The New Straits Times, September 24, 2000
By Prof Dzulkifli Abdul Razak
"I LOVE my heart, let it beat" - this is the theme of the First World Heart Day observed today, the last Sunday of September.
Co-sponsored by the World Heart Federation (WHF), the World Health Organisation (WHO) and Unesco, the objective is to highlight the importance of a healthy lifestyle for a healthy heart.
Heart disease or more generally, cardiovascular disease (CVD), has emerged as one of the world's biggest killers. It is the main cause of death in developed countries, and by 2020 is expected to be the topmost cause of death in developing countries as well.
As observed by the WHF: "It is a disease without geographic, gender, or socio-economic boundaries."
The central message of World Heart Day is that heart disease is largely preventable and controllable. There are several ways to reduce risk factors, but the focus this year is on a simple one: physical activity, especially walking, which is not only the easiest but also the most convenient form of exercise for most people.
It also sends the message that individuals can take responsibility for their own health.
Other preventive steps include a healthy diet, not smoking tobacco products, maintaining a reasonable body weight, and avoiding stress.
Also to be avoided are higher lipid and sugar blood levels related to a sedentary lifestyle, obesity and stress. The general public, therefore, needs to know that everyone can reduce the risk of CVD - and indeed other chronic diseases such as diabetes and some cancers - by taking action to modify personal risk factors.
Earlier this year, the biggest community-based study on heart disease ever undertaken - the WHO Monica Project - was published in The Lancet.
The risk factors studied included cigarette smoking, blood pressure, blood cholesterol and body weight. Heart disease rates were reported to fall in most of the populations studied, as did cigarette smoking, blood pressure and cholesterol.
WHO, while noting that most of the trends are moving in the right direction, also said the increase in obesity, and in smoking among women, requires immediate public health action.
Taking all the study populations as a whole, decline in smoking seems to have contributed most to the reduction in male heart disease risk. In women, decrease in blood pressure emerged as the strongest determinant.
Overall though, it was found that the relation between the fall in heart disease rates and the change in risk factors was more apparent in men than in women.
A US study made available last month in the New England Journal of Medicine, further reiterated that healthier habits rather than better medicine may account for most of the dramatic drop in heart disease among women over the past two decades.
Researchers at the Harvard School of Public Health and Brigham and Women's Hospital found a 31 per cent decline in coronary heart disease as a result of healthier diets and quitting smoking.
For example, during the course of the study, participants' consumption of red meat dropped by 38 per cent, intake of trans-fats dropped by 31 percent, and use of high-fat dairy products decreased by 43 per cent. These changes were complemented by increases in consumption of cereal fibre, folic acid and fish.
At the same time, the smoking rate declined by 41 per cent. However, these gains achieved through healthy behaviour were somewhat offset by gains in weight - the number of overweight participants increased by 38 per cent.
The American Heart Association's journal Hypertension recently reported that regular exercise and weight loss can be a first option for treating overweight individuals with moderately high blood pressure. It may keep them from having to take anti-hypertensive drugs.
Reducing blood pressure through exercise and weight loss could move many people from an early hypertension (Stage 1) into the "high normal" category and many others from "high normal" to "normal", says study author Dr Anastasia Georgiades of Duke University Medical Centre, North Carolina.
The research also emphasised the importance of reducing blood pressure at times of increased mental stress. Adds the author: "Like high blood pressure itself, an exaggerated cardiovascular response to mental stress is an additional risk factor for heart disease. By lowering stress-induced blood pressure levels and altering other physiological responses to stress, exercise and weight loss may prevent future damage to blood vessels and the heart."
Those who followed the weight-loss diet and exercise programme, as well as those in the exercise-only group, showed an overall reduction in cardiovascular reaction to stress.
In short, the finding has special implications especially in developing countries where heart disease and stroke epidemics are rapidly advancing. WHF expressed concern that developing countries which have yet to overcome the "first wave" of CVD (rheumatic heart disease and Chagas' disease which result from infections), are already being hit by the "second wave" - ischaemic heart disease. The incidence of ischaemic heart disease is likely to rise sharply in the near future in these countries, due mainly to changing lifestyles - increased smoking, introduction of fast foods, and less physical activity.
This is especially so in the light of shrinking resources for health care worldwide. Moreover, WHO notes: "In the long run, a preventive approach with emphasis on better diet, more exercise and reduction in smoking will also prevent other non-communicable diseases, such as diabetes, certain cancers and chronic lung diseases." A recent WHF study predicts that, without an aggressive preventive action, the result will be a "global pandemic" of heart disease.
In Malaysia, the Ministry of Health has been advocating healthy lifestyles in various campaigns. It has also been approaching CVD appropriately by combining strong preventive efforts with essential medical treatment.
However, the number of Malaysians experiencing cardiovascular disease continues to be of concern. This, at least in part, is due to the people not heeding the health campaign messages seriously. For example, the number of smokers continues to rise despite numerous warnings, involving even youngsters.
It is therefore timely that we be reminded to love our heart and let it continue to beat in a healthy manner. It is time that we take charge of our own health, and make the right decisions by giving priority to health, including going for regular check-ups to detect any problem early. We must learn and practise stress control; live a tobacco-free lifestyle and in a smoke-free environment. Regular exercise is helpful as is a healthy and balanced diet.
Last but not least, do not forget to whisper to yourself: "I love my heart", everyday - and listen with care to its ceaseless rhythmic beats.
Recommended website: http://www.fi.edu/biosci/preview/heartpreview.html
