Modern lifestyles not heart-friendly

Need to shift focus to healthy living

HEART problems are on the rise globally, and more acutely so in this part of the world. Dr C.G. Suresh, Senior Consultant Cardiologist at Mubarak Al-Kabir Hospital, discusses the causes and cures of some of the common heart diseases in Kuwait in this interview. Modern lifestyle, he blames, is the main culprit, and throws in an ethnic factor to it that puts most Asians at risk and you have a pernicious combination in this region. The expert cardiologist delves into the details of what happens to the blood vessels of the heart when that unfortunate event that we even today look upon as a final frontier before death — heart attack —occurs.

Question: What are the common heart problems you see in Kuwait?
Answer: The common heart problems, not just in Kuwait but all over the world, pertain to a disease that affects the blood vessels supplying the heart muscle. This vessel is the main source of blood to the heart muscle. What I am talking about is a disease known in medical parlance as atherosclerosis. People these days commonly develop this condition, which leads to the blockage of the artery.

Q: What happens when a person develops atherosclerosis?
A: Atherosclerosis basically is a condition in which bad cholesterol gets deposited in the blood vessel creating the block. There are many factors that can cause that block, particularly smoking. Then there are factors like high blood pressure, diabetes, high cholesterol, and also a strong family history of that kind of heart problem. Lack of exercise and overweight are also factors that can be instrumental in developing atherosclerosis.
When the blood vessel supplying blood to the heart muscle gets blocked, then you have a heart attack. What happens is that at the site of the fat deposition, the blood clots and the vessel is blocked, not allowing blood to flow through. This is when a heart attack occurs.

Q: How does a blood clot occur within the blood vessel?
A: What happens is that when fat deposits on a particular area the pressure there builds up. As blood squeezes through, the blood platelets get deposited over the fat tissue. This ultimately leads to the coagulation of blood.

Q: What are the other heart related problems?
A: Atherosclerosis is a commonly found problem, but there are other problems too. Problems related to the heart valves are also seen widely. Earlier valves were affected due to rheumatic heart disease. But now there are other problems that are known to affect the aortic valve in the elderly people.
Then you have diseases that affect the heart muscle itself, making it weak. These include certain kinds of infections, or some nutritional disorders.
These are also serious issues concerning the heart.
Then another major illness of the heart is the cardiac arrhythmia.
This basically involves the pace of the heartbeat, either it slows down abnormally or it speeds up abnormally. It’s also called rhythm disorders.
However, the worrying thing is that heart problems are rapidly on the increase.
Especially, the first problem I told you about, atherosclerosis. This is seen more among Asians than other ethnic groups.
When I say Asia, I don’t mean just the subcontinent, but also the Middle East. Our genes are more closely linked.

Q: So, it shows that there is a genetic factor to it, doesn’t it?
A: Definitely there is a genetic factor to it. And together with that, the rapidly changing lifestyles around the world provide for a rather dangerous combination. Look around you. Look at the growing number of automobiles on the roads.
With cars now being accessible to even people from the lower rungs of the economic ladder, lower middle class, exercise has dropped drastically. Everyone is leading a sedentary lifestyle.
Another hidden factor in this modern lifestyle is the pollution. Not much attention is being paid to this aspect of modernity when the health effects of modern living are studied. The pollution released from automobile exhaust has a big impact on our lungs and hearts. In the long term, I am sure a lot of studies are going to come out about how pollution is affecting the general health of populations around the world.

Secondly, our eating habits are also changing. Fast food culture is picking up. The problem with fast food is that we don’t know how the food is cooked. Especially the way cooking oil is used.
Oil is actually innocent, though it is blamed for most of our lifestyle sicknesses. The harm lies in how the oil is used.
You should not repeatedly boil the oil. However, this is what happens in most fast-food joints. The same oil is heated until it almost evaporates completely.
This kind of treatment of oil greatly increases the load of oxidants in the oil. Oxidants are very harmful to the blood vessels of the heart. Not just of the heart, but blood vessels everywhere in the body. Oxidants are behind the increasing number of stroke patients, as it affects the blood vessels in the brain, just as it is culprit behind the growing number of heart attacks.
Therefore, eating habits too play a very important role.

