FUNMILAYO AREMU reports that cardiovascular diseases are on the rise in the country, just as she identifies their causes, symptoms and what can be done to prevent their occurrence.
Sunday (not real name), drank his tenth bottle of beer while singing along to Sunny Ade music playing in the background. With his fingers, he motioned for the bartender to bring him three more bottles.
Huffing and puffing on a cigarette, he sang “Ma j’ayeoni o, mi o m’eyinola o, ma j’ayeoni o, mi o m’eyinola o,” translated as – I will enjoy my life today because I do not know what tomorrow may bring. A couple of hours later, he staggered drunkenly to his house which was a few blocks from the bar.
This is Sunday’s everyday ritual. After working during the day as a bus driver, he often retires to his favourite bar, consuming about 15 bottles of beer and at least two packs of cigarettes, a habit through which he might later develop a case of hypertension or worse, die of sudden cardiac arrest.
This is just an example of a diverse kind of habits many Nigerians indulge in on a daily basis and, according to the World Health Organisation (WHO), are the most significant behavioural risk factors for cardiovascular diseases which are the leading causes of death globally.
As its name suggests, cardiovascular diseases (CVDs) are diseases of the heart (cardio) and blood vessels (vascular). The WHO identifies some of them as coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, and deep vein thrombosis.
The Nigerian Cardiac Society (NCS), a non-governmental organisation, in a circular signed by the publicity secretary, Dr AdeseyeAkintunde, on World Heart Day, held on 29th September, 2022, explained that about “four out of five deaths arising from cardiovascular diseases are due to heart attacks and strokes, and one-third of these deaths occur prematurely in people under 70 years of age.”
Providing a further breakdown of the nature of CVDs in the country, a consultant physician/cardiologist and Head of Internal Medicine, Federal Medical Centre, Abuja, DrOlugbengaAbiodun, expatiated that hypertension or Hypertensive Heart Disease (HHD), heart failure, cardiomyopathies (a disease of the heart muscle that makes it harder for the heart to pump blood), coronary heart disease (CHD), rheumatic heart diseases (damage to the heart muscles and heart valves), arrhythmias (heart rhythm problems), congenital heart diseases, stroke and chronic kidney disease are the most common. A claim corroborated by Dr Tina Anya, another consultant physician/cardiologist at the Federal Medical Centre Abuja, who rated hypertension and diabetes as the most prevalent.
Hypertension, a most potent CVD
Although some people might have heard of hypertension and heart attack, they might not be aware of other CVDs or know the factors that cause or increase the risk of getting them. According to DrAbiodun, “the number one risk factor for death globally and in Nigeria is hypertension and it affects three to four out of every 10 adults. In Nigeria, about 15-30 per cent of adults living with hypertension are aware, while only 20 per cent are on treatment and 10 per cent have their blood pressure (BP) controlled.
“Other [causes] risk factors for CVDs include smoking, diabetes mellitus, obesity, abnormal cholesterol levels, harmful alcohol use, physical inactivity, infections such as rheumatic fever and tuberculosis, and recreational drug use, especially among young people. Lastly, non-modifiable factors that increase the risk of CVDs are increasing age and positive family history of CVDs.”
Abiodun added that CVDs occur more commonly in men than in women before menopause and the risk of CVDs increases with increasing age. He, however, noted that some CVDs are gender and age-specific. He said, “peripartum cardiomyopathy is seen in women during or shortly after pregnancy while rheumatic heart disease largely affects children and young adults.”
Dr Anya, while validating Dr Abiodun’s claim that CVDs can be inherited, disclosed that being a black person is also a risk factor for CVDs. “Most of the time, it is inherited. a majority of people with hypertension or diabetes inherit it. It is in their bloodline. For diabetes, it could also be acquired. Obesity is closely associated with diabetes. For hypertension, there are other conditions that can also result in hypertension. Things like kidney disease can cause hypertension, and endocrine diseases, like the disease of the thyroid, and adrenal glands. There are other conditions that can manifest with hypertension.” she explained, adding that, “for the secondary cause of hypertension, if you treat the cause, the blood pressure normalises. But for the primary cause, which is the inherited one, it is genetic so there is no treatment per se, you just manage it.
“Unfortunately, a lot of people feel the black race is cursed. Being black is a risk factor for CVDs. Increasing age, the male gender is also a risk factor. These are risk factors that you can’t do anything about. One can’t change his age, race or gender. Then, of course, heredity. You can’t change your gene.”
Conceding that all these basic factors like race, gender and age can be linked to CVDs, one might begin to “wonder if there are other causes people consider inconsequential. It is no longer news that the economy is failing apart, forcing many people to live below the poverty level. Besides, with inflation, rising cost of goods and services coupled with the insecurity bedeviling the country, perhaps there are more risks around us than we know.
When asked if socio-economic factors could contribute to the increased risk of CVDs, Abiodun and Anya confirmed that it was possible due to the high level of stress that Nigerians go through on a daily basis.
