blood than they should. This makes them unable to rid the body of excess water and salt. So eating too much salt can lead to even more fluid buildup. It also increases your blood pressure, which makes the already weakened heart work harder. Many studies have looked at the health benefits from reducing salt in various parts of the world; successfully implementing national targets like salt reduction could not only save thousands of lives each year but also avoid millions of naira in health care expenses and thousands of cases of poverty from medical bills. Salt target could reduce CVD deaths by 11 percent. By reducing the risk of developing CVD in the first place, it would also prevent households from having to pay costly health care fees, which can lead to additional financial deprivation. The money will be saved mostly among middle-class families.”
Consultant Physician/Cardiologist, Lagos University Teaching Hospital (LUTH), Idi Araba, Dr Akinsanya Olusegun-Joseph explained that the risk of both stroke and coronary disease increase as the blood pressure rises above 110/75. Reducing the blood pressure in hypertensive patients, even those with mild hypertension, lowers the risk of stroke. The target blood pressure in this setting is not well defined, and should be individualised. A goal of <130/80 mmHg seems reasonable for most patients. If you have high blood pressure (hypertension), it is important to attempt to identify and exclude reversible (secondary) causes. The major goal of high blood pressure (antihypertensive) therapy is the reduction of cardiovascular disease (including stroke). In most persons with hypertension, especially those age >50 years, the primary focus should be on achieving a blood pressure <140/90 mmHg since that is directly associated with a decrease in CVD complications. In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mmHg. If you fall into the prehypertension range (120–139/80–89), the doctor will likely recommend lifestyle changes, including- Lose excess weight, exercise, limit alcohol to two drinks a day for men and one drink a day for women, cut back on salt and quit smoking.
On the role of tobacco as a factor in CVDs, Vice President, World Heart Federation/African Heart Network, Dr Vash Mungal-Singh said the risk increases with the number of cigarettes smoked and has been reported to increase the incidence of MI 6-fold in women and 3-fold in men compared to nonsmokers. “The chemicals in tobacco smoke harm blood cells and can damage the function of the heart and the structure and function of blood vessels. This damage increases the risk of atherosclerosis. Smoking decreases the tolerance for physical activity and increases the tendency for your blood to clot. It decreases the HDL (good). Risk for heart disease increases greatly if one smokes and have a family history of heart disease. Smoking also creates a higher risk for peripheral artery disease including aneurysms.
“Smoking is also an important risk factor for stroke. Inhaling cigarette smoke produces several effects that damage the cerebrovascular system. Women who take oral contraceptives and smoke increase their risk of coronary artery disease and stroke significantly. Over time, CAD can lead to chest pain, heart attack, heart failure, arrhythmias or even death. Smoking by itself is a major risk factor for heart disease. When combined with other risk factors—such as abnormal cholesterol levels, high blood pressure, overweight, or obesity and/or diabetes —smoking further raises the risk of heart disease. Smoking also is a major risk factor for peripheral arterial disease (PAD). PAD is a condition in which plaque builds up in the arteries that carry blood to the head, organs, and limbs. People who have P.A.D. are at increased risk of heart disease, heart attack, and stroke. It is also important to avoid other people’s smoke. The link between secondhand smoke and heart disease is well known. Each year about 38,000 people die from heart and blood vessel disease caused by other people’s smoke. Non-smokers who are exposed to secondhand smoke at home or at work increase their risks of developing heart diseases by 25 to 30 percent. It will do a lot of good to quit smoking if one already has heart disease, as the lungs can begin to heal themselves as soon as one stops harming them with more smoke.”
On how obesity/overweight leads to CVD, Dr Akinroye said overweight and obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Body Mass Index (BMI), a measurement which compares weight and height, defines people as overweight when their BMI is between 25 kg/m and 30 kg/m, and obese when it is greater than 30 kg/m. Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, high blood pressure, certain types of cancer, and osteoarthritis. Obesity is most commonly caused by a combination of excessive dietary calories, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illnesses. Since many of the negative effects of obesity on health are manifested in chronic diseases, it is encouraging that control of other risk factors for cardiovascular disease, such as high cholesterol and hypertension, has improved over the past 40 years, particularly among those who are overweight or obese. An important exception to this trend is diabetes, the prevalence of which is at an all-time high and continues to increase rapidly. Improved treatment of obesity-related diseases is thus vital to improving the nation’s health. The primary and best treatment for obesity is proper nutrition and physical exercise. In severe cases, surgery (gastric bypass) may be needed to reduce stomach volume and the ability to absorb nutrients from food.”
Mrs Mungal-Singh said: “The conclusions of this study are clear: to stop people dying prematurely from cardiovascular disease we need both the political will and a firm commitment from health leaders to put in place some progressive strategies right now.
“To help health leaders enact practices and policies to meet these targets and protect their populations from premature cardiovascular deaths the study also makes several practical recommendations on how to meet these targets, including: Laws to enact smoke-free indoor work places, public places and public transportation. Higher taxes on tobacco products in order to fund tobacco control programmes, and complete bans on all forms of advertising and promotion of tobacco products. Policies to reduce sodium in packaged foods, and public awareness campaigns around diet and physical activity. Funding drug therapy and counseling for people who have previously had or are at high risk of having a heart attack or stroke. And fiscal methods that increase the price of foods high in saturated and trans fats and sugar.”
