Cardiovascular disease: know your risk profile

Posted on 15 October 2013

In South Africa, we are facing more than one epidemic: cardiovascular disease poses a serious problem to our population. Cardiologist Dr Phillip Mills, from Mediclinic Constantiaberg, explains.

How serious is the problem of heart health in South Africa?
One of the largest case-control studies that looked at risk factors for cardiovascular disease, the InterHeart Study (2004), looked at 30 000 subjects across 52 countries, and it’s the best study for seeing the risk factors in sub-Saharan Africa and South Africa in particular. In the total South African population, there are 800 deaths per 100 000 as a result of cardiovascular diseases. Every 10 minutes, one South African dies from cardiovascular disease. This is identical to the figure for HIV/Aids-related deaths. We are facing two mega epidemics at the same time. Now that we are seeing an emerging middle and upper class in the black population, we are seeing more cardiovascular problems within that group than before.

Apart from genetics and family history, what lifestyle factors are the greatest contributor to heart attacks?
The following five risk factors cause 90% of heart attacks.
1)    Smoking: Puts 39% of the population at risk.
2)    Hypertension (high blood pressure): Puts 30% of the population at risk.
3)    Diabetes: Puts 17% of the population at risk.
4)    Abnormal cholesterol: Puts 62% of the population at risk.
5)    Abdominal obesity: Puts 58% of the population at risk.
Psychosocial factors, like stress, also play a big role, as do diet and exercise. We need to pay attention to our intake of fresh fruit and vegetables, our alcohol intake, and know where we stand on the above risk profile factors.

There’s a perception that we only need to start looking after our heart health later in life. Is this a myth?
It is indeed. What the InterHeart study showed was that the average age of heart attacks in South Africa is 52, four years younger than in Europe. Cardiovascular disease starts in the teenage years, and just continues every decade therafter. At age 50, more than half of the population has sub-clinical heart disease. One American study of seemingly healthy 50-year-olds, in the normal weight range, found a third had underlying heart disease they were not aware of. And only one in 2 000 had none of the risk factors for heart disease. So by midlife, it is often too late. We need to improve our risk factors and look after our heart health far earlier.

South Africa has one of the highest rates of hypertension (high blood pressure) in the world, and it’s a major risk factor for heart attacks, strokes, heart failure and aneurisms.

Are there any symptoms for this?
Yes, we have one of the highest rates, and the black population show a 42% risk of developing it. Unfortunately, a third of patients die as a result of hypertension without knowing they have it. Cardiovascular disease is a silent killer. Get screened and know your risk profile. By 20, you should ideally know you have none of the five risk factors mentioned, and also consider the other three: exercise, diet, stress. Thereafter, you can get screened every couple years. But after menopause, women should be screened annually.

If I have many reasons to start caring for my heart – a family history of high cholesterol, a sedentary lifestyle and poor diet – what is the most important first step to take?
Many of the risk factors overlap, and by eliminating just one, you won’t reduce your risk of heart disease to zero. You can only do so by taking all five into account. It can be done: cardiovascular disease is 90% treatable. You can reduce your risk factors 100% – I know, I’ve done so personally.

If I have some risk factors, and haven’t exercised in a while, could I put myself in danger of having a heart attack if I were to start exercising vigorously?
Exercise over the long term is one of the most powerful ways or reducing your risk of cardiovascular disease. But if you start a vigorous exercise programme in mid-life, without knowing your risk factors, it could be dangerous. Just look at the cardiac arrests that happen on big race days, like the Cape Argus Pick n Pay Cycle Tour. People are often not aware they have sub-clinical heart disease. It is very important to be sure your profile is optimal before starting a vigorous new exercise programme if you are over 35.

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The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.

Published in Cardiology

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