|| Impact

Consultant Cardiologist - Director of Cardiology and Cardiac Services, Gold Coast Hospital, Gold Coast, Australia

Accelerated Athero-coronary Metabolic Syndrome(AAMS) is a newly described disease that has been identified to be spreading very rapidly all over the world. This disease is a disorder of the body's metabolism that is manifested as severe heart disease. This can lead to heart attacks at a younger age and if severe enough even lead to death. It has been observed that the majority of heart attacks among people of South Asian origin (including Sri Lanka) is a result of AAMS.

Heart disease and heart attacks as we know was initially identified and described in white Caucasian male subjects. All the major medical research work in the area of coronary heart disease over the last century has been carried out among people of European origin living in countries such as USA, England, Canada and Australia. Based on the results of such research, tests and treatment protocols were developed to address heart disease in the West. As a result of these constant innovations mortality associated with heart disease has halved over the last fifty years among white Caucasian males. Today, in the Western world coronary heart disease remains a disease mainly among the populace of low socio-economic strata in the white Caucasian communities.

The fore-mentioned research work also identified risk factors that lead to the development of heart disease. These risk factors such as smoking, high cholesterol levels, diabetes, high blood pressure, obesity and physical inactivity increase one's risk of developing heart disease. On the other hand proper control of the above risk factors would render a degree of protection from heart disease.

Whilst heart disease has been controlled quite successfully among the Westerners, the incidence and prevalence of heart disease among people of South Asian region and those who have migrated to other countries from this region has increased dramatically over the last few decades. What is further more alarming is that mortality rate from coronary heart disease has quadrupled among the South Asian over the same period of time. In my research work among people of South Asian origin living in Sydney, Australia, I discovered that coronary heart disease among South Asians is much severe compared to that among white Caucasians.

Their coronary arteries when examined by angiography showed serve disease and also the first heart attack was at a much younger age in South Asian compared to the White Caucasian.

The first heart attack in fact occurred on the average 20 years earlier in the South Asian. Whilst heart disease onset was in the mid seventies in whites it occurred in the mid fifties in the brown skinned. Subsequently similar observations were made among the South Asians living in the USA, England, Fiji and Mauritius. Now the information coming from Sri Lanka, India, Pakistan and Bangladesh confirms these facts and raises major concerns about the health of the general population in this region.

Highest prevalence

According to global statistics regions such as Kerala in India, Sri Lanka and Bangladesh record the highest prevalence and incidence of coronary heart disease in the world.

The mortality rates from heart disease too are comparatively very high in this region. Because it affects younger individuals it has the potential to threaten a whole generation of an entire population bringing in major social and economic consequences.

In addition to increased severity and the onset at a younger age there are many fundamental and characteristic feature of coronary heart disease among South Asian ethnics that are different to what is described as heart disease in the white Caucasian ethnic.

Life style

The fore-mentioned "traditional" cardiac risk factors of smoking, high cholesterol levels, diabetes, high blood pressure, obesity and physical inactivity alone does not explain the increased risk of heart disease in the South Asians. Most comparative studies have shown that apart from the increased incidence of diabetes South Asians had a lesser prevalence of the traditional cardiac risk factors compared to the Whites. Even without any of the above risk factors being present the Sri Lankans are at a high risk of heart attacks and this is due to a genetic susceptibility which is accentuated by environmental and lifestyle factors. However, if any of the above risk factors are present the already high risk level becomes even higher.

Thus, heart disease in the South Asian is ethnic is an entirely different disease to that of the White Caucasian and as such needs to be identified and named differently. The heart disease of the South Asian is the consequence of a combination of abnormalities in the entire body's metabolism. The net effect of these abnormal bodily functions eventually manifests as a deadly form of heart disease or a severe heart attack that comes about at a relatively younger age. A group of world-renown researchers led by myself upon closely analysing the factors and features associated with heart disease in the South Asian decided to name this disease as AAMS - Accelerated Atherocoronary Metabolic Syndrome. Already some major characteristic features of the AAMS disease have been identified by the research work carried out in the recent past. Even with normal total cholesterol levels South Asians with AAMS have an abnormal and dangerous composition of the different cholesterol sub types. One such sub type that seem to be present at very high levels is called LP(a). Usual blood tests done to ascertain your cholesterol level does not report your LP(a) levels. South Asians usually have high levels of LP(a) in their blood and unless specifically looked for this may go unnoticed and thus untreated. High LP(a) can increase one's risk of heart attacks to a dangerously high level. High LP(a) level is a major feature of the AAMS disorder.

