About 45 per cent of heart attacks are silent? Does it mean that its warning signs are overlooked?
This is true because many people do not experience the classic signs of heart attack. For instance, an elderly person may not have the usual feeling of a heart attack. If somebody has diabetes and already has an injury on the neurons that serve the heart, such may not have the feeling.
Generally, women and those that have a nervous system disease do not have the classic symptom of heart attack, similarly those using drugs that may inhibit the nerves from sensing the pain.
Now, the general symptoms of a heart attack include feeling unwell, chest pain (around the heart area); painful shoulder or arm, dizziness, difficulty breathing and heart palpitations.
What is the population most affected by heart disease in Nigeria?
Studies by Nigerian Cardiac Society indicate that heart disease afflicts people more in their middle age, unlike what obtains in Europe, America or Japan where heart diseases are problems of the elderly, usually above 65 years. In our environment, it occurs in those that are about 50 years, almost 20 years earlier than in high-income countries.
The disparity occurs for many reasons. Hypertension, a risk factor for heart disease, occurs in Nigerians at an earlier age. Also, poor access to healthcare and blood pressure drugs also contribute to the early incidence of heart diseases in Nigerians.
Moreover, our attitude to attending hospitals, including its late diagnosis, makes complications come earlier in our society.
What is the prevalence of heart disease in Nigeria?
When you say heart disease, it is a spectrum. Take, for example, hypertension, the commonest cause of heart disease in Nigeria, on the average, 30 per cent of the adult population older than 15 years have high blood pressure.
Similarly, hospital statistics indicate that about seven to 10 per cent of people who are admitted to the medical ward in our hospitals have heart failure.
It is said in the social media that a high cholesterol diet is safe for the heart. What is the stand of the Nigerian Cardiac Society?
Nigerian Cardiac Society, in the communiqués it issued after it’s just-concluded national scientific conference, asked the Nigerian public to disregard that.
High cholesterol is bad. We know from robust data from high-income countries that the higher the cholesterol, the more likely it is to have a heart attack. High cholesterol is harmful, especially in the presence of other risk factors such as hypertension.
The study that the social media was flying around may have used low particles cholesterol to assess the impact of cholesterol. So it is not likely to be correct. From science, we know that the plaques that clog blood vessels (arteries) are all cholesterol substances.
So the higher the amount of cholesterol, the more the likelihood a person may have heart disease. We still educate our patients that they should reduce their intake of saturated fat, which increases their cholesterol.
Is salt good for the heart?
It is well known and documented in medicine that high salt intake is bad for the heart, although, some people say it is controversial. Nonetheless, the higher the salt intake, the more likely an individual will develop a high blood pressure.
Population-based studies, especially in Europe and America, indicated massive reduction in blood pressure in populations whose salt intake has been reduced.
The Nigerian Cardiac Society is encouraging the government to introduce policies that will reduce intake of salt at the population level, as part of measures to curtail increasing cases of hypertension.
What steps can be taken to prevent heart attack cases in Nigeria?
For many years, science has shown us the risk factors for heart disease. For instance, if you reduce blood pressure, the likelihood of having a heart attack is reduced
Also by cutting down on smoking, ensuring weight reduction and reducing the intake of fatty foods and processed foods, individuals can reduce their risk of developing heart disease. Increased consumption of fruits and vegetables to about five portions a day is also heart-friendly.
These are modifiable risk factors that if, in a population they are drastically reduced, the cardiovascular health of the population will be improved.
Is it possible for someone that is trim and fit to have a heart disease?
Yes, we know if you have a trim population and an obese one, there is the likelihood that heart diseases will be higher in those that are obese than those that are trim and fit. It does not mean that it does not occur in the trim population. It is just that the risk is lower.
Basically, other factors such as family issues and genes can modulate the onset of heart diseases, and so if the gene for heart disease is present in a slim person, such still stands a risk of developing heart diseases despite been fit.
Individuals are told to know their numbers because it can predict the age of their heart and chances of developing heart problems, why is this important?
What we know is that the risk factors of heart disease are all cumulative. Also, if you compare a 50-year-old man with another that is 25 years old that have exposed themselves to same cardiovascular risk factors, the heart of the 50-year-old man will be older and will stand a higher risk of developing a problem.
Age is a stronger risk factor for heart disease. But a person can also increase the age of his heart when he is obese, if he smokes and takes excess salt or alcohol. And so, the higher the likelihood of developing a heart disease.
Now, experts have a formula based on population data that can help predict one’s risk of developing a heart problem. Some of the numbers that will be imputed into the formula include age, gender as well as blood pressure, weight and height values. It can predict a person’s likelihood of developing heart disease in five years or even 10 years from now. It is, however, not absolute.
How will you assess the level of treatment patients get for heart problems in Nigeria? What are the challenges?
Poor access to treatment is not peculiar to heart conditions. Why heart problems are very prominent is because it affects people in the prime of their life. You may have seen someone today and the next day, you are told that the person slumped and died because of the side effects of high blood pressure or heart attack.
But access is much more than the availability of facilities; people also have poor financial access to treatment and drugs. So, we need to ensure universal health coverage in order to bridge some of these gaps. Also, we need improvement in the facilities in our hospitals to bridge this gap.
Treatment of heart conditions is very expensive. We have shown in our studies that even one-year treatment of heart failure is terribly expensive, especially indirect cost.
Also, we must build according to international best practices to ensure people can easily walk. People cannot walk on the streets because of the risks. Most walkways have been converted to parks and markets; also recreational places like parks have been taken over by so many other things. These are some of the issues that we need to address as a country to ensure healthy hearts.
and then