Cardiovascular disease is a silent killer. It is up to us to mitigate the risks by committing to a healthy lifestyle and keeping our cholesterol in check. Consultant cardiologist Dr Alexander Borg tells Adriana Bishop how patients can help themselves.
If there is one thing we have all learnt in the past two years it’s that there is nothing more precious than our health. And yet, finding time to dedicate to our health is always a struggle, something that needs to fit in with the rest of our life.
Keeping our body in good running order is a lifetime commitment. But committing to changing our lifestyle and our diet for the sake of our health is invariably met with: “No chance, too busy.”
“It’s hard to justify being too busy to care for your health,” is the prompt response from consultant cardiologist Dr Alexander Borg who has ditched his car and cycles everywhere, in an attempt to squeeze exercise targets into his packed schedule.
“People make excuses all the time about physical activity and we need to break out of that mentality”.
The odds are stacked against us. Malta holds the ignominious record as the most obese country in the EU. On top of that we’re also the least active of all Europeans. It then comes as no surprise that cardiovascular disease is the leading cause of death in Malta accounting for around 34 per cent of all deaths.
When you consider that 80 per cent of premature cardiovascular events can be prevented by addressing risk factors such as high blood pressure, high cholesterol, obesity, physical inactivity, smoking and psychological stress, then we can begin to acknowledge that the solution really is up to us.
A silent killer
Atherosclerotic cardiovascular disease (ASCVD) is a silent killer. Most of us live without any symptoms whatsoever as fatty deposits (plaque) silently build up in our arteries until it is too late, the plaque ruptures through the artery walls, the artery starts to bleed, forming blood clots that travel through the body leading to a heart attack or stroke.
ASCVD also causes kidney disease and sexual dysfunction in men. In fact it is more common in men manifesting itself around the age of 50, but after the menopause women experience an increased risk of ASCVD. By the age of 65 both men and women are equally at risk of ASCVD.
The stealth of the disease has led the Global Heart Hub, a non-profit alliance of heart patient organisations, to define sufferers as “an invisible nation”. It estimates that 300 million people worldwide live with ASCVD while two billion others are at risk. As many as 15 million people die of ASCVD every year. It says ASCVD remains “a health challenge that continues to be hidden in plain sight.”
Consultant cardiologist Dr Alexander BorgCholesterol is one of the major risk factors as too much of the bad kind (low-density lipoprotein or LDL-C) leads to atherosclerosis with fat deposits building up in the arteries making it difficult for blood to flow through your arteries. Eventually that build-up hardens, narrows the arteries, the deposits can break suddenly forming a clot that causes a heart attack or stroke. High cholesterol can be inherited but it is often caused by wrong lifestyle choices and an unhealthy diet which makes it preventable and treatable.
Am I at risk?
How can we tell if we are at risk? A simple medical check-up is a good start.
“There is no official structured screening programme in Malta but I would suggest patients should start checking their cholesterol at the age of 35, or earlier in case of a family history,” suggests Dr Borg. “Hopefully people have the foresight to check in advance, before it gets too late. It is a simple blood test and these days you don’t need to fast beforehand.”
Patients are often concerned about their cholesterol level, comparing notes with friends and family. Every person has their own individual target level of cholesterol they need to aim for in discussion with their physician.
“It is extremely important to motivate patients and give them a sense of direction, to explain to them what is abnormal and what they have to aim for. Targets can be confusing. There isn’t a single target for everyone. The target is tailored according to the patient’s baseline risk. I don’t treat a number, I treat a patient. The treatment is based on a more nuanced decision,” explains Dr Borg.
Lifestyle changes
Treatment is more than just dishing out medication. Medications are a last resort and – if not combined with healthy habits - they are just a “whitewash” for the numbers to look good. Adopting a healthy lifestyle should always be the first measure.
“This should happen regardless of whether a person has high cholesterol or not,” emphasises Dr Borg. “Lifestyle change is fundamental. Medication is only an add-on. You still need to change your lifestyle. Some people fall in a trap, thinking that now that they are taking a pill they can do whatever they want. It is not easy to get patients to eliminate certain types of food they have been enjoying all their life. But they must understand that after the change they will learn to enjoy wholesome food choices, lose weight, feel energized and less lethargic and, ultimately, feel happier. There will never be any regrets in changing their unhealthy lifestyle or losing their unhealthy habits.”
He added that patients can help themselves by making some small but significant lifestyle changes such as stopping smoking, cutting down on alcohol, reducing the intake of saturated fats and replacing them with the components of a Mediterranean diet namely vegetable oils, leafy vegetables, fruit, fish, oats, high fibre grains, brown pasta and rice, legumes, pulses and nuts.
Exercise of course is another key feature of the overall treatment. “My prescription for exercise depends on the patient’s baseline fitness,” says Dr Borg adding he would recommend a minimum of 150 minutes of moderate intensity exercise per week.
“It is ok to get a bit short of breath and people should aim to sustain the physical activity even for 10 minutes, not stop immediately as soon as they get out of breath.”
Supporting medication
Even when medication is prescribed, patients need to commit to the treatment with a degree of responsibility. Statins have an undeservedly bad reputation, but a recent study published in the European Heart Journal has reported that the true side effects of statins only affect between six and 10 per cent of patients. As many as 50 per cent of patients stop taking the drugs, reduce their dose or take them irregularly because they complain of muscle pain, headaches or digestive problems.
“Most side effects are psychological, conditioned by bad press about statins,” points out Dr Borg. “Statins are life-saving drugs when given to the right people. Stopping statins will increase the risk of cardiovascular disease. Only a small minority actually experience true side effects of statins and this is usually dealt with a change in dose or type of statin.”
All statins are available free in Malta on the government formulary, but the most advanced forms of treatment are not and come with a hefty price tag which the patient would have to cover.
“This is a major barrier to moving on to more advanced therapy in Malta,” remarks Dr Borg. “These are medications which are given in addition to statins when targets have not been achieved. Some are tablets and others are injections which are given twice a year and are very effective.”
Ultimately it is all down to us. “Patients need to take more responsibility for their own health,” says Dr Borg. “Most of the changes, most of the mitigation of risk is up to the patient. The doctor really plays only a minor part.”
For further information about the Invisible Nation by Global Heart Hub in collaboration with Novartis visit www.invisiblenation.globalhearthub.org
Article by the Maltese Cardiac Society to raise awareness about Atherosclerotic cardiovascular disease (ASCVD)