Today is World Heart Day:

Heart healthy habits ensure longer, healthier life

by Carol Aloysius

Preventing heart disease

Look before you eat. Eat a variety of fruits and vegetables every day. (Five servings - they are naturally low in fat and high in vitamins and minerals and anti oxidants). Eat coloured vegetables and fruits Eat a variety of grain products
Choose non-fat or low-fat products.
Use less fat meats - chicken, fish and lean cuts Switch to fat-free milk-toned/skimmed milk

For my car, I want the best mechanic

...But for my body, I follow hearsay and advice from friends, kitty party, local quacks…. Just anyone. And decide for the worst

Heart disease is the leading cause of mortality and morbidity worldwide and in Sri Lanka. Once a disease of the elderly, it is now increasingly being found in young persons, some in their early and late twenties. Health officials blame our present lifestyles and the food we eat plus the strains and stress of our fast-paced life as being the main causes for this sharp surge in heart and heart-related diseases, compared to the incidence of heart disease at the turn of the previous century. Then, our grandparents lived in stress free environments, exercised more frequently in fields, cycling to work or walking miles to school, and ate home-grown healthy food.

Today the scenario has changed. The rise in population and the shift from village to urban neighbourhoods in search of employment brought a distinct demographic change. The pace of life increased as the rat race for jobs increased. People have less time to exercise, cook, eat healthily, let alone grow their own food. Instead, with both husband and wife often working to give their children a better life, eating outside the home has become the norm. Housewives have stopped cooking and begun switching to instant foods, processed foods, foods containing high cholesterol and dripping with saturated fats.

Instead of preparing a healthy home cooked rice and curry meal for their children, they pack sandwiches, noodles, with Chinese rolls and biscuits or chocolates for dessert into their lunch boxes.

Children have increasingly become addicted to these instant junk foods and refuse to eat the healthy lunches which a few stay-at-home parents with time on their hands take time and trouble to prepare for them. Instead of drinking milk or water, most children now drink highly sugared drinks including colas.

The result: Obesity leading to early diabetes in children, which end in hypertension, premature strokes, and cardiac arrests.

Today, on World's Heart Day, Consultant Cardiologist, Sri Jayawardenepura Hospital, Dr Naomali Amarasena discusses how to prevent this debilitating and often fatal disease. She said it is avoidable by adopting healthy life style habits, healthy eating, and exercise at a very young age and throughout one's life.

Excerpts...

Question: What is the main function of the heart?

Answer: The heart is the most hard-working muscle of our body. It pumps 4-5 litres of blood every minute during rest. It also supplies nutrients and oxygen rich blood to all body parts, including itself.

Q.What is Atherosclerosis coronary artery disease?

A. Over time, fatty deposits called plaque build within the artery walls. The artery becomes narrow. This is atherosclerosis

When this occurs in the coronary arteries, heart does not get sufficient blood, the condition is called coronary artery disease, or coronary heart disease

Q. What are the symptoms of Coronary artery disease?

A. No symptoms for a long period. However a chest pain for short period on exertion also known as Angina or minor heart attack. Myocardial Infarction or major heart attack-Severe chest pain, death of heart muscle, heart failure, irregular heart beats and ends with sudden death.

Q. How Big is the problem?

A. It is No. 1 killer disease worldwide 12 Million deaths annually. However, during the past 30 years there has been a sharp decline in developed countries due to rising health awareness and government programs. But in poor developing countries there is an alarming increase of the disease, especially India.

Q. What are the main causes for the disease?
* Genetic predisposition
* Poor handling of fats and metabolic syndrome
* Diabetes, obesity, high BP, Coronary artery disease
* Environmental insults
* Urbanisation
* Sudden change in lifestyle

Q. What can increase the risk of a heart attack?

A. There are non modifiable and modifiable factors. Non Modifiable Risk Factors which one cannot help having include the following:

Age:
Men over 45;
Women over 55
Sex
Race
Family History
Modifiable Risk Factors are:
High Cholesterol
Smoking
High Blood Pressure
Diabetes
Obesity
Alcohol
Physical Inactivity
Cholesterol (A type of fat)

Q. How does cholesterol pose a risk?

A. Everybody needs cholesterol; it serves a vital function in the body. It circulates in the blood.

But too much cholesterol can deposit in the arteries in the form of plaque and block them. There are no symptoms till heart attack.

Good vs. bad cholesterol

LDL cholesterol is known as bad cholesterol. It has a tendency to increase the risk of heart disease. LDL cholesterol is a major component of the plaque that clogs arteries. HDL cholesterol is known as the good cholesterol. Higher in women, increases with exercise. HDL cholesterol helps carry some of the bad cholesterol out of arteries.