Q: What do the oxidants actually do? Do they accumulate as plaque on the walls of the blood vessels?
A: These oxidants are very injurious to the blood vessels, and corrode the inner lining of the blood vessels. They damage the blood vessels by scouring away the lining. The roughened surface of the blood vessel then becomes conducive to accumulation of cholesterol as fat is able to cling to these areas better. This in turn leads to the blocks that we discussed earlier.
So, to sum up, lack of exercise due to modern facilities, sedentary lifestyle and bad eating habits lay a lot of stress on the heart.

Q: Why do you think Asians are more vulnerable to this disease, because the problems of lifestyle are there everywhere in the world?
A: If you consider 50 years ago, the comforts of modern living were available only to the very affluent. The very affluent are only a small percentage of the population anywhere in the world. And so, the problems created by modern lifestyle were not seen rampantly in the population. However, now the situation has changed.
Thanks to finance on the one hand, and price wars among brands on the other, modern facilities, from cars to household appliances, all designed to make work easy, are available to all and sundry. So, the middle class, who form a sizeable chunk of the population, have got access to these comforts now.

However, in the West, there has been greater awareness of the harms of modern lifestyle, and people have already started moving into workout regimens and other ways of staying physically active, while simultaneously giving more importance to healthy diet. Fish and vegetables are important components in their diet.
In Asia, due to our economic progress in recent times, the focus is more on wealth generation than health. What I suggest is that the focus should always be on people’s wellbeing. Wellbeing is a very comprehensive term. Wellbeing doesn’t come from money alone. Cars and villas can’t bring you wellbeing. It comes from your physical and mental sound health.
Physical health comes from healthy living habits. And mental health comes from good relations and understanding between people within the family and society. Take for example countries like Canada are not as rich as some countries in the Middle East. However, their social index is on a higher scale. That’s what I mean by wellbeing. Canada has a strong social welfare system. There is a fair distribution of wealth in Canada.

The government in Canada has a strong system in place to take care of the poor. So socio-economic differences are not too steep, there is a balance. In Canada or the UK, whether you are rich or poor, your access to healthcare is the same.
If you are on a waiting list for some treatment, your case will be considered strictly on merit and nothing else.
So, it’s high time we shifted our focus to healthy living. Kuwait is of course doing a lot to increase awareness among the people to fight lifestyle diseases. We as people should also learn to appreciate the importance of health in our life, and give it some time every day by way of exercise. We must understand that both physical and mental health is the basis for everything else in life. Even to be professionally successful we need to be firstly of sound body and mind.

Q: You mean to say the there is greater awareness in the West on health issues than here?
A: Definitely the awareness is much more there than here. Also, the governments there have taken it as a priority to increase awareness and also create facilities for the people to make exercise part of their lifestyle.
If you track the trajectory of lifestyle diseases, they initially affect the rich or the affluent people in the society. Then there is a gradual shift because the affluent people get educated on healthy living and do the necessary changes to their lifestyles. Now, if you see, exercising in the morning and including salads in the diet are all part of the culture of the affluent all over the world. Whereas the lower middle class in many parts of Asia, are only now getting exposed to burger culture — for an average middle class Asian, driving his family down to a hip fast-food joint and having a great time was a dream he is now living. We have to make everyone aware and move towards a healthier way of living.
If you have a heart attack at the age of 40, your life undergoes a big change. That’s the productive years of your life, and your productivity will go down. You will not be able to work as you would like to. You will not be able to support a family. You may have your aged parents depending on you. So, if you don’t take health seriously, you run the risk of early heart attacks, which can defeat the very purpose you neglected your health for, material success.
When this happens on a massive scale, when you have more youngsters developing heart diseases, it affects the very productivity of a nation. So, this is also an issue of economy.

