DESPITE a better understanding of cardiovascular disease (CVD) and advances in its treatments, CVD remains the number one killer in most industrialised countries. In 1997, 75% of cases admitted to government hospitals in Malaysia were due to cardiovascular disease.
Cardiovascular disease broadly covers disorders of the heart and blood vessels. Deaths due to the narrowing of arteries that supply blood to the heart muscles increased from 32.7% to 38.3% during 1965 to 1989.
It would surprise most Malaysians that CVD can be prevented. Health educators and professionals are finding it an uphill task as it is difficult to convince people of the benefits in the prevention of CVD when they have no disease symptoms. CVD is a progressive disease and it may take years before symptoms unfold. Many people do not realise that they may have it until they get a heart attack or stroke.
Rather than try to convince the masses to be pro-active in taking care of their heart, health professionals are taking the approach to identify those who are at significant risk of CVD but without symptoms as yet and offer active intervention; that is to provide them appropriate advice and treatment to reduce their risk.
Risk factors are factors that directly affect the development of the narrowing and hardening of blood vessels called atherosclerosis leading to CVD. The risk factors that play an important role in a person’s chances of developing cardiovascular disease are: age, gender, ethnicity, family history, diabetes, obesity, smoking, high blood pressure, lack of physical activity and high cholesterol.
CVD risk increases with age possibly due to the wear and tear of living. Men are at a greater risk of developing heart disease at an earlier age compared to women. This is attributed to the protective effect of the woman’s hormone oestrogen against heart disease until menopause when the risk becomes the same. South Asians, in particular, Indians, have a higher risk compared to other ethnic groups.
Some of these risk factors can be changed, modified or treated unlike the non-modifiable ones – you cannot change your age, gender or disown what you have inherited in your genes from your parents.
Coronary risk prediction chart
A coronary risk prediction chart is used by doctors to calculate an individual’s risk of having a heart attack or stroke over the next 10 years. This tool takes into account factors such as age, gender, cholesterol readings, blood pressure and whether the patient is a smoker or non-smoker or if diabetes is present.
Prevention strategies are called for if the calculation indicates that he is a high risk individual. These strategies focus on the risk factors that can be changed with diet, lifestyle modifications and, if needed, with medicines or herbs.
Managing modifiable risk factors
Diabetes increases heart attacks and strokes by two to three times in men and four to six times in women. This condition is due to the dysfunction of insulin, a hormone that maintains normal blood sugar level. Uncontrolled blood sugar causes damage to blood vessels and nerves. It is of utmost importance that diabetics learn to manage their blood sugar levels to reduce incidence of heart disease.
Studies conclusively prove that obesity is a major risk factor for CVD as well as other diseases such as Type II diabetes, hypertension, gall bladder disease and arthritic conditions. Granted it is a chore, diet and increased physical activity are the only ways to reduce and maintain body weight. Crash dieting is not advisable as it leads to a yo-yo effect in weight that causes more harm than good. Adopt an eating plan that can be sustained and as part of a lifestyle rather than one that takes the joy out of eating.
Cigarette smoking is known to decrease the good HDL-cholesterol and increase thickening of blood and clotting that contributes to the building of fatty deposit in the walls of the arteries. Heavy smokers who smoke at least 20 cigarettes a day have two to four times the risk of getting heart attacks than non-smokers.
The occasional puff is no assurance either as no level of smoking has been determined to be safe. If the thought of having to kick the habit turns you cold, take heart that studies show that within a few months of cessation, the risk of coronary heart disease starts to decline. A smoker who stops for two to three years reduces his risk to the level of a non-smoker.
High blood pressure literally pummels blood vessel walls, causing damage to its lining. The damage attracts more fat to be deposited on the vessel wall thus narrowing the lumen of the artery. A narrowed blood vessel requires more force for the blood to push through and this raises the blood pressure further. This creates a vicious cycle that ultimately leads to kidney damage and death unless blood pressure is reduced.