Q. Does obesity also pose a risk of heart attacks?

A. People who are overweight (10-30 percent more than their normal body weight). Obese persons have two to six times the risk of developing heart disease.

Normal waist-hip ratio
0.85 for women; 0.95 for men
Apple-shaped are at a higher risk

Pear-shaped paunch store fat on the hips and thighs, just below the surface of the skin. Apple-shaped paunch store body fat around the abdomen and chest, surrounding internal organs

Q. Any other contributory factors?

A. Physical Inactivity.
Cigarette Smoking -

* Increases blood pressure

* Decreases HDL

* Damages arteries and blood cells

* Increases heart attacks

* Cigarette smoke contains more than 4,000 chemicals, and 200 of these chemicals are poisonous

Alcohol consumption

In small amounts it is beneficial: 1-2 drinks. In large amounts it adds fat and calories and raises BP.

Diabetes

At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of heart attack or stroke

A diabetic is more likely to die of a heart attack than a non-diabetic ~80 percent diabetics die from heart disease

Risk of sudden death from a heart attack for a diabetic is the same as that of someone who has already had a heart attack.

Q. How do all these factors interact?

A. Risk operates across a continuum - no clear-cut line

(Blood Pressure; Cholesterol; overweight; Smoking)

The risk is multiplicative when many risk factors co-exist; risk factors often cluster together

The majority of events arise in individuals with modest elevations of many risk factors than from marked elevation of a single risk factor

Prevention

Rule No. 1 - Limit/avoid the following foods:

Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks, candy, junk food

Limit foods high in saturated fat, trans-fat and cholesterol

Eat less than six gms of salt a day

Have no more than1-2 alcoholic drink a day if you are a regular drinker

Foods rich in Cholesterol and Saturated fats

Egg yolk

Fatty meat and organ meat (Liver)

Butter chicken / Batter fried fish!

Milk fat - Ghee, Butter, Cheese, Ice Cream, full cream milk, Hidden Fat such as Bakery biscuits, Patties, Cakes, Pastries,

Rule No. 2 - Exercise

Maintain a level of physical activity that keeps you fit and matches the calories you eat Serves several functions in preventing and treating those at high risk

Reduces incidence of obesity

Increases HDL

Lowers LDL and total cholesterol

Helps control diabetes and hypertension Exercise, Exercise, Exercise

Mortality is halved in retired men who walk more than two miles every day

Regular exercise can halve the risk of heart disease, particularly in men who walk briskly

Someone who is inactive has as great a risk of having heart disease as someone who smokes, has high blood pressure or has high cholesterol

Exercise significantly reduces the chances of diabetes and stroke

With regular exercise, blood pressure in those with hypertension is reduced by as much as 20mms Hg

Moderate to intense physical activity for 30-45 minutes on most days of the week is recommended

* Complicated exercise machines or sweating it out in the gym not essential. JUST WALK!

Rule No. 3 - Stop Smoking NOW!

* The risk of heart attack starts decreasing within 24 hours of quitting smoking, within one year of quitting, CHD risk decreases significantly, within two years it reaches the level of a non-smoker

* Smell and taste improve within days

* Within three months of quitting, the smokers’ cough disappears in most people

Benefits much beyond Heart Disease

Rule No. 4 - Know your cholesterol level

Total cholesterol: 200;

LDL; 100

HDL; 40 triglycerides; 200

Get the levels tested routinely and keep them under control.

Benefits of reducing cholesterol

Ten percent reduction of blood cholesterol produces 20-30 percent decline in CHD deaths.

Controlling Blood Pressure

* Adults should have their blood pressure checked at least once every two years, as there are no symptoms to tell if you have high blood pressure

* Optimal levels: 120 /80 mm Hg

* If high, modify your lifestyle - Diet, Weight, Exercise, Salt restriction

* Adhere to the prescribed medication without fail, to decrease chances of getting heart disease. Do not stop your medicines without consulting your doctor, even if the blood pressure becomes normal.

Q. How does blood sugar or diabetes cause a heart attack?

A. All adults should have their blood sugar checked regularly, as there are no early symptoms of diabetes

Normal blood sugar: Fasting; 100; post meals;140 If high, modify your lifestyle - Diet, weight, exercise. Adhere to the prescribed medication without fail, to decrease chances of getting heart disease. Do not stop your medicines without consulting your doctor, even if the blood sugar becomes normal.

If you or someone in your family is already diagnosed with heart disease don’t get disheartened. Science has made significant progress. Just monitor risk factors much more aggressively.Eat healthy, walk regularly, watch your weight, quit smoking immediately and keep your weight under control.