Q: Okay, now what are the signs that youngsters, or anybody for that matter, keep a lookout for? Is it the waist circumference, weight or anything else?
A: First of all Asians, including people from the Middle East, have to realize that they are a high-risk category for heart disease.
So, that puts us in a situation where we have to be alert irrespective of any other factor. While, yes overweight, waist circumference and so on are all indicators, I think, it’s better that we don’t wait for symptoms to show up, and that we change our lifestyle.
It’s only a matter of time. Because if a person who has a normal waistline today, is going to end up with an above-average waistline if he is not going to change his ways. So why wait for that situation to occur, start working from today, so you will be healthy throughout.
Secondly, sometimes weight and size parameters could be misleading. Asians are generally of a smaller stature. And our fat deposition is around the abdominal region, so it may not show up until it is really excessive.

Moreover, when I say lifestyle change, I am not asking you to undergo a huge leap from your current lifestyle. It’s easy to make exercise a part of your lifestyle. We all have cars, and it’s not practical to give up our cars and start depending on public transportation. But we can choose to park our cars a little away from where we want to go and take a small walk. Take stairs instead of lift.
Go out to a garden on a weekend instead of a restaurant. Play with your children. Or go to the zoo, and walk around to see the animals. These things help.
Talking about eating habits, you don’t have to give up all your favorite foods. But may be you can decrease the quantity of fatty, unhealthy foods, and include leafy, green salads to your diet. Eat fruits every day. Stress reduction programs will also help.

Q: What are stress reduction programs?
A: Yoga for example. It’s good for stress reduction. Prayer is also good for stress reduction. All activities that calm your mind and relax you mentally and physically are useful for stress reduction. But more important than anything else is to give up smoking.
I think these values have to be inculcated in children at a very young age. Schools should teach children these things. We must have programs in our schools to teach children the healthy way of living, the harms of smoking and bad diet and so on.
It is wrong to assume that heart problems begin at the age of 30 or 40. It starts much earlier than that. It’s like a pipe in your house. The problems don’t arise the moment rusting begins in the pipe. But the rust takes time to worsen to show as a leak or other problems. Similarly, the blood vessels of the heart begin to wear early if children are living unhealthy lifestyles. We hear of people suffering heart attacks at 25. It’s the result of slow deterioration from childhood. Atherosclerosis can start as early as 15. Just a few days ago, I had a heart attack patient who was just 27.
Earlier, we used to see heart attacks occurring only after 50 or 60. But now it’s happening at a very young age. Here in Mubarak Hospital we are doing a lot of research on heart diseases.
One of the pioneers of cardio-vascular disease in the region is Prof Mohammed Zubair. He is a Professor of Cardiology in the Faculty of Medicine, and I am fortunate to be working with him for the last many years.

Q: Can a person who has undergone a cardiac surgery live a normal life again? Or will he have to cope with many restrictions?
A: The reason we do an angioplasty, which is removing the blocks using a balloon, or a bypass surgery, if the patient has multiple blocks, is aimed at getting the patient back to normal life. A heart attack at 40 can cripple the person. So, the aim of a surgery is not only saving life, but also to bring the person back to normal by enabling him to do work again. We try to improve his exercise capacity. In 90 percent of the cases, the patient is able to live a very normal life after surgery.

Q: Don’t they have any restrictions at all in life after surgery?
A: Well, there will be some restrictions, like they are not allowed to lift heavy weights.

Q: That is for life, is it?
A: Yes, that’s for life, and he may also have to take some medication for a long time. But 90 percent of the patients are able to work and live as they used to before they underwent the surgery.

biography
Dr C.G. Suresh is Senior Consultant Cardiologist at Mubarak Al-Kabir Hospital, and Lecturer at the Faculty of Medicine. He did his MBBS and MD from Government Medical College in Trivandrum. He passed MRCP in the UK and did specialist training in cardiology in Manchester. He worked in the UK for some years before coming to Kuwait in 1995. Dr Suresh is the President of the Association of Indian Professionals (AIP).

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