A cardiologist at the University College Hospital, Ibadan and fellow of the International Society of Hypertension, the West African College of Physicians and Nigerian Cardiac Society, Dr Abiodun Adeoye, in this interview with FUNMILAYO AREMU, speaks on cardiovascular diseases, the habits Nigerians engage in that are harmful and some issues in the health sector.
What are the cardiovascular diseases that Nigerians are more prone to?
When we are talking about cardiovascular diseases, you know, cardio means the heart and vascular means vessels. So, when talking about cardiovascular diseases, we are talking about diseases of the heart and vessels. Cardiovascular diseases account for the major cause of death that is not related to infections per se, non-communicable diseases. Out of these cardiovascular diseases, we have stroke, heart attack which is a myocardial infarction, we have heart failure. Those are the major ones. But because of the complications of hypertension itself, we can have renal failure, and it can progress like that. More than 75 per cent of the deaths reported from non-communicable diseases are from cardiovascular diseases.
Are these diseases gender-specific?
It is gender-based. For cardiovascular diseases, you can look at the aetiology in one way, you look at the environment, you look at the genetic makeup and you look at our habits in general. Cardiovascular diseases; stroke, hypertension, and heart attack, are commoner in men compared to women. What has been postulated which is being confirmed is that the hormone which is found in women, especially when they are still menstruating, the oestrogen, protects them from these diseases. But as soon as they reach menopause, they tend to be on par with men and sometimes even surpass the frequency of having the disease. In further studies, looking into the genetic makeup, when you are talking about men, you are talking about chromosomes ‘X’ and ‘Y’ and for women, it is chromosome XX. There have been some particular gene that has been coded in the male chromosome, especially the ‘Y’ that would code and exhibit the tendencies to have cardiovascular diseases. There is a gender difference in cardiovascular disease.
What about in terms of age, what age is it most prevalent?
As people grow in age, they tend to have it more and the reason is simple. There will be ageing factors, the vessels that are supposed to be elastic, as people grow, become less elastic and thicker than what they used to be. So, what will now happen is, eventually, at the peripheral vessels, there is what we call resistance to the flow of blood. So, once there is resistance to the flow of blood, then the heart will be working more to overcome that and that means more tension and high blood pressure. So, older people tend to be at risk of these diseases compared to younger people.
What are the causes of cardiovascular diseases?
We will look at it generally, we can only look for the risk factors. Let’s take, for example, hypertension, we have what we call primary hypertension. At times, we will say it is essential that as we grow in age, it will come. Then, we look at secondary hypertension. That is, we have identifiable aetiologies of hypertension. Once the primary cause is known, we will be able to treat it. Primary, maybe a problem with the endocrine system, it can be a result of hormonal imbalances, congenital abnormalities of the kidneys, the arteries and all that. That is about 10 per cent. For the 90 per cent, there is no specific aetiology. So, what we have is what we call the risk factors. So, when you are talking about cardiovascular risk factors, you have ones that are modifiable and unmodifiable. The unmodifiable risk factors are the ones we have mentioned earlier, age, and race; being a black man, you will tend to have a higher risk of developing hypertension and having a stroke than a Caucasian. If you have a family history of hypertension or cardiovascular disease compared to those who have no history of such in their families, those with a family history have a higher risk. Now, it is even in the order of, if you have a family history where your mother has it, it is a higher risk than having it in your father, and when you now have both parents having the risk, then you have a double risk. So, we have the family, the genetic makeup, and then the age and sex factors as we have discussed. Now, to the modifiable, it means it is modifiable, it is within your control. It is the unhealthy habits that we talk about, unhealthy diet, sedentary lifestyle, alcohol ingestion, smoking, and all that are the ones you can control. You can decide not to smoke, but you can’t determine whether you’ll be a man or a woman. Those are the risk factors.
With the state of the economy, a lot of people are groaning, there is inflation, coupled with stress that people go through daily, do you think these could also contribute in one way or the other to our health, particularly, our heart?
That is why this year, the focus of the world heart day celebration was premised on the heart itself. ‘Heart for every heart’ and we have three focuses there. We have the heart for you, yourself. This is where the stress component will come in. definitely, stress does lead to cardiovascular diseases because when you are tensed up, there will be adrenergic hormones, and all that is released, and when this happens, the heart will run more than necessary without rest. The blood pressure will go up and if this happens unchecked, it can lead to stroke or heart attack. That is why we always say you don’t need to carry the burden too much. I always tell my people, if you know that when you ply a particular road, there will be a traffic jam, you already know and you still go through that same road and end up complaining about the traffic. Why stress yourself? When you already knew, so, calm down and stop stressing yourself. It is part of the system of the body to have stress, but the ability to manage it matters. So, when one cannot cope with it, the blood pressure will rise and it can lead to stroke.