In addition to improving your heart-health these measures are sure to enhance your appearance. Adhere to you medicines and listen to your doctor. Don’t wait for a heart attack to take action. Don’t wait for a second life, we are not cats.

Q. Your message to the public?

A: Heart disease is often avoidable. Following a heart-healthy lifestyle doesn't have to be complicated, and it doesn't mean you need to live a life of self-deprivation. Instead, find ways to incorporate heart-healthy habits into your lifestyle - and you may well enjoy a healthier life for years to come.

Oldest practising surgeon honoured

The senior-most practising consultant surgeon, with a medical career spanning over 57 years to date, Dr. B.J. Masakorala was honoured with an honorary fellowship of the College of Surgeons of Sri Lanka at the inauguration of the 42nd annual academic sessions of the College of Surgeons of Sri Lanka joint meeting with the Royal College of Surgeons Edinburgh on August 21, 2013.

Dr. B.J. Masakorala

Dr. Masakorala, born in 1930 was the most senior surgeon among a distinguished list of nine Sri Lankan and foreign fellowship receivers. They were honoured for the recognition of their exceptional contribution to the Sri Lankan surgery and/or surgical training, national/international surgical leadership.

Dr. Masakorala hailing from the southern province started his primary schooling in Hikkaduwa, where he excelled in his studies and is considered to be the only doctor living to have received the prestigious Denhem Scholarship awarded by the British government in 1940. He entered English school Hikkaduwa, after receiving the scholarship for the Southern Province, Galle electorate.

One of his batch mates in Hikkadaduwa was the current president of Economic Association of Sri Lanka, Prof A. D. V. de S. Indraratne. One of the main passions of Dr. Masakorala was to put his experience into paper and to teach young medical students whenever he was free and give them the opportunity to learn.

Among some of his papers published, the 1st was in 1975, on Necrotising Enteritis talk given to the College of Surgeons Ceylon. This was published in the Ceylon Medical Journal, 1976, Vol 21. He has continued to read papers since then and some of his papers are on obstructive jaundice, F.N.A.C. Of thyroid gland, techniques of hepaeto enterostomy and then went on to read papers on side mirror injuries and later on the 1987 Pettah bomb blast, where he was the surgeon in charge of the National Hospital.

At the honorary fellowship presentation Prof. A.H. Sheriffdeen (Consultant Surgeon), who gave the citation, recalled that he and Dr. Masakorala served at the national hospital Colombo where “MAS “served as the senior surgeon and he as a lecturer and that their friendship was a long standing one.

Dr. Masakorala is married to Bandu and has two children, Shiromi and Rohan.

Global HIV/AIDS epidemic ‘could be over by 2030’

But figures among men who have sex with men ‘still out of control’

The global HIV/AIDS epidemic could be over by 2030, a leading UN official has said, as new figures showed that infection rates have dropped by a third since 2001.

Globally, there were 2.3 million new HIV infections in 2012, down 33 percent, while new infections among children have dropped even further, down 52 percent to 260,000.

Speaking in New York, Dr Luiz Loures, the deputy executive director of the United Nation's HIV/ AIDS agency (UNAIDS), said that ending the epidemic in just 17 years’ time was a “viable target”.

The UN is set to exceed its own goal of providing HIV treatment to 15 million people in low and middle income countries by 2015. Nearly 10 million people in these countries were accessing life-saving antiretroviral therapy by the end of 2012 - a 20-percent increase in just one year, according to UNAIDS's 2013 Report on the global AIDS epidemic. Progress has been made both in the treatment and in the control of HIV, Dr Loures said. AIDS related deaths have dropped by 30 percent, since peaking at 2.3 million worldwide in 2005.

“I think that 2030 is a viable target to say that we have reached the end of the epidemic,” Dr Loures said. “HIV will continue existing as a case here or there but not at the epidemic level we have today… We can get to the end of the epidemic because we have treatments and ways to control the infection.”

Significant progress has been made since the UN targeted HIV/ AIDS epidemic in the landmark Millennium Development Goals, which set out goals for poverty and disease reduction for 2015.

“Over the years, the gloom and disappointments chronicled in the early editions of the UNAIDS Global report on the Aids epidemic have given way to more promising tidings, including historic declines in Aids-related deaths and new HIV infections and the mobilisation of unprecedented financing for HIV-related activities in low- and middle-income countries,” said UNAIDS executive director Michel Sidibé in his introduction to this year's report.

However, the report also found that progress has been slow in securing HIV services for people most at risk of HIV infection, including men who have sex with men, sex workers and people who inject drugs.

- The Independent