Heart disease
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Highlights

  • Cholesterol levels are dangerously high among UAE patients, say doctors; citing latest data from 30,000 patients 
  • High lelves of bad cholesterol is a major risk factor in cardiovascular disease, which kills 4x more each year than COVID-19 in 20 months
  • Cardiologists weigh in on many factors, including lifestyle, stress and heredity, that lead to heart disease.
  • Know the dos and dont's of curbing CVD risk.

Cardiovascular disease (CVD) is a key risk factor for COVID-19. But by itself, CVD is far deadlier — with nearly 400% more deaths each year, compared to COVID.

For context, the deadly pandemic has so far claimed 4.55 million lives in nearly 20 months (from January 2020 to September 13, 2021), according to a Johns Hopkins University figures.

Fact: CVD kills an average of 17.9 million per year (3.93 times more than COVID), making it the leading cause of deaths globally, according to WHO data.

Dr Anil Cardiologist
Image Credit: Jay Hilotin / Gulf News / Supplied photo

Amid reports cholesterol levels are dangerously high among UAE patients, three cardiologists weigh in:

What is the main cause of cardiovascular diseas (CVD)?

There are many causes, instead of just one. Dr. Anil Prahalada Rao Kumar, consultant cardiologist at Aster Jubilee Medical Centre in Bur Dubai, describes CVD as a “range of disorders” that affect the heart and blood vessels.

Major causes include:

  • Hypertension
  • Stroke
  • Atherosclerosis
  • Peripheral artery disease
  • Vein diseases

What are the biggest contributor to CVD?

Dr. Srinivasan Kandasamy, Cardiologist at Zulekha Hospital, point to “fatty plaques” (or atherosclerosis) as the key driver behind CVD. Doctors point to the usual suspects behind cardiovascular disease:

  • Unhealthy lifestyle
  • Unhealthy diet
  • Lack of exercise
  • Obesity
  • High cholesterol, high blood pressure
  • Excessive alcohol consumption
  • Smoking
  • Stress

“Unhealthy lifestyle ranges from smoking, unhealthy diet, intake of salt-rich food or excess-calorie food, leading to obesity. These are the biggest contributors to increased fatality due to cardiovascular diseases,” said Dr. Kandasamy.

Dr. Srinivasan Kandasamy, Cardiologist at Zulekha Hospital, point to “fatty plaques” (or atherosclerosis) as the key driver behind CVD. Doctors point to the usual suspects behind cardiovascular disease:
Image Credit: Jay Hilotin / Gulf News / Supplied photo

What CVD risk factors are beyond control?

Two factors — age and heredity — are out of your control.

From what age does heart diseases typically start?

The risk of heart disease increases around the age 45 in men and 55 in women.

Does heredity play a part in risk factors for CVD?

Yes. Your risk may be greater if you have close family members who have a history of heart disease.

How does it start?

Current scientific evidence shows that chronic inflammation is a starting point of CVD, said Dr. Kumar. Chronic inflammation plays a key role in the “pathogenesis” (disease development) of CVD and coronary artery disease. This chronic inflammation, also known as “atherosclerosis”, is a major contributor to CVD incidence and deaths.

Dr Brajesh Miittal
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What does 'atherosclerosis' lead to?

Inflammatory processes involve the sub-endothelial area of the arterial wall, accumulating fat and fat-laden macrophages, among other cell types, said Dr Kumar.

Inflammation is only a response, said Dr. Kumar. “What promotes inflammation it is the disruption of the endothelial function. Inflammation also leads to thrombus formation, and multiple pathological consequences such as calcification, stenosis, rupture, or haemorrhage.”

In its advanced form, atherosclerosis is a major risk factor for coronary heart disease, stroke, peripheral artery disease, heart failure — or sudden death.

Is there something we can do about stress?

There's good stress and bad stress. “Stress is a part of life for just about everyone,” said Dr Kumar. “Sometimes it is not easy to recognise stress because we are caught up in the flow of life.

The good news: oxidative stress (imbalance between free radicals and antioxidants in your body) and systemic inflammation are modifiable by nutrition.

“We can also control these risk factors: excess food intake and physical inactivity, which contribute to the secretion of pro-inflammatory cytokines,” said Dr Kumar.

Cholesterol in UAE
Image Credit: Seyyed dela Llata / Gulf News

Is diet high in fat/meat increase CVD risk factor?

“Eating foods rich in trans fats increases the amount of harmful LDL cholesterol in the bloodstream,” Dr Kumar said. “This reduces the amount of beneficial HDL cholesterol. Trans fats create inflammation — then heart disease, stroke, diabetes, and other chronic conditions.”

