Know your risks for heart disease

Echocardiogram in progress

Stress test in progress

By
Dr Hj Nazar Luqman,
Specialist Cardiologist & Head of Cardiology RIPAS Hospital

Photos/Graphics: RIPAS Hospital

Cardiovascular diseases, commonly called heart diseases, are one of the leading medical problems in Brunei Darussalam, and they are a leading cause of death worldwide too.

Among all the heart diseases, coronary artery disease that leads to heart attack is the most common.

Coronary arteries supply blood to the muscle of heart, thus helping it to pump. When blocked, these arteries cannot supply enough blood to the heart muscle - as a result, various grades of "coronary artery disease" develops.

This may lead to angina - chest pain, myocardial infarction (heart attack), heart failure (poor pump function of the heart), or even sudden death. It is not a disease of old age alone - many young people suffer and can die too from this disease.

There are many risk factors that predispose to the development of coronary artery disease.

A combination and multiplicity of these risk factors determines the development and progression of coronary artery disease. Some risk factors cannot be modified like age, sex and family history but many others can.

Thus with proper control and management of risk factors, the disease spectrum of coronary artery disease can be modified or prevented. The modifiable risk factors are diabetes, high blood pressure, raised cholesterol and smoking.

Control of these risk factors is, therefore, of vital importance in the prevention of coronary artery disease.

Once the heart arteries are diseased, patients develop chest pains, heart attacks and even sudden death. Therefore, early recognition of symptoms by patients and hence, early diagnosis and treatment by doctors, are equally important in the management of heart disease.


Risk factors for coronary artery disease

Modifiable:
- Diabetes
- Hypertension
- Raised cholesterol
- Smoking
- Obesity & metabolic syndrome
- Lack of exercise

Non Modifiable:
- Age >40 in males, post menopausal females
- Male gender
- Family history of coronary artery disease


Managing the risk factors

Diabetes, hypertension, hyperlipidemia, obesity and smoking are major risks for Ischemic heart disease. All of these can be screened and all of them are modifiable.

Early detection, prompt treatment and adequate control of these can lead to an enormous impact on the burden of IHD domestically. Studies published indicate high prevalence of diabetes and hypertension.

40.7 per cent of patients who have diabetes also develop hypertension. Therefore, the risk of IHD increases several folds in this group of patients.
It is important to note that the incidence of diabetes and hypertension increases after the age of 40. This information should be assimilated with the fact that elderly population here is fast increasing. This also gives us an idea of the target population to screen and focus on preventive strategies.

An audit conducted on patients of coronary artery disease who require intervention shows the high prevalence of hyperlipidemia, hypertension and diabetes in these patients.

Up to 80 per cent of the patients have hyperlipidemia as defined by international criteria, 60 per cent have hypertension and 40 per cent diabetes. Smoking is also highly prevalent in these patients.


Measures to Control Coronary Risk Factors

Prevention:
1. Raising public awareness
2. Institution of screening programmes
3. Appropriate dietary measures: avoiding excess fat and calories
4. Regular exercise and physical activity
5. Avoid smoking and smokers

Controlling the risk factors (in consultation with your doctor):
1. Adequate control of diabetes through diet, drugs and exercise
2. Regular medication and control of hypertension
3. Achieving guideline-based target cholesterol
4. Early detection of any coronary artery disease through proper investigations like ECG, Stress Test, Echocardiogramn and Cardiac CTAngio.

