Feature: World Heart Day
By Mussarat Hussain

WORLD Heart Day is being observed today (Sunday) under the aegis of the World Health Organisation (WHO) with a concern over growing incidence of heart problems in the developing countries, especially in the South Asian countries, prompting health authorities to map out working plans to surmount the fatal disease. The theme of this year's World Heart Day is "Teenagers".

According to a conservative estimate about 1500 people died of heart attack alone in the Punjab during 2003 which was five percent higher than year 2002. It points out the sketchy data available with various hospitals here.

Data with Federal Health Ministry shows that three thousand people suffering from heart ailments died all over the country in the same period, showing three percent over all increase. "We lack record of deaths caused by heart problems in the province", noted cardiologist Prof. Muhammad Azhar of Punjab Institute of Cardiology observed saying we can get 200-year old record at John Hopkins Hospital at Baltimore, USA.

Health experts have criticised lack of death records at the hospital saying that cause of deaths in our hospitals are simply notified as "cardiac arrest" that prevents determining the exact nature of disease and changing pattern of treatment, thereby hindering advancement in medical research.

Heart disease is rapidly spreading all over the world. In some countries it has emerged almost as an epidemic. Most of the cardiac diseases are preventable. This year the World Heart Day is being observed to focus on the causes and prevention of heart diseases, particularly in children and adolescence.

"The major cause of heart disease is high-cholesterol, which is in many cases inherited in families and is also increased in young children and adolescence with the result that unless it is detected early it causes problems at a very young age", eminent cardiologist Dr. Naeem Tareen observed.

Despite strict ban on sale of cigarette to the under-aged, smoking is increasing among school children which can be witnessed outside schools or the examination halls when "exhausted" children light cigarettes immediately coming out of the examination halls.

Another major reason of heart disease, particularly in Pakistan, is rheumatic fever which usually damages the heart valves. In order to prevent this damage, patients with rheumatic fever should get prophylaxis and get antibiotics, Dr. Naeem observed.

Great advancement has been made in treating and diagnosing valvular and congestive heart disease including non-invasive tests as echo-cardiograms, Magnetic Resonance Imaging (MRI) and trans-oesophageal echo-cardiogram.

All types of congenital heart diseases are treatable by surgery but unfortunately in Pakistan congenital heart disease is very common and there are very few medical centers where surgical treatment is available and affordable with the result that there has been quite a few patients particularly children who have gone to India to get medical care.

India has worked to create an impression that cardiac care is better in India than Pakistan. There are good medical facilities available in Pakistan but unfortunately we have not been able to attract and keep Pakistani-American Surgeons and Cardiologists in the government sector.

In adults, the last decade has shown great advancement in diagnosing and treating heart disease. These days heart disease is easily diagnosed by stress-tests, thallium stress test, echo-cardiogram and coronary angiogram. The role of surgery is on the decline and surgeries with limited thoracotomy are on the rise. Robot surgery is also being used in many centers in USA. Patient selection and follow-up of the patient is very important.

Gene therapy holds lots of promise with excellent results so far. Other big reasons for heart disease are smoking, diabetes, high- lood pressure, and pollution. Cigarettes advertisements alluring particularly young children needs a check.

"There should be screening of children in school and children should be detected for heart diseases including high blood pressure, and high cholesterol. This will not only markedly decrease the health bill and expenditure of the government but will also create employment opportunities for young doctors", noted cardiologist Dr. Tareen concluded.

Nine factors causing heart attacks

A major global study has found that the vast majority of heart attacks may be predicted by nine easily measurable factors which apply to virtually every region and ethnic group world-wide.

The Interheart study, one of the largest case control studies examining the importance of heart disease risk factors, looked at more than 20,000 people in 52 countries from all inhabited continents of the world.

The study was coordinated by Dr. Salim Yousuf, Professor of Medicine at the Michael G. DeGeorge School of Medicine and Director of the Population health research Institute at McMaster University and Hamilton Health sciences, Ontario, Canada.

Aga Khan University (AKU), Karachi was the coordinating centre for Pakistan with five centres in Karachi, Hyderabad Islamabad contributing nearly 1,400 subjects to the study.

Dr. Khawar Kazmi, Head, Section of Cardiology at Aga Khan University Hospital (AKUH), was the national coordinator.

The study found that the most significant risk factors are cigarette smoking and an abnormal ratio of blood lipids (appropriate in B and A-1), which together account for two-thirds of the global risk of heart attack. Additional risk factors include high blood pressure, diabetes, abdominal obesity, stress, inadequate consumption of fruits and vegetables, and lack of daily exercise. Worldwide, these nine factors can collectively predict over 90 per cent of potential heart attack.

The Interheart study involved 15,152 individuals who had suffered one heart attack and 14,820 others who did not have heart disease but who were of the same age, gender and from the same city.

This major study is the first examination of whether risk factors for heart attack have a similar or different impact on all major ethnic groups and major areas of the world. It included 4,000 South Asians, 7,000 people of European extraction, 2,00 from Latin America, 1,400 Africans, 6,000 Chinese, 3,500 Arabs and 2,000 subjects from other parts of Asia. The Interheart study results were presented at the European Society of Cardiology (ESC) conference in Munich, Germany, in August 2004 and results were published in the prestigious medical journal-The Lancet on September 11, 2004.

According to Dr. Khawar Kazmi of AKUH, conventional wisdom had previously suggested that only half of the risk of heart attacks may be foreseen. However, the INTERHEART findings mean the overwhelming majority of heart attack risk may be predicted.

These factors appear to predict the majority of the risk in virtually every region, every ethnic group, in men and women and in the old and the young, said Dr. Kazmi. This suggests that the message of preventing cardiovascular disease can be quite simple and generally similar across the world, after taking into account economic and cultural differences.

“Since these risk factors may be modified, this study will change the way we look at heart attack prevention. It means we should be able to prevent the majority of premature heat attacks in the world. This is a landmark study”.

Dr. Kazmi explained that the study suggests that a combination of lifestyle changes including smoking cessation, healthier diet and increased exercise could lead to an 80 per cent reduction in the risk of heart attacks”, he said.

In this connection, AKU’s Smart Heart programme is also celebrating World Heart Day on September 26, 2004. The theme this year is “Children, Adolescents and heart Disease” and an education -cum-entertainment progrmme has been arranged on the day for school children at AKUH.●