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How to prevent cardiovascular diseases

By Paul Adunwoke
15 January 2017   |   3:53 am
Apart from congenital heart disease, CVDs are largely, chronic disorder developing more often than not, insidiously; throughout life and usually progressing to an advanced stage by the time symptoms occur.


Consultant Cardiologist at the Lagos University Teaching Hospital (LUTH), Lagos State, Dr. Akinsanya Olusegun Joseph, in this interview with PAUL ADUNWOKE, spoke on ways of preventing, treatment and management of cardiovascular diseases.

What are cardiovascular diseases?
Cardiovascular diseases (CVDs) are a group of disorders that affect the heart and blood vessels. They are the leading causes of death globally, including coronary heart diseases, cerebrovascular diseases, hypertensive heart disease, valvular heart diseases, congenital heart disease, peripheral vascular disease, heart failure, heart muscle disease cardiomyopathies, among others.

Apart from congenital heart disease, CVDs are largely, chronic disorder developing more often than not, insidiously; throughout life and usually progressing to an advanced stage by the time symptoms occur.

What are the symptoms to watch out for?
There are varying symptoms and signs depending on the particular disease. Common complaints, however, include, exertional chest pain, central or left side chest pain that occur during activities or exertion and relieved by rest or some specific drugs.

For some patients, the pain can occur during an emotional outburst. Pain typically, last few seconds to minutes, can spread to the left shoulder and upper limb. In the worst case scenario, the chest pain can occur at rest, or can be very excruciating and may last for several minutes to hours or may lead to death when there is heart attack.

Difficulty in breathing on exertion, which may progressively worsen to a point where the patient can be breathless at rest. Other patients may experience difficulty in breathing while lying down, necessitating the need for more pillows to sleep. In the worst case scenario, the patient would not be able to sleep even while seated or propped up. Also, patient may wake up often gasping for air.

Awareness of heartbeat, better known as palpitation is also a common symptom. Here, irregular heartbeat, a major cause of palpitation may be the patient’s complaint.

Another symptom is cough, which may be dry initially, later become productive of whitish, frothy foamy sputum.

Patients with stroke can present with sudden weakness of the face, arm, or leg, usually of one part of the body, with reduced or loss of function of the upper or lower limb of the affected part.

Other symptoms include, sudden onset of numbness of the face, arm, or leg, especially, on one side of the body; sudden loss of balance or coordination. Before stroke sets in, patient may have sudden, transient loss of vision of one eye, lasting few seconds to minutes.

Patients with peripheral vascular disease can present with activity induced numbness or pain, usually in the lower limb, initially, which can progress to numbness/pain at rest of the lower limb.

How can cardiovascular diseases be prevented?
Prevention of CVD, ideally starts during pregnancy and lasts until the end of life. The reason for this is because certain conditions or situations during pregnancy can predispose the unborn child to cardiovascular diseases. For instance, a woman who smokes or takes alcohol, especially during pregnancy can put the unborn child at risk of developing congenital heart disease, including hole in the heart. A baby with intrauterine growth retardation, poor growth while in the womb, with resultant low birth weight is at risk of developing CVD, later in adult life when compared with babies born with normal weight.

On the other hand, very big babies at birth (usually of diabetic mothers) have an increased risk of developing diabetes and CVD as well later in life.

However, prevention types can be divided into primary, secondary and primordial types. Primary prevention is targeted at those at high risk of developing a first cardiovascular event. For instance, men and women with combinations of smoking, elevated blood pressure (BP), diabetes or dyslipidemia.

This basically, involves lifestyle modification and treatment of identified risk factors in high-risk patients.

Secondary prevention is targeted at those with established CVD, post-stroke, post-myocardial infarction. These are strategies aimed at preventing a recurrence of the CVD they had encountered. This also involves lifestyle modification, treatment of the risk factors, the CVD, and co-morbidities.

