How to address spike in heart disease cases, deaths, by NHF

•Study found eating refined grains was associated with an increased risk of premature heart disease, while whole grains consumption reduced risk

A Professor of Medicine, Consultant Cardiologist and Past Chairman of Nigerian Heart Foundation (NHF), Basden J. C. Onwubere, told The Guardian that the burden of heart diseases in Nigeria is significantly high, worrisome and appears to be steadily increasing. Onwubere said the diagnosis and treatment costs, as well as the medical effects of heart diseases, constitute a burden.

Onwubere, who is also the Past President, of the Nigerian Hypertension Society (NHS), Past Provost, of the College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Enugu, said there are several reports from various parts of the country on the current statistics on heart diseases in Nigeria. “One report says that cardiovascular disease is responsible for 33 per cent or ‘one-third’ of nearly half a million non-communicable deaths in Nigeria yearly. More reports are emerging,” he said.

Why the rise in heart disease in Nigeria? Onwubere blamed current changes in lifestyle: more sedentary lifestyles, taking alcohol in more than recommended amounts, eating diets that are not heart-healthy, smoking cigarettes, and others.

On the connection between COVID-19 and air pollution, the cardiologist said: “Yes, COVID-19 particularly, and air pollution to a reasonable extent made the situation in Nigeria worse. Effect of COVID-19 on heart diseases was extensively discussed during a recent World Heart Day celebration.”

On causes of heart diseases in Nigeria, he said the most common cause of heart disease in Nigeria is high blood pressure, commonly called hypertension. Others, Onwubere said, are infections and other non-communicable diseases like diabetes.

On recommendations on how to address the situation, the cardiologist said the problems with hypertension are mainly the low awareness level and the current high cost of treatment in Nigeria. He said less than 20 per cent of Nigerians who are hypertensive in Nigeria are aware.

Onwubere said the World Hypertension League recommended World Hypertension Day to improve awareness globally, including in Nigeria in the month of May every year. He said most societies- NHF, Nigerian Cardiac Society, NHS and others- comply with this programme and other activities to address the problem.

On the association of trans-fats, energy drinks and palm oil with rise in heart diseases, Onwubere said: “Trans-fats and energy drinks should be taken in recommended amounts, otherwise they constitute great cardiovascular risks.

“Palm oil when taken in quantities greater than recommended amounts can cause heart disease.”

On the affordability of treatments for heart diseases, the cardiologist said treatment for most types of heart diseases is currently done with high out-of-pocket expenses and costs are out of reach by most Nigerians. He said the government needed to fund the health sector appropriately, as well as ensure effective health insurance programmes.

Also, in commemoration of World Heart Day 2022, a Member of the Nutrition Committee, NHF, Mrs Dolapo Coker, disclosed that globally, heart disease is the number one cause of death worldwide, claiming 18.6 million lives yearly.

Speaking at the World Heart Day 2022 in Lagos, last week, she disclosed that at least 80 per cent of premature death from heart disease could be avoided if five main risk factors—tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol and air pollution are controlled.

Speaking further, she noted that a new survey by World Health Federation highlights the global concern surrounding the link between climate change and cardiovascular disease, with climate change and air pollution ranked as the third most serious issue in relation to cardiovascular health among the respondents.

She added that healthcare providers must help improve cardiovascular health and prevent cardiovascular death mortality by issuing regular reminders to at-risk groups about the dangers of extreme weather events, including tips on managing excessive heat events.

The first lady of Lagos, Mrs Ibijoke Sanwo-Olu, called for a comprehensive approach and strategy to ensure that people are aware of the threat that the disease poses.

Represented by a member, of the Committee of Wife of Lagos State Officials, Mrs Patience Ogunubi, said: “I’m excited to know that NHF is aligning with World Health Foundation to address the challenge.”

She added that The-bike-A Heart initiative is a good development on the importance of physical exercise.

She noted: “Cycling must be encouraged. Lagos is taking the lead to boost Non-Motorised Transportation. The state is working on infrastructure to ensure seamless implementation of Non-Motorised Transport plans.”