Secondary prevention (for those who already have coronary artery disease):
1. Aim to prevent progression or recurrence of coronary artery disease
2. Regular medications
3. Regular exercise for at least 30 minutes daily.
4. Controlling underlying risks like diabetes, hypertension and hyperlipidemia
5. Stay away from smoking and smokers
6. Recognise cardiac symptoms early and prompt reporting to doctor

This article was prepared in conjunction with the World Heart Day, through the help and efforts of all healthcare personnel in the Cardiac Centre at RIPAS Hospital

Source: Weekend 23 August 2008

The healthy way to weight loss

By

Awg Ilham bin Hj Md Ali,

Dietitian, Community Nutrition Division,

Public Health Department,

Ministry of Health

PART 1 OF 3

WORKING IT OUT... An overweight boy doing sit-ups at a school in Singapore. AFP

Weight Loss (Behaviour Modification)

"I'm a serial yo-yo dieter and have tried all the fad diets, one of them being high protein low carbohydrates diet. I always look for the easy option. I've finally realised it doesn't exist. I can lose weight on certain fad diets but always revert back to my old eating habits."

Proper nutrition and physical activity are not the only prerequisites to achieving and maintaining appropriate body weight. Behaviour and attitude are supporting factors. Therefore, the real success of losing weight permanently is through changes made in one's lifestyle. Every change works best if you are prepared.

Once you have made up your mind to lose weight, you should make that commitment and go into it with a positive attitude. We all know that losing weight is a challenge. It takes time, practice and support to change lifetime habits. But it's a process you must learn in order to succeed. You and you alone are the one who has the power to lose unwanted pounds.

If you always look at the negative side of things, you'll become a downbeat, pessimistic person. Even slightly negative thoughts have a greater impact on you and last longer than powerful positive thoughts.

The first step you should take is to adopt healthier eating habits. Habits, good or bad, are formed by repetition. Eating habits are no exception.

If you are in the habit of snacking when you watch TV, you were reinforcing that habit until finally it became a part of you. Other habits are formed in the same way.

Some of these habits are: eating while reading, eating the minute you come in the house, eating when the kids come in from school, or eating while cooking dinner.

What you can do is keeping a diary which refers to recording some aspect of your behaviour, such as foods eaten, exercise sessions, medication usage, etc, or an outcome of these behaviours, such as weight.

Self-monitoring of a behaviour can be used at times when you're not sure how you're doing, and at times when you want the behaviour to improve.

Self-monitoring of behaviour usually changes the behaviour in the desired direction and can produce "real-time" records for review by you and your health care provider.

For example, keeping a record of your exercise can let you and your provider know quickly how you're doing, and when the record shows that your exercise is increasing, you'll be encouraged to keep it up.
Some people find that specific self-monitoring forms make it easier, while others prefer to use their own recording system.

A motivation list will help you keep track of the things you want to get out of losing weight.

Here are a few examples:

- More energy to spend quality time with family and friends.
- Fit into all your clothes.
- Live a long, healthy life
- Not be uncomfortable in public
- Not become breathless climbing stairs
- Do "active" things
- Wear nice clothes

The following techniques can be adapted as part of your daily routine in achieving a healthy, long term weight loss:

1. Eat three meals a day in accordance with 'The National Healthy Food Pyramid.' Don't skip meals.
2. Prolong your meals by: eating slowly, putting down your eating utensil between each bite: do not pick up your eating utensil until you have swallowed the bite hesitating between bites, even if you're eating finger foods.
3. Don't shop when you are hungry.
4. Carry appropriate snacks from home and avoid vending machines.
5. Choose a specific place in your home or office to eat all of your meals. This will become your "designated eating place" and should not be changed. Try not to eat at your desk at work. This would make you prone to eat all daylong and not just at mealtime.
6. Engage in no other activities while eating (such as reading or watching television).
7. Do not keep food in any room in your house except the kitchen. Do not keep food such as cookies out on the counters. Do not store items in "see-through" containers.
8. Serve yourself on a smaller plate. Minimise contact with excessive food (serve individual plates; do not put serving dishes on the table).
9. Encourage others to eat appropriate foods with you.
10. Arrange for rewards for each unit of weight loss.
11. Ask family and friends for reinforcement (praise and encouragement).

Next time you go and grab a quick snack, ask yourself - "Am I really hungry?"