“They also contribute to insulin resistance, which increases the risk of developing Type 2 diabetes. Even small amounts of trans fats can harm health: for every 2% of calories from trans fat consumed daily, the risk of heart disease rises by 23%.”

Dr. Brajesh Mittal, Consultant Cardiologist, Medcare Hospital Al Safa, said: "A diet rich in fatty food and meats definitely increases the risk of CVD. These (types of the food) lead to higher blood levels of bad cholesterol deposited in the arteries — causing blockages."

23%

Rise in the risk of heart disease for every 2% of calories from trans fat, according to Harvard Medical School cardiologist Dr Dariush Mozaffarian

What are the key sources of trans fat?

Trans fat can be found in:

  • Baked goods, such as cakes, cookies and pies.
  • Shortening.
  • Microwave popcorn.
  • Frozen pizza.
  • Refrigerated dough, such as biscuits and rolls.
  • Fried foods, including french fries, doughnuts and fried chicken.
  • Nondairy coffee creamer.
  • Stick margarine.

What's the problem with red meat?

red meat generic
Greater intake of total, unprocessed and processed red meat are known to be associated with a higher risk of CVD — independent of other dietary and non-dietary CVD risk factors, said Dr. Anil Prahalada Rao Kumar, consultant cardiologist at Aster Jubilee Medical Centre in Bur Dubai.

"There is some evidence that red meat alters the gut microbiome, leading to higher levels of certain metabolites and pro-inflammatory cytokines in the blood, which have in turn been linked to greater risk of heart disease,” he added.

Dr Kandasamy said studies show that “high-fat, high-calorie, high red meat-containing food, fried items — in whatever form, whether veg or non-veg — do contribute to heart disease.”

What processes are behind red meat intake that contributes to higher CVD risk?

Several mechanisms contribute to an adverse effect of red meat intake on risk of CVD, said Dr Kumar.

  • Increased blood levels of low density lipoprotein (LDL) cholesterol.
  • Red meat is low in polyunsaturated fat.
  • Excessive iron intake might catalySe several cellular reactions involved in the production of reactive oxygen species, thus increasing the levels of oxidative stress.
  • Scientists hypothesised that sialic acid N-glycolylneuraminic acid in red meat generates a pro-inflammatory, atherogenic (promotes formation of fatty plaques in the arteries) state in humans.
  • High-sodium content of processed meats is likely to increase the risk of coronary heart disease — by increasing blood pressure and vascular resistance.tO

To reduce CVD risk, what advice do you give to people?

Dr Kumar:

“Heart disease is a leading cause of death, but it's not inevitable. While you can't change some risk factors — such as family history, gender or age — there are plenty of other ways you can reduce your risk.”

Dr Mittal:

“Maintain a healthy life style — healthy food, low-fat, low-calorie foods, with fruits and salads, regular exercise, weight maintenance, yoga/meditation, adequate sleep, periodic check-ups after 40 years. Also monitor blood pressure, diabetes and cholesterol.”

Dr. Kandasamy:

“As a cardiologist, I advise people to maintain a healthy lifestyle, avoid smoking, take less calory and less fatty food — once in a while that’s fine, but not as a routine diet pattern. Try to take less salt, and less-calorie food. Take sugar/sweets, carbohydrates. Consume more protein-related diet, consume foods rich in dietary fibre, try to control your risk factors including diabetes, hypertension or any other risk associated with chronic morbidities.”

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Individuals with higher meat intake have smaller ventricles, poorer heart function, and stiffer arteries — all markers of worse cardiovascular health.

WHAT IS THE POLYPILL STRATEGY?

  • In a landmark study published in 2003, researchers found it is possible to reduce the risk of ischaemic heart disease (IHD) by up to 80%. The study, published in the BMJ, stated the “polypill strategy” leads to a proportional reduction in ischaemic heart disease (IHD) events and strokes, prevalence of adverse effects and life-years gained.
  • The “polypill strategy” study was led by N. J. Wald of the Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, University of London. In randomised trials, they found that the polypill strategy largely prevented heart attacks and stroke if taken by everyone aged 55 and older — and everyone with existing cardiovascular disease.
  • The formulation includes: a statin [i.e. atorvastatin (daily dose 10 mg) or simvastatin (40 mg)]; 3 blood pressure lowering drugs [for example, a thiazide, a β blocker, and an angiotensin converting enzyme inhibitor], each at half standard dose; folic acid (0.8 mg); and aspirin (75 mg).
  • Safety: Researchers showed that the Polypill would, depending on the formulation, cause symptoms in 8-15% of people and is “acceptably safe”.
Dos and dont's
Image Credit: Gulf News / Jay Hilotin