She also advised Nigerians, especially the youths to desist from an unhealthy lifestyle, such as drug abuse, lack of regular exercise, smoking excessively, alcohol, sugary foods and lack of regular check- up.

Communication Advisor, NHF, Mr. Abiola Awe, explained that Bike-A-Heart Route initiative, which would take place in Lagos Island and Mainland next month, is to encourage Nigerians to embrace healthy lifestyles through cycling.

Corporate Communications and Branding Manager, Quest Oil, Gerald More, disclosed that the organisation is embracing cleaner energy such as solar. He also stressed the need for improved health quality.

Chief Executive Officer (CEO), i-Fitness, Folusho Ogunwale, noted that due to harmful health lifestyle heart disease is found in older people. Nowadays, he said younger generations are victims of heart disease.

Meanwhile, in one of the first studies to examine the relationship between different types of grain intake and premature coronary artery disease in the Middle East, researchers found a higher intake of refined grain was associated with an increased risk of premature coronary artery disease in an Iranian population while eating whole grains was associated with reduced risk.

The study will be presented at the American College of Cardiology (ACC) Middle East and the 13th Emirates Cardiac Society Congress, taking place in Dubai, United Arab Emirates, October 7-9, 2022.

According to the researchers, previous epidemiological studies have reported an association between different types of grain intake with the risk of coronary artery disease. The current study evaluated the association between refined and whole grains consumption and the risk of PCAD in an Iranian population.

Premature coronary artery disease (PCAD) refers to an atherosclerotic narrowing of coronary arteries in males under 55 years old or in females under 65 years old. It is often asymptomatic early in the course of the disease but may lead to chest pain (angina) and/or heart attack with the progressive development of narrowing (stenosis) or plaque rupture of the arterial wall. Risk factors for PCAD include smoking, high cholesterol, high blood pressure and diabetes.

“There are many factors involved in why people may be consuming more refined grains as opposed to whole grains and these cases differ between people, but some of the most important factors to consider include the economy and income, job, education, culture, age and other similar factors,” said Mohammad Amin Khajavi Gaskarei, MD, of the Isfahan Cardiovascular Research Centre and Cardiovascular Research Institute at Isfahan University of Medical Sciences in Isfahan, Iran, and the study’s lead author.

“A diet that includes consuming a high amount of unhealthy and refined grains can be considered similar to consuming a diet containing a lot of unhealthy sugars and oils.”

Whole grains are defined as containing the entire grain, while refined grains have been milled—ground into flour or meal—to improve shelf life but they lose important nutrients in the process. The 2019 ACC/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease recommends a diet that emphasizes the intake of vegetables, fruits, legumes, whole grains and fish to decrease heart disease risk factors.

The study recruited 2099 individuals with PCAD from hospitals with catheterization labs in different cities and ethnicities throughout Iran who underwent coronary angiography (women aged ≤ 70 and men ≤ 60). In total, 1,168 patients with normal coronary arteries were included in the control group, while 1,369 patients with CAD with obstruction equal to or above 75 per cent in at least a single coronary artery or ≥ 50 per cent in the left main coronary artery made up the case group.

Participants were given a food frequency questionnaire for dietary assessments to evaluate dietary behaviours and evaluate the association between whole grain and refined grain intake and the risk of PCAD in individuals without a prior diagnosis of heart disease. After adjusting for confounders, a higher intake of refined grains was associated with an increased risk of PCAD, while whole grain intake was inversely related to a reduced risk of PCAD.

“As more studies demonstrate an increase in refined grains consumption globally, as well as the impact on overall health, it is important that we find ways to encourage and educate people on the benefits of whole grain consumption,” Khajavi Gadkari said. “Tactics to consider include teaching improved dietary choices in schools and other public places in simple language the general population can understand, as well as on television programs and by continuing to do high-level research that is presented at medical conferences and published in medical journals. Clinicians must also be having these conversations with each other and their patients.”