Major features

Standard treatment given for high cholesterol levels does not always control LP(a) levels effectively. This requires different additional medications. In addition, Sri Lankans have been discovered to have high levels of a substance called Homocysteine in the blood. This too is a feature of the AAMS disorder and contributes to increasing one's risk of developing heart disease and early heart attacks. Additional medications particularly vitamin B12 is necessary to control this high Homocysteine levels. In addition to the above it is likely that there are few other different factors that enhance the risk of heart disease among South Asians. World Health organisation has predicted that in another 20 years 75per cent of the adult population in the developing world would be affected by heart disease. The majority of people in this category would be AAMS patients. Given the population growth in the Indian sub-continent it is likely that AAMS would become the most common disease and the most dangerous disease in the world affecting billions of people, particularly in the Indian sub-continent (including Sri Lanka). Experts say that every male over the age of 25 and every female over the age of 40 in the Indian subcontinent is at a high risk of developing AAMS.

New risk factors

To prevent this epidemic it is important to address the traditional cardiac risk factors in this population. However in addition, the novel risk factors and the emerging risk factors need to be identified and tested for.

Once identified, these should be effectively treated using the new medications to achieve good control. More research work and development needs to take place to understand this new disease better and thus concerted efforts should be put in place to control this emerging and devastating epidemic. Though Sri Lankans are not as obese as Westerners they have the propensity to store fat in the abdominal region. This pattern of body fat distribution is directly related to a very dangerous risk of developing heart disease. This is a key feature of the AAMS disease and explains why, though smaller in body size comparatively, Sri Lankans develop heart disease more aggressively than the White ethnics.

A permanent cure or a means of prevention of AAMS is still to be discovered. It is believed that multiple factors that include genetics, environment, lifestyle, food habits, stress etc. come to play in the development of AAMS. The studies currently under way may shed some light into these factors.

However, a great deal of work remains to be done to unravel the intriguing mysteries surrounding this disease. If not addressed properly AAMS has the potential to be an even more dangerous epidemic than AIDS.

Rohan Jayasinghe is Professor of Cardiology in Griffith University, in Queensland, Australia, while being the Consultant Cardiologist and Director of Cardiology and Cardiac Services, Gold Coast Hospital.

Having graduated from Sydney University with First Class Honours, he read for his MSPM and PhD in New South Wales University. He is a Fellow of Royal Australian College of Physicians. His advanced training was done in the USA, where he discovered a new mytral valve that could be installed without open heart surgery, for the first time in the world. It has got several world patents. Prof. Rohan Jayasinghe is the founder Director of Asia Pacific Interventional Advances (APIA) which held its annual convention from November 2 to 29 in Sydney.

How parents can deal with a messy, untidy child

Messy means being careless, disordered, untidy and lacking neatness or precision. Child is unusually untidy and careless concerning clothes, toys, school materials or appearance. Dirty habits are also obvious when child will not wash or frequently gets very dirty. Arguments over personal appearance and messy rooms frequently occur between parents and young teenagers.

1. Child develops messiness as a means of asserting independence and power or expressing anger.

2. Child does not understand the need to develop neat habits or be tidy. Child may be lazy and uncaring.

3. Child has never learned how to be neat and organised. Parents did not model this type of organised behaviour.

4. Child is overprotected. Parents took care of things and never really expect child to be tidy.

5. Parents give 'double messages'. They state their expectations to child to take care of his room and yet communicate the feeling that child is incapable of this.

6. Child lacks positive reinforcement for the learning and carrying out of neat behaviour.

1. Encourage simple rules of neatness from an early age such as putting toys in a box or keeping certain types of toys in one place.

2. Model neatness both in personal appearance and taking care of objects at home.

3. Teach the doing of tasks in an orderly manner, for example, in painting activities your child can first cover the table with newspaper before mixing the paints and doing the actual drawing. The activity ends with child throwing the dirty newspapers away and putting up his drawing on the clothes-line to dry.

4. Encourage your child to undertake regular chores throughout childhood and adolescence such as setting the table, washing or drying the dishes, making his bed and putting dirty clothes in a pail.

5. Get your child to actively participate in his personal grooming by letting him choose his own comb, brush or towel.

6. Teach and model concern for others. Child will then become neat in order to please others.

1. Praise or reward your child for the slightest attempt at being neat and organised. A point system can be designed where points can be earned by your child for any form of neatness. These points can be used to earn privileges and rewards.

2. Establish a contract with your child. Grant him some privileges or rewards for neat or tidy behaviour.

3. Demonstrate and reward steps to neatness. Tasks to be completed are broken down into steps. Thus keeping his room neat can involve the following steps:-

4. Use charts to help your child list the specific tasks of neatness that is expected like combing hair and when it should be done. A reward can be given for the completion of tasks.

5. A penalty can be imposed whereby any toys, games or clothing not in their proper place will be locked away for a period of time.

6. Offer your child something pleasurable like watching TV after she cleans up a mess.

Chuckle a day...

A prisoner who is desperate to get out of jail has been teaming with his doctor and has been in & out of the hospital on some pretext of illness.

He is now in one of such visits and very desperate to get out of jail permanently, tells the doctor, "Look here, doc! You've already removed my spleen, tonsils, adenoids, and one of my kidneys. I only came to see if you could get me out of this place!"