Heart diseases claim more lives than most other ailments. The best preventive measure is to keep the Six-S syndrome in mind
EVERY now and then we hear about the ever-threatening increase in heart diseases in Pakistan. In 1999, the WHO published a list of 10 major causes of death and heart diseases featured at the top of that list.
According to one report, heart diseases claim more lives than cancer and traffic accidents put together. We also know that diagnosis and treatment of heart ailments can be very expensive. If someone gets affected by an illness called the Ischaemeic heart disease (IHD), he will have to undergo treatment for the rest of his life.
The question that rears its head is: what preventive measures can be taken to counter problems caused by heart diseases? Well the answer is not so simple. If we are serious about the issue, we should combat the Six-S phenomenon. It comprises smoking, sedentary living, sugar, saturated fat, salt rich diet and stress. We can also call it the Six-S syndrome. Let us look at the syndrome.
SMOKING: Who would dispute the fact that smoking is a major risk factor that can cause Ischaemic heart disease (M), hypertension, heart failure, periperal arterial disease and cerebrovascular disease?
Tobacco plays a lethal role in the process of atheroseleosis that leads to the IHD. Tobacco contains nicotine and carbon monoxide. Both these toxic substances narrow the arteries, increase the pulse and workload of the heart. They cause damage to the inner lining of the arteries (endothelium) where fat particles are deposited, and later blood clotting takes place.
Smoking in the presence of other risk factors becomes even more lethal and the chances of atherosclerosis and subsequent clinical IHD are increased many fold.
No smoking or to quit smoking, therefore, is the first step in the fight against heart diseases. It has been proved by different studies that by giving up smoking, chances of heart attack and sudden death reduce considerably.
SUGAR: Sugar is medically known as diabetes mellitus (DM). DM is a very common disease that can affect all vital organs of human body. This relatively unknown disease often goes unnoticed unless the blood sugar level is checked on a regular basis. The ratio of people affected by DM is much higher in the subcontinent as compared to other parts of the world. This is perhaps due to our dietary habits and genetic factors. Maturity onset diabetes mellitus (the most common form of DM also known as type-II or non-insulin dependent DM) is related to obesity and is a modifiable as well as preventable disease. Low sugar and high fibre diet, combined with exercise, reduces the chances of getting affected by diabetes mellitus. Those who are diabetic must have optimal blood sugar control to avoid complications associated with it.
Normal blood sugar levels reduce the chances of IHD and its related complications, in particular heart attacks and heart failure. As mentioned earlier these various ‘S’ syndromes are major risk factor for the IHD individually, but in the presence of other risk factors their threat is multiplied. Diabetes mellitus is no exception and it makes a lethal combination with other risk factors, particularly the HBP.
SALT RICH DIET: There is a strong co-relation between dietary salt intake and hypertension (HBP). The HBP, as we all know, is a common coronary risk factor prevalent in over 18 per cent of adult Pakistan population (above the age of 15). There are an estimated 12 millions hypertensives in Pakistan.
The HBP is not as prevalent in communities that have a low salt intake. The dietary approach to stop hypertension (DASH) includes in the JNC VII guidelines. They recommend that the daily salt intake of an individual should be less then six grams.
Pakistani food items usually contain a large amount of salt. The latest guidelines suggest that one must keep the blood pressure below 130/80 mmhg.
SATURATED FAT: Saturated fat is other factor that we must take care of. Red meat, organs, ghee, eggs that we all seem to enjoy are the major sources of cholesterol, which is another significant contributor to athersolerosis. Hypercholestrolaemia (raised total and LDL cholesterol also called the bad cholesterol) has a direct correlation with heart diseases. Therefore cholesterol reduction is very crucial.
To reduce the amount of saturated fat we should use more and more vegetable oil which has a high proportion of polyunsaturated and mono unsaturated fats. The ideal oil is the one which has 1: 1: 1 ratio of saturated, mono unsaturated and polyunsaturated fat. In addition to hyperchlotralaemia low levels of HDL cholesterol (a better kind of cholesterol) are also associated with increased incidents of heart diseases. South Asians usually have low HDL cholesterol because of genetic reasons. Substitution of saturated fat with polyunsaturated fat is a fundamental step towards hoping for the reduction in heart diseases. Fortunately various commercial preparations of polyunsaturated fat are now widely available which give you similar taste and convenience of cooking with much reduced cholesterol levels.
Omega fish oils and vitamin E is used by various experts to increase HDL cholesterol levels. However, the evidence to support this is not very strong. In order to prevent heart diseases, saturated fat should not contribute more than 10 per cent of the total daily calorie intake of an individual. For those who suffer from heart diseases it should be less then seven per cent. The cholesterol level of a normal individual should be kept below 200mg/dl and those with heart diseases must keep it below 100mg/dl.
SEDENTARY LIVING: Sedentary living refers to people who do not indulge much in physical activity. They are found sitting most of the time. With increase in prosperity, people adopt a lifestyle where they spend most part of the day sitting in the car, office, TV lounge and then go to bed. On top of this comes parties and eating rich food which adds to the problem. Remote controls, computers, televisions and other modem appliances have reduced the need for doing things manually to an unimaginable extent adding to sedentary living.
In addition to this lifestyle, as a community we have not developed parks or other places where people can exercise. A lack of will and motivation compounded by the paucity of facilities has resulted in creating couch potatoes.
Sedentary living is responsible for heart diseases, both directly as well as indirectly. Directly, because it makes you unfit for any physical challenge and one can receive cardiac insult by relatively low physical work. Indirectly, because sedentary living contributes to obesity, hypertension, diabetes and dyslipidaemias.
It has been clearly proved that people who exercise on a regular basis lead a physically active life and have less chances of developing cardiac ailments.
The culture of going for a brisk walk has to be incorporated into our routine life. In addition to the walk, one can indulge in any other form of physical exercise or recreational sport too. Outdoor exercises are preferred over indoor. The best place to introduce the culture of exercise is schools, where it should be made compulsory.
STRESS: It is the most ill-defined and poorly understood factor. Qualitative description and quantitative gradation of stress is a difficult task. Descriptions and thresholds of stress differ from person to person. A number of personalities determined by genetic traits and environmental factors react to various emotional and physical stimuli in different manners.
The definition of stress can be argued, but simply uttering anything (factor, cause) which makes a person worry and puts his system under tension can be called stress. It is mostly either a normal response to too much tension or abnormal response to ordinary tension.
Stress affects the heart in different ways, mostly indirect. Stress at times plays the role of a precipitating factor for a cardiac event like heart attack. Social deprivation and a lack of security are some of the well-known contributors to stress.
Stress management is a somewhat difficult task. People adopt various means of reducing their stress by indulging in various recreational, religious and social activities. Simplicity, a bit of ignorance and total reliance on Allah are some of the universally known ways to get rid of stress.
As a Muslim it is my strong belief that if we adopt the divine values and teachings of our religion we can overcome all stresses of life.
Heart diseases claim more lives than most other ailments. The best preventive measure is to keep the Six-S syndrome in mind 