According to Abiodun, “Rheumatic heart disease and tuberculosis of the heart are diseases of poverty and poor living conditions. Stress can also lead to the adoption of harmful habits that promote the development of CVDs.”
On the destructive habits that many Nigerians engage in that could put them at risk of developing CVDs, DrAbiodun believes that our adoption of the western lifestyle has made it possible for them to pick up some unhealthy habits like “… taking unhealthy diet (high-fat diet and soda), high salt intake, physical inactivity, smoking, harmful use of alcohol, and recreational drug use. Others that are generally harmful to our health include self-medication, the use of herbal concoctions, bad health care-seeking habits, and refusal to follow competent medical advice.”
While corroborating DrAbiodun’s claim, Dr Anya explained that “smoking is a risk factor for CVD, particularly coronary heart disease. People who smoke increase their risk of developing a heart attack by as much as tenfold compared to those who do not smoke.
“Binge drinking (excessive alcohol consumption) also increases the risk of heart attacks and haemorrhagic stroke. These days, people use all sorts of harmful substances. These drugs are harmful to the heart. They can cause abnormal heart rhythm, which can cause arrest.”
She explained further that people who engage in such acts put themselves at risk of sudden cardiac death.
On the symptoms of the deadly diseases, Dr Anya mentioned that the diseases do not present with any symptoms. She said, “The unfortunate thing is that these diseases can be asymptomatic. The person will not notice anything until the disease is already causing damage to the organs. There are no straightforward symptoms of hypertension. For diabetes, it may be a bit more recognisable. The person will just find that he is always thirsty. There will be a constant desire for water because the high blood sugar will make him constantly dehydrated.
“They may also find out that they eat a lot but still feel hungry. It may just be unexplained weight loss for some people, that is how diabetes manifests. There could be abnormal sweating. They could have blurred vision, they also urinate a lot, and particularly for those who urinate outside, they may notice that sugar ants would accumulate where they urinate.”
Preventing cardiovascular diseases
Though, it would seem preventing CVDs is far to seek, maintaining a healthy lifestyle, medical experts believe, is far cheaper and best option. According to Anya, healthy lifestyles that involve “a healthy diet which entails low carbohydrates and fat, high in vegetables and fruits,” should be adopted. “Salt intake should be controlled. What we tell people is no added salt to already cooked food. So, if you taste the food and you feel it is not tasty enough, don’t add any salt to it. That would help to control your salt intake.
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People, she said further, should “avoid processed food; that is, food that is not in its natural form. Things like carbonated drinks, canned food, refined meat, sausages, and packaged meats which are sold in supermarkets. Essentially, food that is not in its natural form. Avoid processed food as much as possible.
“Food should be taken as close to its natural form as possible. Then, exercise is very important. When we exercise regularly, we keep our hearts healthy. The heart stays active and we are also able to control excessive weight gain when we are physically active because weight gain in itself is a risk factor for CVD, obesity is a risk factor. Some people feel obesity in itself is a CVD.”
When asked how often people should go for check-ups, Dr Anya told Sunday Tribune that “What is recommended from the age of 40 is that you should have a check-up at least once a year. But what I would recommend is for people who have a family history of CVD, apart from the annual checks, should check their blood pressure and blood sugar level at least once quarterly because they already have the family history.
“Those who have no family history can stick to the once-a-year check. But, truthfully, we have got to a point where every family should have a digital blood pressure monitor at home so that people can check impulsively. That way, people who have this disease will be discovered earlier. It doesn’t have to be detected in the hospital. And if we form a culture of having these things in our homes and encouraging family members to check, we will be able to detect when those values are rising out of range. So, we would seek medical attention earlier,” she advised.
Speaking on the normal blood pressure value, she said: “WHO recommends that the normal blood pressure has its systolic value, the one on top, should be less than 140 and the diastolic – the one below – should be less than 90. Blood pressure can also be low when the systolic is less than 90 and the diastolic is less than 50.
“However, for some people, even before they get to these values, they are already having symptoms that will suggest that their blood pressure is low. You can’t really give a benchmark for low blood pressure; you may have to individualise it. For somebody in his 60s, if the blood pressure is around 100 over 60, he may tell you that he feels dizzy. For him, that value is already low. It is not as clear cut for low blood pressure, as it is for high.”
Dr Abiodun advised that “Nigerians should adopt healthy lifestyle choices. The advent of mobile technology is a veritable tool that can assist Nigerians in the promotion of healthy lifestyle choices. An example is the use of mobile phones through apps in encouraging healthy eating, exercising regularly, reminders about medication use, and interfacing with qualified healthcare professionals in the comfort of their homes.”
Dr Anya also recommends that people eat healthy, stay active and try to reduce stress as much as possible. She said: “The truth is, for every day that you make the right choice, you are in your own way playing a role in elongating your life. We should see ourselves as stewards of the lives that God has given us. We should always opt for a healthy choice.
“Nigerians say something must kill a man, but the truth is you don’t have to choose the poison that kills you. Let God determine how we die, we don’t have to help ourselves to our graves.”
and then