Primordial prevention are measures targeted towards preventing the expression or appearance of risk factors. This may include measures put in place even before birth, like good antenatal care, avoiding risk factors that can predispose the unborn child to cardiac diseases like congenital heart disease, for example smoking as highlighted earlier, irradiation during pregnancy.

Also avoiding infections, especially torches complex toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and syphilis.

Furthermore, as much as possible, every form of nutritional deficiencies should have been corrected before pregnancy to eliminate the deleterious effects, which include congenital heart disease on the unborn child. Educating the populace, especially our women are key in this regard.

Factors that would prevent the possibility of developing hypertension, diabetes mellitus, obesity, high cholesterol levels are also important in primordial prevention. Eating right, maintaining healthy weight, avoiding smoking, exercising regularly are all geared towards preventing the development of risk factors.

This also means that very early in life the children are exposed to and taught the importance of eating healthy diets, non-exposure to smoking, regular participation in sports in school. Prevention strategies can also be individualised, or population institutionalised based. While individualised approach entails education, counseling on lifestyle modification, and treatment of risk factors, institutionalised approach has to do with educating and increasing awareness of risk factors for CVD, and how healthy lifestyles prevent CVD. It also involves making policies targeted at reducing the risk factors in the larger society. For instance, policies aimed at reducing salt and saturated fat contents in foods, as well as, doing away with smoking and similar tendencies could be encouraged. Tobacco and erring companies can be heavily tasked.

In addition to this, we can also have national days that would promote health. For example, national walk for life day; national exercise day, national cycling day among others.

Additionally, companies, organisations, schools, local government areas can also imbibe the above-institutionalised approaches. All these would help in having a healthy and a health-conscious society.

How does lifestyle contribute to CVDs?
Lifestyle is a major player in the prevention or development of CVD. The fact remains that 80 per cent of CVDs are preventable, and cultivating a healthy lifestyle is of utmost importance in this regards.

Healthy lifestyle practices help to lower the risk of developing hypertension, diabetes mellitus and obesity.

For those who already have the risk factors, healthy lifestyle practices help to reduce the risk of developing CVD.

Smoking cessation decreases the risk of developing hypertension, heart attack, and heart failure. It also decreases the risk of developing cancer, degenerative diseases of the brain like Alzheimer’s disease.

What types of food help in preventing cardiovascular diseases?
Food is very important in the prevention of CVD, just as it increases the risk of one contacting it. This is because eating healthy diets impact positively on the cardiovascular health and wellbeing of everyone.

Heart-healthy eating is very important and should be encouraged because increased salt has been implicated as a risk factor for hypertension, heart failure and heart attack.

Reduced salt intake is not limited to table salt, but includes salty condiments. Also, studies have shown that increase in salt intake gears the risk of developing heart failure, stroke and renal failure, whether the patient is hypertensive or not.

So, everyone is advised to increase the intake of fish, especially those rich in omega three fatty acid like Salmon. They reduce the risk of atherosclerosis by increasing the level of good cholesterol in the body.

It is important to also increase the intake of nuts like groundnuts, cashew nuts, and walnuts. Cereals and whole grains like oatmeal are also heart-healthy. They reduce bad cholesterol levels, increase the good cholesterol level, and reduce blood pressure and the risk of developing hypertension. They also reduce the risk of developing diabetes.

It is also important to reduce cholesterol and fatty meals as this would help in reducing the risk of accumulation of cholesterol in the blood vessels, which leads to the reduction of heart and blood vessel damage.

The intake of sugary food and drinks, red meat and processed meals have the same negative effects on our cardiovascular health.

Because fruits and vegetables have lots of anti-oxidants, which are beneficial to heart health, reducing the risk of atherosclerosis, heart attack as well as cancers, their increased intake is highly recommended. Apart from this, they also reduce the aging process, and improve the health of other organs like the brain and the kidneys.

Stopping or reducing alcohol intake is a great idea because increased alcohol intake can predispose one to hypertension, elevated fats, especially the triglycerides and heart attack.