In 1968, he had suffered a massive heart attack while preparing to attend a state dinner in the honour of King Husain of Jordan. Apparently, the damage to his heart had been severe and progression of the disease unrelenting. Two recent American presidents, Eisenhower and Johnson, suffered from heart disease as well and like President Ayub Khan, died of it. Only a few decades ago, the understanding of cardiovascular disease and the measures for prevention were only meagre.

Although it still remains the leading cause of morbidity and mortality worldwide, some remarkable progress has been achieved in understanding the causes of heart disease and much has been learnt about prevention and treatment. The high incidence of heart disease in western countries has long been recognised. It is much less well-known, however, that people of South Asia — India, Pakistan and Bangladesh — share a genetic predisposition to this disease and suffer from it at a disproportionately high rate. Similarly, the common perception that women are less vulnerable to heart disease than men, although widespread, is unfounded. In fact, the rate of heart disease in women has been escalating in recent decades and, after age 50; they suffer and die from it more often than men of comparable age.

During the past several decades, a number of risk factors making people vulnerable to heart disease have been identified. Besides genetics, diabetes, obesity, high consumption of fat and sugar, smoking and lack of regular exercise all contribute to the development of this disorder. In addition, high cholesterol and elevated blood pressure strongly correlate with the incidence of cardiovascular disease. Obesity, which has a powerful negative effect on health, promoting diabetes, high blood pressure and heart disease has become so common that in the United States, nearly one-third of all children are now classified as obese. In Pakistan, it used to be rare to see overweight people, but this no longer is the case, especially in big cities.

Medical research has shown that certain lifestyle changes can significantly reduce the risk of heart disease. For example, a healthy diet that emphasises the intake of fruit and vegetables, rather than meat, weight control and regular exercise can be very effective.

Besides a low-fat diet, certain nutrients can have a very favourable effect on health. A class of unsaturated fatty acids, known as omega-3, found abundantly in fatty fish or fish oil, is believed to enhance the rate of survival of heart patients. They are credited with reducing the risk of abnormal heartbeat and lowering triglyceride levels in blood. How they mediate their effect has not been known, however. Studies published recently in The Journal of the American Medical Association provided further evidence that they indeed promote the survival of heart-disease patients. Furthermore, they were shown to work by slowing down the aging process by alleviating chromosomal damage in body cells. Moderate consumption of fish is therefore considered beneficial for prevention of heart disease.

Benefits of dietary factors have not been confirmed in all cases. Unlike the studies of omega-3 fatty acids, experiments with certain other factors have yielded contradictory and confusing results. For example, beta carotenes, vitamin E and selenium were at one time touted as highly effective against heart disease, diabetes and in reducing the risk of cancer. Yet, more recent studies failed to show any of these putative benefits. Worse, in some cases the intake caused opposite effects, increasing the occurrence of diabetes, cancer and heart disease.

One nutrient that is currently attracting much attention from medical researchers is vitamin D, as some doctors believe that it can lead to stronger bones, besides boosting resistance to many diseases, including diabetes, cancer and high blood pressure. Consistent with this premise, higher blood levels of vitamin D have been associated with excellent health. Normally, the body is able to synthesise vitamin D from exposure to sunshine, but this ability is severely impaired in older populations. Similarly, people with darker skin show lower levels of the vitamin in their blood, and therefore need to supplement it from outside sources. Cod liver oil, milk and yogurt that have been fortified with vitamin D, are excellent sources of vitamin D. While potential benefits of vitamin D are tantalising, they are yet to be proven in further studies.

It is not only the amount and type of food we consume that affects our health but what we add to it for taste also has important implications. For example rich food served at weddings and other festive occasions in Pakistan is often heavily salted. Excessive consumption of common salt has long been known to be associated with an increased risk of cardiovascular disease. In a recent issue of the New England J. Medicine, researchers have shown that even a modest reduction of salt in diet could significantly lower the risk of stroke and heart attack, especially in women, and may ultimately eliminate the need in patients with high blood pressure to use medication to control it.

Besides dietary changes, certain other measures can also enhance the quality of life. Latest research has confirmed that inadequate amount of sleep can lead to high blood pressure, heart disease and stroke. Findings reported from the University of Chicago strongly suggest that even an hour of extra sleep can confer many health benefits, including significant reduction in rate of blockage of arteries, consequent stroke and heart attacks.

Finally, while we still lack the ability to lengthen the ultimate human life span, there is no reason why we cannot adopt some simple lifestyle changes in order to make our life both healthy and enjoyable.