You mentioned diet; so what are those things we ingest that may be harmful to the heart?
You see, food is good for the body, but you must take the right component. We have carbohydrates, fat, and protein. So, the order in which you take them matters. All of them will either give you nutrients; carbohydrates will give you energy; for protein, you need them to build your immune system, cells and all that. But, when taken in excess, it becomes trouble, especially the fat component. If you are taking too much fatty food, you will be prone to coronary heart disease. The vessels will be blocked and then it can lead to heart attack or stroke. I don’t know if you have attempted it before, put your hand inside oil and put it inside water, it becomes sticky. The same thing happens if you are taking fatty food, they settle on the linings of the vessels that carry blood to the brain, and heart. I wouldn’t know how many of us have seen the water reticulations; drainage pipes in people’s houses, when it gets blocked, and you are trying to fix it, you’ll see plaque, thick and white being flushed out of the pipes. It is the same thing with the vessels that supply the brain and the heart. So, when next you are taking your unhealthy fatty food, you are clogging the vessels and it builds up and when it is totally blocked, it leads to stroke or heart attack. So, what is expected is, in the right quantity, carbohydrates, not in excess, take vegetables, fruits and if you can control it, less salt. In fact, what is advocated is a levelled teaspoon of salt as the quantity of salt you must take in a day. And if you are going to take fruits or vegetables, we have what we call measures of serving. You are supposed to have five servings a day. Let’s take for example if you are taking an apple. Apple should be about 80 grams or thereabout. So, you are expected to take five of it in a day. So, that means 80grams multiplied by five will give you 400grams. But some people will say it is too expensive. But if we look at what we consume. How much is a plate of rice from the eatery now?
About N1500.
How much will five apples cost?
Not up to N1500.
You see, you can afford to buy food from an eatery at N1500, if you take it three times in a day, that is N4500. Meanwhile instead of taking it three times a day, maybe you take it twice and supplement it with fruits. What I always advocate is to go for fruits in season. If it is mango that is in season, take mango. Just make sure you take enough fruit. Each time you are eating take fruit with it. Vegetables, in larger quantity. What it does is that it fills up your stomach and intestine. It will not allow those toxins to stay long in your system. If you take fruits, you will use the toilet almost every day. But if you take meat pie, you might not go to the toilet for like two to three days. That means the transit time for the food to pass through your intestine will be longer and the system would have been able to absorb all those toxins that are not good for the body. But if is fruits, the useful ones are absorbed quickly and the excess passed as faeces.
In your opinion, do you think Nigerians take their health seriously?
There are two ways to it. I have seen people who take care of their health. They are bothered about their health, but definitely, they do not have access to health. In terms of finance or non-availability of healthcare and things are getting too expensive. So, that is why I believe prevention should be our focus. But we can say, deliberately, some people don’t take care of their health. You know that if you take alcohol in excess, it will damage your heart and you are taking them, saying it is something that will kill a man. And unfortunately, by the time the heart fails and the leg is swollen, he will now run to the doctor and want the heart to go back to normal. When he could have prevented it.
So, some are just careless about their health. For some people, it is because of their job, they sit down for hours. That is why we encourage people by telling them to take walks or strolls if they have been sitting for an hour. Then you do regular exercises, it will help.
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If you could put a number to it, what percentage of Nigerians do you think deliberately don’t take their health seriously?
When you look at it, I do not have the data, so I can only guess. From my little practice, those that don’t take their health seriously are common among the youths. The youths and middle-aged. By the time they get old, high blood pressure would have come and they will now want a miracle to bring it down. But when you look at people who need to take caution but aren’t, they are low in percentage. They are definitely less than 30 per cent. But when you look at high blood pressure, at least one in three, or three out of ten people that have hypertension are not aware that they have it. So, it might now be that, if they take care of their health and go for regular check-ups, they would have been aware and taken care of themselves. But many people don’t check until when complications set in. So, if we add those groups of people, including those that know their health status and are not bothered, the percentage will be very high, more than 70 per cent.
A lot of Nigerians take herbal medicine, some people even use skin care products made by self-acclaimed cosmetologists. Do you think some of these things we take, especially herbal concoctions, can have an adverse effect on our health?
I am not against herbal medicine, but I am totally against how we are practicing it in Nigeria. That is to now say, if you ask me, I will tell people not to take herbal concoctions. Because one, the preparation is not right. There is no prescribed dosage as to the quantity. They are not formed in targeted treatment. They tell you to drink the concoction, claiming it takes care of hypertension, diabetes, sexual abnormalities, fibroid, etc. The same drug. But, if these are taken wrongly as majority of people are taking them, it can damage the heart, kidney and liver. Some of the concoctions are alcohol-based and water-based. When you take the alcohol-based, that means you are taking alcohol and most times they use a high concentration of alcohol. So, when you take them, you are damaging your organs. Go to the car parks and garages, you see them, they take them in excess. And many of them have been coming down with renal and heart diseases.
