Under 40? Start saving for that angioplasty if you don’t eat well or exercise, say experts

Genetics, bad eating habits, couch-potato syndrome put younger and younger Pakistanis at risk.

KARACHI: An angioplasty to clean out your heart pipes can cost at least Rs250,000 but sometimes patients need to undergo more than one, as it is not a permanent fix. What is infinitely cheaper though, is for people to eat well and exercise to avoid heart disease.

This simple message is however, not getting through to the average Pakistani, especially the under-40 crowd. Up to a quarter of the patients well known cardiologist Dr Asad Pathan sees are now in this bracket. “This is a very alarming trend which holds true for the entire South Asian region,” he told The Express Tribune on Friday at a session at the Tabba Heart Institute. In fact, up to 20% of the patients seen at Tabba, where Dr Pathan is a consultant cardiologist, show no other risk factors except for what they get from their genetics.

Heart disease is the number one cause of death worldwide, killing 17 million people annually. It is estimated that by 2020 the incidence of cardio-vascular diseases will rise by 111%. More specifically, the World Health Organisation estimates there were 675,657 deaths in Pakistan due to cardiovascular disease (CVD) in 2010. One in four people under the age of 40 years in urban Pakistan are believed to have underlying CVD.

What is it about the South Asian genetic pool which makes them more vulnerable to heart problems?

Medical director and chief of cardiology at Tabba Dr Bashir Hanif explains the phenomenon. “One reason is that the good cholesterol in the body is most of the time in the 20s or low 30s for South Asians,” he said. Normal HDL is more than 40, and the higher the better. Narrow heart vessels are another problem. The narrow vessels may cause blocks in the blood flow, which may cause angina or chest pain.

When speaking of surgeries, or more specifically coronary artery bypass grafting, doctors warn against deceptive numbers. According to the chief of cardiothoracic surgery at Tabba, Dr Khalid Rasheed, of the average 1,000 patients who undergo surgery at the institute every year, around five per cent are about 40 years old. This means close to 50 people in that age bracket undergo surgery each year. “Ten years ago that number [five per cent] was less than one. And 20 years ago the number was definitely zero,” Rasheed said.

Another disturbing trend is the shift from a dominance of non-communicable diseases from communicable or infectious ones in the last 15 years. “South Asia, Pakistan in particular, was already pressed by the burden of communicable illnesses such as TB and polio,” says Prof. Mohammad Ishaq, the executive director of the Karachi Institute of Heart Diseases. “Now we have to deal with a new set of illnesses such as hypertension, diabetes and heart-related complications.”

Of course, genetics are just one part of the picture. Smoking, a sedentary lifestyle and stress also lead to bad hearts.

Three of four deaths in developing countries are attributed to heart problems. Of these between 70% and 80% can be prevented by steering clear of smoking, whether passive or active. Tabba’s Hanif says personal measures need to be taken. “When my father refused to quit smoking despite my insistence, my children stopped talking to him till he eventually gave in,” Hanif said.

Thirty minutes of activity every day, preferably brisk walking, is highly recommended along with a balanced diet. Use the stairs instead of taking the lift. Be informed. “You need to know your numbers,” Hanif said.

This includes your blood pressure, cholesterol, blood glucose, waist-to-hip ratio and body mass index. Central obesity or excessive fat deposits around the hip and waist can prove hazardous to the health as well and need to be closely monitored.

Executive director at the National Institute of Cardiovascular diseases, Prof. Khan Shah Zaman recommends returning to our old values of eating out less and playing more sports on the street instead of staying glued to the TV or gaming console.

Published in The Express Tribune, October 3^rd, 2011.