Obesity, excessive alcohol consumption, excessive salt intake and lack of physical exercise are also contributory factors to high blood pressure (hypertension). Diet modification, exercise and weight loss should be the first approach to reducing blood pressure.
To understand why a lack of exercise increases the risk of CVD risk is to recognise its benefits. Regular exercise strengthens heart muscle, raises good HDL levels, thins blood, reduces blood pressure, fights off the flab and imparts a general sense of wellbeing. Physical activity needs to be incorporated as a lifelong habit and encouraged from young.
Without doubt, high cholesterol contributes to coronary heart disease deaths. The standard healthy recommendation of a low-fat diet has little impact on cholesterol levels as 90% of the cholesterol in the body is a by-product of some of the body’s vital processes.
The solution is to totally avoid consumption of food that increases the production of cholesterol and to improve its removal from the body to prevent it from clogging the arteries.
Animal fats and excess trans-fatty acids raise LDL levels (harmful cholesterol) and lower HDL levels (“good cholesterol”). Trans-fatty acids are found in deep fried foods, processed foods, margarines and commercial baked goods such as pastries, cookies, doughnuts and crackers.
A diet high in fibre, whole grains, fresh greens, vegetables, fruits, garlic, onions, nuts and seed is excellent for removing excess cholesterol from the body. Marine fish are also good sources of fatty acids that help in lowering cholesterol levels.
Apart from incorporating diet and lifestyle changes, recent studies now affirm that guggulipid, a gum resin from the Commiphora mukul tree can help to remove cholesterol. A double-blind placebo-controlled study shows that by supplementing with guggulipid capsules containing 100mg guggulsterones daily over six months together with a low fat diet results in a 11.7% drop in total cholesterol, along with a 12.7% decrease in LDL cholesterol and a 12% decrease in triglycerides. At the same time it raises the total cholesterol/HDL cholesterol ratio by 11.1%.
Guggulipid has been used for over 2,000 years in Ayuverdic medicine for obesity and fat disorders. It has also been approved by the Indian health authorities for the treatment of heart disease. More than 300 tons of the resin is used annually for medical purposes in India.
Research shows that guggulipid works in various ways to reduce cholesterol levels due to its chemical structure and antioxidant properties. Baylor College of Medicine shows that the chemical structure of guggulipid blocks the FXR receptor (farsenoid X receptor), which regulates the conversion of cholesterol to bile acids. When bile acids reach a certain level in the body, FXR is activated to interrupt cholesterol being converted, which allows it to build up in the blood. By blocking the activity of FXR, guggulipid causes more production of bile acids, thus allowing the body to rid itself of more cholesterol.
Much as LDL has been blamed for the deposit of cholesterol in blood vessel walls, it was observed that this happens when LDL cholesterol becomes oxidised. Guggulipid’s antioxidant property thwarts the oxidation of fat, hence preventing it from being dumped along blood vessel walls. Guggulipid also reduces the stickiness of platelets and prevents them from clotting and blocking arteries.
Your heart is in your hands
Get your blood pressure and cholesterol checked. If you have more than one risk factor, your chance of developing cardiovascular disease increases. The greater the number of risk factors, the higher your chances of developing heart disease. Ask your healthcare provider to calculate your risk and start taking charge of your health.
Dept. of Public Health, Ministry of Health, Malaysia http://ncd.dph.gov.my
Williams et al, Primary Prevention of Heart Disease. The Pharmaceutical Journal (Vol 270)18 Jan 2003
Cheng A. et al, Reducing global risk for cardiovascular disease: using lifestyle changes and pharmacotherapy. Clin Cardiol 2002 May;25(5):205-12
Singh RB, Niaz MA, Ghosh S.,Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia. Cardiovasc Drugs Ther 1994 Aug;8(4):659-64
Uriza NL, Moore DD, Gugulipid: A Natural Cholesterol-Lowering Agent. Annu Rev Nutr 2003 Feb 26
n This article is courtesy of a panel of herbal medicine and natural healthcare practitioners. For more information, e-mail email@example.com .
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