I remember when we were young, Dogon Yaro Azadiractin indica leaves were used to cure fever-like illnesses, maybe malaria. At that time, it used to work for us. That is why I believe that if our experts in herbal medicine can work with the orthodox, go into the lab, practice and blend these things in the right proportion, to me, we will be able to have breakthroughs in herbal medicine. But I learnt that government agencies are making efforts to regulate the practice. The orthodox drugs also use some of these herbs. But because of the high laboratory technology involved, they are able to tell us the components of the drugs, the quantity to take at the appropriate time and when we notice some side effects, to consult doctors. We don’t have all these with herbal medicine.
You have mentioned that alcohol intake, stress and our diet can cause cardiovascular diseases, are there other harmful habits that Nigerians are guilty of, that can cause this?
Number one, eating late is not good, because you will not have enough time to burn the excess food. But if at all you will eat anything late, it should be fruits and a very light meal. But unfortunately, in some cultures, solid food like Amala, Eba, and Pounded yam is eaten as dinner. So, that is not good for our health. And if you eat these kinds of food at night, you will notice that you will not sleep well and if you don’t sleep well, your blood pressure will not sleep. When you are sleeping your blood pressure should be at its lowest. It is only when you are about to wake up that it should come up.
Similarly, the WHO and Cardiac societies are saying we should use our hearts for nature. Nature in the sense that, now, air pollution is so much and it is injurious to our hearts. It makes the blood pressure to be high and then it can lead to stroke or heart attack.
People don’t use firewood like before but some still do. Those kinds of things damage the vital organs as time goes on. For some people, it is because of their occupation, while for some, it is what they use in their homes. I want to plead with us that we should use less of those things that can cause pollution. We did a study, and we went to some houses to measure the degree of air pollution, when you compare those that are not hypertensive and those that are hypertensive, the quantity of indoor pollution is higher in those with hypertension compared to those without. So, next time you are burning that firewood, you are increasing the risk to everybody around you. At times while driving, you cannot drive past some vehicles because the smoke from them has covered everywhere. And yet, that vehicle will continue on the road, we have our regulatory bodies that are supposed to put that vehicle off the road, but they are not doing it. Those are the habits we have, and unknowingly, we are killing ourselves.
How would you advise Nigerians on their choice of lifestyle?
My advice is for all Nigerians to practice a healthy lifestyle, regular exercise, and brisk walk most days of the week for at least 30 minutes. Exercise and make sure you sweat. You can walk, swim, and dance, but make it consistent. Don’t do it this week and then in another three months. It will not work that way. Avoid physical inactivity. If you are inactive, you will become obese. By being active and burning calories, the tendency for you to be obese will reduce. Because you are obese, the risk of hypertension, and cardiovascular disease increases. As we have mentioned before, your diet; less fat, less of salt, and high-quantity consumption of fruits, and vegetables. If you are taking alcohol, from my experience, I will advise you to not take alcohol, but if you still want to, let it be in moderation. If you are smoking, you just have to stop. Avoid stress. I always tell people that they can cope with situations around them and avoid stress. Now, when it is time for your holiday, take your leave and don’t take work from your office home. Don’t burden yourself with responsibilities; paying the school fees of almost 10 people, is enough stress. Help as many people as are within your capacity. Some people even take loans because they want to satisfy their uncle’s children. All those are unnecessary stress and can lead to hypertension. Run away from calorie drinks; soda, energy drinks, when you take them, you run the risk of diabetes and heart attack and stroke is not far from there.
What do you think the government should do to make the prevalence of heart-related diseases reduce?
Before government will do this, we the health caregivers should work together in the area of research, and our service and let all of us know that what is common to all of us is the health of our patients and the community. We should come up with policies that the government can implement. For example, if you want to bring down heart-related diseases, you can discourage the use of alcohol. The use of tobacco. Government should execute promulgated laws that ban smoking in open places and increase taxes on tobacco production. If we can implement that and enforce it, it will help the system. Government should fund the health sector. The budgetary allocation should increase, provide tools for healthcare workers and make the environment conducive, give us a living wage. Make strong efforts to stop the brain drain and turn the existing brain drain into “brain gain”. Employ health caregivers when due with encouraging allowances. There is an obvious rise in the burden of “Burnout syndrome” among healthcare givers and its effect on heart-related diseases is a call for action!
Many Nigerians are now self-acclaimed pharmacists that whenever they have some symptoms, they just take pills at their discretion. Would you say they are practising first aid treatment or abusing drugs and what is your advice to Nigerians who engage in such habits?
