Dr Brajesh Mittal, Deputy Medical Director, Consultant Interventional Cardiologist at Medcare Safa Hospital
Has the treatment of heart disease been successful? Are people living longer, healthier lives?
Cardiovascular diseases can be prevented to a great extent by modifying risk factors. People are able to live a better and longer life if they adopt these rightful measures. Even though awareness is all time high, heart disease continues to be the lead killer. We are seeing more patients in our clinics for health checks. More awareness, better screening and diagnostic tools are enabling people to reduce the impact of risk factors for heart attacks. But we are still very far from achieving our goal. If somebody suffers, timely intervention can prevent a lot of damage/deaths from acute heart attacks.
According to WHO, 17.4 million died of heart and circulatory diseases in 2004; this is likely to rise to 23.6 million by 2030. Deaths due to the heart-related diseases rank as number one killers. Although the incidence in the west has been declining in last two decades; this part of the world carries a high menace. WHO data clearly showed that the death rates due to these diseases are twice as high in the Middle East as in western countries. Data from DHA and HAAD suggest that atleast one in three patients die of heart related diseases: heart attacks being the number one.
Heart attack is an area where a lot of lives can be saved if proper actions are taken at the right time. Studies have also shown that many patients drive down in their own car or public transport; that should be avoided – the patients must be transferred by the ambulances, which are equipped with the resuscitation measure in case any catastrophe occurs on the way.
A DHA survey in 2015 showed the cardiovascular diseases to be number one killer — accounting for 28 per cent of all deaths. HAAD data of 2010 showed deaths due to cardiovascular diseases to be as high as 37.5 per cent. Priorities are to address the risk factors, that is obesity, high blood pressure, smoking, diabetes, high cholesterol and lack of physical activities. According to HAAD if these interventions are not done then the death rate would increase by 25 per cent in next five to six years.
Some unhealthy lifestyle habits have led to weight problems in this country. How does obesity affect the heart?
Unhealthy habits (poor dietary habits and lack of physical activities) lead to obesity. Obesity leads to more diabetes, hypertension and contribute to higher morbidity and mortality from heart diseases.
The threshold for cardiac arrests and cardiovascular disease (CVD) worldwide is 65 years, while people in the UAE are suffering from the CVD at an average age of 45.
What sort of changes have occurred in the cardiovascular field over the past several decades?
The GCC heart registry has all important data on CVD in the UAE, which helps us get a clear picture of the challenge we face. We have begun screening people at a younger age of 35 for CVD, to be able to catch the condition early and intervene. The government has levied taxes on carbonated and energy drinks, and cigarettes to discourage these habits.
Curbing obesity in the early stages is important and the health authorities have introduced health plans in schools, serving healthy and nutritiously balanced food in schools as well as running fitness programmes. These and many other initiatives will help us educate the community, create greater awareness about heart conditions and tackle this issue.
To prevent heart disease, people have to know what to look for. What are some symptoms that might indicate a problem?
Chest pain (and sometimes easy fatigue/ breathlessness/quick rise of heart beats) on exertion should prompt people to seek further evaluation.
Sudden severe compressive chest pain with nausea/sweating/dizziness/breathlessness can indicate a developing heart attack and urgent medical help must be sought.
There is considerable evidence that the onset of cardiovascular diseases may be delayed or prevented through interventions aimed at modifying risk factors and it is, therefore, appropriate to dedicate time and effort on key primary prevention strategies such as smoking cessation, alcohol reduction, healthy dietary habits, weight reduction, etc.
Our mission in this order is to prevent the first attack; treat it fast if it happens; do our best to prevent any further attack.
Once treated for heart disease, can an individual ever be free of it?
Once somebody is treated, the further episode in the life can be prevented to a great extent; thanks to good medicines, and proper execution of lifestyle measures.
Dr Farzad Ghaedi, General Practitioner, Medcare Al Safa Hospital
Climate change, together with other natural and human-made health stressors, influences human health and disease in numerous ways. Some existing health threats will intensify and new health threats will emerge. Not everyone is equally at risk. Important considerations include age, economic resources, and location.
Some heat-related illness and death risks have diminished in recent decades, possibly due to better forecasting, heat-health early warning systems, and/or increased access to air conditioning for the population. However, extreme heat events remain a cause of preventable death nationwide. Urban heat islands, combined with an aging population and increased urbanisation, are projected to increase the vulnerability of urban populations to heat-related health impacts in the future.
Public health can be affected by disruptions of physical, biological, and ecological systems, including disturbances originating here and elsewhere. The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health.
Climate change is already impacting health in a myriad of ways, including by leading to death and illness from increasingly frequent extreme weather events, such as heatwaves, storms and floods, the disruption of food systems, increases in zoonoses and food-, water- and vector-borne diseases, and mental health issues. Furthermore, climate change is undermining many of the social determinants for good health, such as livelihoods, equality and access to health care and social support structures.
These climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, ethnic minorities, poor communities, migrants or displaced persons, older populations, and those with underlying health conditions.
What are the diseases associated with long-term exposure to pollution and what effect do these diseases have on a person’s vulnerability to respiratory and lung-related issues?
The health effects of air pollution remain a public health concern worldwide. Exposure to air pollution has many substantial adverse effects on human health. Globally, seven million deaths were attributable to the joint effects of household and ambient air pollution. Subjects with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma are especially vulnerable to the detrimental effects of air pollutants. Air pollution can induce the acute exacerbation of COPD and onset of asthma, increase the respiratory morbidity and mortality. The health effects of air pollution depend on the components and sources of pollutants.
Combustion of solid fuels is a major source of air pollutants in developing countries. To reduce the detrimental effects of air pollution, people especially those with COPD or asthma should be aware of the air quality and take extra measures such as reducing the time outdoor and wearing masks when necessary or reduce the air pollutants indoors, people should use clean fuels, burn fuel more efficiently and vent emissions to the outside. Air cleaners that can improve the air quality efficiently are recommended.
More people have started complaining about post-Covid ailments and health issues. What is causing these issues?
While it’s clear that people with certain risk factors (including high blood pressure, smoking, diabetes, obesity and other conditions) are more likely to have a serious bout of Covid-19, there isn’t a clear link between these risk factors and long-term problems.
For some people, coronavirus disease causes symptoms that last for weeks or months after the infection has gone. This is called post-Covid-19 condition or “long Covid”. Although most people with Covid-19 experience mild symptoms or moderate illness, about 10-15 per cent of cases progress to severe disease, and about 5 per cent become critically ill.
SARS-CoV-2 can attack the body in a range of ways, causing damage to the lungs, heart, nervous system, kidneys, liver and other organs. Mental health problems can arise from grief and loss, unresolved pain or fatigue, or from post-traumatic stress disorder (PTSD) after treatment in the intensive care unit (ICU).
In recent years, there has been an increase in the incidence of respiratory illnesses. How can one persuade society that protecting the environment is also protecting our health?
Available evidence indicates that efforts to improve air quality lead to rapid improvements in health, which have been noticed as little as one week following reduced exposure. For example, reductions in air pollution leading up to the 2008 Olympic Games in Beijing resulted in lower biomarkers of inflammation and higher birthweights among residents. When pollution levels later rebounded, these indicators deteriorated.
This experience highlights the importance of maintaining air quality regulations during shocks such as Covid-19, despite pressures that may emerge to relax such regulations in the light of a temporary improvement in air quality or a push to reduce the compliance costs associated with such regulations.
Good air quality not only has the merit of potentially reducing the vulnerability of individuals and communities to pandemics similar to Covid-19, but also of generating wider benefits for public health, well-being and resilience.
