Coronary artery disease and its prevention
Dr Md Habibe Millat
Coronary artery disease (CAD) is a major public health problem in developing countries. Incidence of CAD is the highest in South Asian countries like Bangladesh, India, Pakistan, Nepal and Srilanka. Prevalence of CAD has been reported 11 percent in India in 2001. How ever, there is no published data for prevalence or incidence of CAD in Bangladesh. World Health Organisation has predicted, by 2020 up to three quarters of death in the developing countries would result from non-communicable diseases and CAD will top of the list of the killers. Incidence of CAD is 60-70 percent higher in South Asian countries than average European countries. People of south Asian countries has highest rate of death from CAD compare to any other population of the world. Death rate from CAD is 50 - 300 percent higher in our subcontinent than Europe, America, China, and Japan. Rate of premature death due to CAD is approximately 46 percent for male & approximately 51percent for female. In South Asian countries, 50 percent of heart attacks occur under age of 55 years and 25 percent of heart attacks occur under age of 40 years.Blood supply of the heart Coronary arteries (CA) carry pure blood rich in oxygen and nutrients for heart. There are three main branches. Right CA supplies right side of the heart, Left anterior descending artery supplies front of the heart and the Circumflex supplies the back of the heart. They surround the heart, lie on its surface and divide into tiny branches to supply every part of the heart. Blood flows through the centre of the CA, this is called lumen. The lumen can become narrowed, reducing the amount of blood flow through the artery or even can blocked the blood flow. This narrowing is the result of a build up of plaque in patches along the in the inside of the artery wall. This is known as atherosclerosis (a slowly progressive disease of arteries characterised by elevated intimal fibro fatty plaque formed by lipid proliferation and synthesis of extracellular matrix). There are many causes of atherosclerosis, commonly known as risk factors. Risk factors include smoking, diabetes, lack of physical activity, stress, raised cholesterol, high blood pressure, being over weight, age, gender and family history of heart diseases. Bulk of CAD is preventable or at least its occurrence can be delayed. Control of risk factors can prevent CAD. Some of the risk factors are inherited and beyond control such as Age, Gender, Family history of heart diseases. But other risk factors can be easily controlled or eliminated by changing life style. Family medical history Those people are in greater risk if one of their parents or a brother / sister suffers from angina pectoris (chest pain) or has a heart attack, has elevated blood cholesterol level or has high blood pressure or diabetes. Age and gender The risk of heart disease increases with age for both men and women. Women usually develop heart disease later than men but once a woman reaches menopause (cessation of menstruation), she can become just as susceptible. Life expectancy of male is 61 years & female is 60 years in Bangladesh which is lower compared to European and Americans. Diabetes About 3 percent male and 1 percent female population of Bangladesh suffers from Diabetes. Bangladeshi population are 5 times more prone to diabetes than UK population. Diabetes can cause heart disease, kidney disease, eye disease, nerve disease, stroke and poor circulation particularly in legs. Diabetes is a risk factor that you can control. If you have diabetes, taking steps to reduce your heart disease is very important. Follow your doctor's and dietician's advice, eat balance diet, keep your weight under control and exercise regularly. Above all you should maintain your blood sugar in normal level i.e. you should control your diabetes. Raised blood cholesterol levels Approximately 3 percent people of Bangladesh suffer from raised cholesterol level. This signal is a clear warning. A raised cholesterol level can lead to a build-up of plaque on walls of arteries and it is your body's way to notice you that you are at greater risk. Cholesterol level can be reduced by making changes to diet. Cut back on fat, especially saturated fats and eat more fruit, vegetables and fibre rich food. Smoking In Bangladesh 50 percent of male population are smokers (smoke & non smokeless form) and 20 percent of female population are smoker (majority of them chew tobacco with pan). Smoking increases the rate at which plaque builds up on artery walls. It also increases blood pressure and heart rate while narrowing arteries. This makes the heart pump faster but with less room for blood to move. In women, smoking interferes with the production of hormone, which is a natural protection against heart disease. Active and passive Smoking is an important health hazards. Cardiovascular effects of chewing tobacco (with pan) are similar of those of cigarette smoking. Smoking is directly related to coronary heart disease. Smokers are more prone to heart attack than non-smoker. Who survives heart attack, has double the risk of heart attack than non-smoker. Secondhand smoking is also harmful to the same extent. High blood pressure There are approximately 10 percent of male population and 15 percent of female population suffer from high blood pressure in Bangladesh. This is one of the greatest contributors to cardiovascular disease because it puts extra strain on the heart. Many factors contribute to high blood pressure, including obesity, alcohol, stress and a high salt-diet. Check your blood pressure regularly and know what the readings mean. Lack of physical activity This also raises the risk of developing coronary artery disease; perhaps even as much as high blood pressure, high blood cholesterol and smoking. Being overweight Being overweight puts excess strain on heart influences blood cholesterol and blood pressure. It can increase the likelihood of diabetes. Consult your physician to learn how to make necessary changes to your diet to reach healthy weight. Stress The relationship between stress and risk of heart disease, heart attack, stroke, high blood pressure is well documented. If you are using food, cigarettes etc to cope with stress, you should talk to doctor. For a healthy heart manage your stress. To minimise the risk of the heart disease is to tackle all these risk factor together. This is important because many of them are interrelated. Dr Md Habibe Millat, MBBS(Dhaka) FRCS(Edin) is Senior Specialist Registrar of Department of Cardiothoracic Surgery of St. James's Hospital, Dublin, Ireland
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