Heart disease is part of a larger grouping called cardiovascular diseases, which include strokes and heart attacks; cardiovascular diseases, cancers and even mental illnesses are normally included in the NCDs.
These NCDs are generally caused by lack of physical activity, unhealthy eating, alcohol overuse, and inappropriate habits like smoking tobacco and marijuana, and can lead to heart disease, stroke, obesity, diabetes and some cancers. These are called disease risk factors.
Some risk factors, such as gender, age and genetics (family history) cannot be changed by individual activity: these are called non-modifiable risk factors.
The modifiable risk factors include obesity, unhealthy diet, high blood pressure (hypertension); high blood sugar (diabetes); high cholesterol; smoking (nicotine/marijuana), including exposure to smoke – sidestream smoking; alcohol overuse, and inactivity.
Present medical knowledge suggests we can prevent about 80 per cent of the suffering and death from NCDs if we adopt healthy habits.
Some of the ways to avoid any of the NCDs include:
• Maintain a healthy weight. Avoid overweight and obesity if possible. While the pharmaceutical industry has developed quite a few potent medications for promoting weight loss, at this time it seems that this set of medications can only be afforded by high-income countries. Thus for low and middle-income countries, obesity prevention programmes, as opposed to weight reduction, should be the focus, particularly targeting the paediatric population. Persons who are obese are also more likely to develop the other major cardiovascular risk factors diabetes, hypertension and high cholesterol (called dyslipidemia).
• Limit unhealthy foods and eat healthy meals. Generally speaking, the consumption of fresh fruits and vegetables are healthier options, while processed foods, in boxes and tins, tend to have too much salt, sugars, unhealthy fats and preservatives, and are not good for long-term health. It is hoped that the front-of-package labelling will soon become a reality here, and encourage individuals to consider ‘health’ when purchasing food.
• Drink lots of water and stay well hydrated. This is especially important in our already hot climate, and the experts predict even hotter days ahead.
• Limit sugar-sweetened Beverages (SSBs), strongly implicated in our alarming Childhood Obesity Statistics, and mindful that an obese child is very likely to become an obese adult. An ounce of ‘preventing obesity’ is better than a pound of ‘curing obesity’.
• Exercise regularly and be physically active. It is recognised that inactivity (‘laziness’) may be even more dangerous than smoking as a contributor to poor health. Reduce sitting and screen time, as these discourage individuals from being physically active.
• Get enough good sleep. Sleep medicine is an emerging specialty area of medicine, as it is recognised that the quality and quantity of your sleep cycle affects what happens during your waking hours. Adults should aim for five to seven hours of sleep every night.
• Go easy on alcohol and stay sober. Moderation is key.
• [The 11th Commandment of Health]: Thou shalt not smoke. Even exposure to the smoke from someone else – second-hand smoke or side-stream smoking- is dangerous, and can be deadly.
• Know your numbers. Family medicine is evolving to include more of what is termed ‘patient-centred care’: part of this involves the individual taking control of large portions of their health. Thus individuals are encouraged to monitor their blood pressure and blood sugars and to know what these numbers should be.
Perhaps before too long this may be expanded to include blood cholesterol levels. Of the three ‘medical disease’ risk factors hypertension, diabetes and high cholesterol, the order of potency is hypertension (least potent), diabetes, and high cholesterol (most potent). However when any two appear together, e.g. diabetes and hypertension, hypertension and high cholesterol, the potency of the combination rises markedly. The risk of a major cardiac event or stroke rises significantly if all three: diabetes, hypertension and high cholesterol, appear in the same individual, and the term ‘metabolic syndrome’, a condition associated with high risk for sudden death, heart attacks, strokes and a variety of severe medical problems, is used when obesity appears with the other three risk factors. Unfortunately, in some Caribbean populations with high rates of obesity, many patients have metabolic syndrome which contributes to the 80 per cent of people who die from cardiovascular disease.
All adults must avail themselves of the appropriate screening for breast, uterine, prostate and colon cancers. Thus mammograms, pap smears, PSA tests and colon cancer screening should be fitted into the schedule of all adults who treasure good health.
All adults should schedule their periodic health examinations, also called the annual checkup, with their family physicians. Those with established disease need to be monitored more frequently. Apart from prevention, the next step is early detection, in an effort to prevent severe or even life-threatening illnesses. We are witnessing our single public tertiary institution crumble under the load of patients who flock to the Emergency Department. You should not postpone seeing about your health until an accident or emergency develops.
Some, perhaps many, people feel that they only need to go to the doctor when they are unwell. In our population, the profile of illnesses suggests that this is unwise. Diseases like diabetes, hypertension and high cholesterol are all considered ‘silent killers’: they slowly ‘wear you down’ from the inside while you are totally unaware as, in most cases, there are no or very few symptoms. Thus ‘little’ symptoms like fatigue, poor concentration, deteriorating vision, disturbed sleep and many others are often attributed to getting old, needing a tonic, or under stress from too much work/too little pay/too little sexual activity or following WI cricket. When evaluated by a medical professional, any ‘warning signs’ can be detected early, and preventive action taken. On the other hand, when specific symptoms develop, this may signify advanced disease, and even emergency treatment (in the rare scenario that it can be quickly assessed) may not change poor outcomes in the immediate-to-long term.
Staying healthy does not require the same luck as winning the lottery, where only one or two people win. You don’t have to take a chance and hope you too can be a winner. Following a few sensible options, living a life of moderation, having an annual evaluation of your health status, and listening to the advice of your family physician, can go a long way to living well past three score and ten.
Dr Colin V Alert MBBS DM is a family physician.
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