Abu Dhabi: More than 70 per cent of patients who suffer from heart disease or have cardiac risk factors do not maintain the appropriate cholesterol levels to prevent a severe cardiac event, experts at Cleveland Clinic Abu Dhabi have cautioned.
A retrospective review of more than 30,000 patients at two Mubadala Health facilities — Cleveland Clinic Abu Dhabi and Imperial College London Diabetes Centre (ICLDC) — with heart disease or related risk factors found that the average LDL cholesterol was an alarming 140 mg/dL. This is three times higher than the acceptable level to prevent a heart attack in such patients.
Excessive LDL or ‘bad’ cholesterol in the body can build up as plaque in the walls of the arteries, causing them to narrow and blocking blood flow to the heart, leading to a cardiac event if left untreated. While an LDL cholesterol range of 100 to 129 mg/dL is acceptable for people with no health issues, this level is considered high for patients suffering from heart disease or those with risk factors.
In fact, about two-thirds of all patients with a major heart attack seen at Cleveland Clinic Abu Dhabi in the last three years had abnormal cholesterol levels.
“A patient with heart disease or those who have risk factors, such as diabetes, obesity and smoking, must aim to maintain LDL cholesterol levels below 70 mg/dL. Every point of increased LDL cholesterol increases risk of a heart attack by 25 per cent. The high bad cholesterol levels that we see in the UAE are shocking and need to be urgently addressed. We strongly urge people to have a regular heart health screening so that they can monitor these essential numbers, and avoid the loss of life and productivity especially among the younger population,” said Dr Hani Sabbour, consultant cardiologist at Cleveland Clinic Abu Dhabi’s Heart and Vascular Institute.
Dr Sabbour said understanding cholesterol levels require a multi-layered intervention approach from physicians and patients.
“There is an inertia towards medical therapy, especially in this age of ‘Dr. Google’ where patients self-diagnose and decide that they know best how to treat their health issues. They fall victim to misinformation about life-saving cholesterol drugs and refuse to follow prescribed treatment plans because of perceived side effects. We also see young high-risk patients who are not convinced that they can have a heart attack because no one wants to think ten years ahead right now,” Dr Sabbour said.
There is an inertia towards medical therapy, especially in this age of ‘Dr. Google’ where patients self-diagnose and decide that they know best how to treat their health issues. They fall victim to misinformation about life-saving cholesterol drugs and refuse to follow prescribed treatment plans ...
At the same time, he says, many general practitioners hesitate to offer aggressive treatments even to high-risk patients because of insufficient knowledge about the guideline recommendations, or a belief that lifestyle changes alone can help lower LDL levels.
“The desirable LDL cholesterol range isn’t the same for a healthy person and for those suffering from risk factors. This can be misleading because patients may believe that they are within their target levels when in fact are still at very high risk. Another thing to understand is that cholesterol-rich foods do not impact the cholesterol levels present in your blood, genetics does. So, lifestyle changes alone cannot fix this,” Dr Sabbour explained.
The diabetes risk
Another major risk factor that is causing a rise in cardiovascular diseases (CVD) in the UAE population is diabetes. According to the International Diabetes Federation, there are more than one million people living with diabetes in the UAE and another 1.2 million with pre-diabetes. Dr Sabbour, who is also a consultant cardiologist at ICLDC, said people with diabetes are two to four times more likely than others to develop cardiovascular disease.
“Insulin resistance causes an abnormal cholesterol profile, lowers HDL or ‘good’ cholesterol and increases LDL cholesterol and triglycerides — the waxy fats that give your body energy — which raise the risk of a heart attack. This is true even if a patient with diabetes has well-controlled blood sugar levels. That is why it is important that they also monitor their cholesterol and keep it within a healthy range, usually with a combination of good lifestyle habits, drugs and statins,” the doctor advised.
Dr Sabbour also said that underdiagnosed familial hypercholesterolemia (FH) is also responsible for abnormal cholesterol levels among local populations in the Gulf region. This is an inherited defect in how the body recycles LDL cholesterol. Those with FH are born with high LDL cholesterol levels, and it can reach above 190 mg/dL over time if not addressed. As one of the co-authors of a recently published study on this issue in Saudi Arabia, Oman, UAE, Kuwait and Bahrain, Dr Sabbour said that FH prevalence was found to be about three-fold of the estimated worldwide prevalence.
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“In 34,366 screened patient records, we found that every one in 112 patients had FH. Patients with FH have 20 times higher risk of developing heart diseases. Unfortunately, our study showed that most patients with FH had an elevated lipid panel. We recommend a national programme and policies for UAE-wide FH awareness, early screening and management of the disease,” he said.
Ahead of World Heart Day on September 29, Cleveland Clinic Abu Dhabi has launched a new heart health campaign, ‘Healthier Hearts, Together’, to educate people about the escalating problem of CVD in the UAE and how to prevent it.