If you take any un-prescribed medication, it is abuse. If you take in excess of the prescribed dosage, it is abuse. What works for Mr A, might not work for Mr B. So, people abuse drugs, especially in this country. Someone who is having body pain will go and take Indocid, paracetamol, iBUFEN and all that, put them together and swallow. That is abuse. What it does is it will damage the organs of the body. Many people die because of this carelessness. I will want to plead that those that regulate, the Pharmaceutical Society of Nigeria (PSN), are doing a good job in that area, they should be able to sanitize. Apart from that, you see people putting all these drugs and exposing them to sunlight in marketplaces, selling them. These are thermolabile medications that are supposed to be kept under a particular temperature. Some are to be inside the fridge, some are to be kept at room temperature and kept away from sunlight. For some of them, ultraviolet radiation can destroy their component. It can make what is beneficial to the system become poisonous, because of the exposure. I will advise that people take prescribed medication, at the right dosages and if you have any concerns, ask your doctor. If you are taking any medication and you notice strange feelings, stop first and call your healthcare giver.
In recent times, there has been a brain drain in Nigeria, particularly in the health sector. A lot of doctors have left and are still leaving, what do you think the government can do to make the health sector juicier for them to stay in the country?
It is not only medical doctors that are leaving, because I have the experience, but even administrators are also leaving, and the IT people are leaving. If you go to banks now, people handling their IT have almost gone and are still going. So, it points to the fact that the system and the environment are not conducive enough. We can only advise the government to make the environment conducive and better secured. When it comes to the health care system, for example, we have a system in place that cannot allow you to employ when you need them and people are over stressed, overworked and even falling sick. They are not happy with the job. If that employee has the opportunity to go to a better place, he will. So, we have to check our policies and make the right economy, the right environment, right tools to work with, equip the health care system; the hospitals. Federal government, state and local government levels are doing their best, it is just that when there are global issues, especially that of the economy, it becomes difficult for the only government to do it. Worldwide, government alone cannot fix the health sector. We need a partnership with the private sector. That is why we are still pleading with the philanthropists, to help us shift their focus towards the health care system. Help us complement the effort of the government to rebuild, renovate, build new ones, equip and make people comfortable in the hospitals. It is not only about salary or pay. It is about the environment. Create the right environment and people will stay. We cannot say people should keep leaving and we will produce more experts, for example, I leave now with the experience, if you bring in a new doctor today, he cannot do the work the way I would do it. No one is indispensable but in healthcare delivery having the mind to replace when they leave may not be productive for our country. We are losing our best brains and this needs to stop.
While some people are trying to take care of their health by living a healthy lifestyle, they still become victims of fake drugs. What do you think is the way out?
I know that NAFDAC has been doing well, and I commend their efforts, but I want to say Nigerians are the enemies of themselves. Because if NAFDAC is doing a great job, what about our borders? Our borders seem porous, people bring in drugs from all those porous borders. But what we can continue to do is to be able to have a good system in place where you can rightly check the drugs. In most teaching hospitals, we have a pharmacy where we have experienced pharmacists who are able to identify good drugs. Especially when the NAFDAC number is attached to it. So, there are other things. I know very soon in Ibadan; we will be having a centre that will be able to look at the bioequivalence and bioavailability of all these drugs. I don’t want to mention specific countries, it has been alleged that some people negatively influence the contents of the drugs. Fake pharmaceutical companies have been discovered in certain markets in Nigeria. It is our people that do these things. So, we need to educate our businessmen that they can still get their business going and be truthful while at it.
Do you think healthcare is easily accessible and affordable in the country, especially at the grassroots?
Yes and No. You know we have a primary healthcare system then each state has their board and also at the national level and they are doing a great job. The one I know in Oyo State, I think we need to commend them. If you go to each local government, you will see that they are developing, renovating and building healthcare centres where they have full equipment and human capacity. So, when we have the health care centre there serving as a comprehensive health centre where other smaller ones can refer patients to, to me, that is making the health care accessible. Then the affordability will now depend on the financial ability of each person. The government have been trying in their own way to come up with free healthcare schemes. I know in some states if you are pregnant, you have access to free healthcare for yourself and your baby for a specified period of time. But I am of the opinion that, rather than making it free, it can be subsidised. Because if this government says it is free, the subsequent one might not be able to continue with it. But with the effort of the National Primary Healthcare Board and the State Primary Healthcare, they are doing their best to make sure healthcare is accessible. But it is not widespread as one would expect. I know of a village where sick people would have to spend close to N2000 to be taken out of the village before they can access care. When they get there, they have to make a deposit before they receive care. For villagers, where will they get that? But if they have primary healthcare close by, which is manned by qualified healthcare givers, then they will have access to it.
and then