You would be surprised at how many times we eat for other reasons such as depression, habit or sheer boredom.

If you find that the reason is one other than hunger, try and replace it with another pleasure to take its place.

(Ministry of Health Public Awareness Programme)

- To be continued

Source: Weekend, 16 August 2008

Ready, set, go breakfast!

Fibre in wholemeal bread and vegetables will make you feel full for a longer duration.




Dosai / chapatti contains fewer calories compared to murtabak.

By

The Community Nutrition Division (CND),

Health Services Department, Ministry of Health

Kring! I slowly opened my eyes and grabbed the screaming alarm clock beside my bed. I rubbed my eyes twice for I could not believe that it was already 6.50am. I thought to myself: "I am running late! My kids are going to be late for school."

I'm sure that this is a typical scenario that many readers can relate to. When we are in a hurry, some of us would choose to skip breakfast altogether. However, we should not skip breakfast, as it is the best way to start the day.

Breakfast literally means "breaking the fast". Imagine you sitting in a car. Early in the morning before you go to work, you need to warm up the engine first before you hit the road. The same applies to our bodies. We need to "fuel it" with breakfast first before we start our day.

Ask yourself these questions: Did I have breakfast this morning? Why is breakfast so important? Why do dieticians and nutritionists all over the world keep reminding people to have breakfast before starting the day?"

Apart from providing you with energy and nutrients, a healthy breakfast gives you many benefits.

The following are the plus points for having breakfast:

(1) Breakfast beats binge eating
Do you ever wonder why those office workers tend to go for high calorie foods during their mid-morning break such as nasi lemak, nasi katok, cucur, murtabak and fried noodles?

This is because most of them skip breakfast. Eating a healthy breakfast will keep you from getting too hungry and thus, will prevent you from overeating later in the day.

(2) It works for weight loss
Skipping breakfast is a common strategy for losing weight, but it is definitely not a smart one.

There's no evidence that suggests skipping breakfast will help one lose weight. Instead studies have shown that most people who skip breakfast tend to eat more calorie-dense foods throughout the day.

Skipping breakfast can also slow down your metabolism, while eating a good breakfast will give your metabolism a boost. If you're trying to lose weight, slowing down your metabolism is definitely something that you do not need.

(3) Breakfast improves performance at work and schools
Breakfast helps to replenish blood glucose levels. Studies have shown that eating breakfast is associated with improved strength and endurance in the late morning, along with a better attitude toward work.

While eating breakfast is important for all ages, breakfast is especially important for children and adolescents.

Studies have shown that children who eat breakfast are more likely to have better concentration, problem-solving skills and eye-hand coordination. They are also more alert and creative and less likely to miss classes.

(4) Helps lower cholesterol, which reduces the risk of heart disease
Research has shown that people who eat breakfast consume less cholesterol than those who skip it.

(5) Better mood
Hormones like estrogen and progesterone regulate the serotonin level in the brain. Unbalanced serotonin level produces mood swings. If your serotonin happens to drop, so will your mood.

Bear in mind that having a healthy nutrition is important because it can balance serotonin levels in your brain, helping you to feel more upbeat and energised. So do not skip your breakfast!

(Ministry of Health Public Awareness Programme)

USEFUL TIPS
What excuses do you have not to take breakfast? Not hungry? No time? Upset my stomach? Not used to having breakfast? Well, breakfast need not be anything difficult to prepare.

* Not hungry?
Something is better than nothing. Drink milk or juice, Eat wholemeal crackers, buns or fruits like bananas.

* No time?
Prepare breakfast that needs little preparation time like breakfast cereals with fresh milk (for kids)/ low fat milk (for adults), toasted bread with peanut butter / cheese or yoghurt with a piece of fruit.

* Perk up cereals
Top cereals with fruit or chopped nuts such as peanuts, pecans and walnuts.

* Having upset stomach?
If you are not used to having breakfast, it is common to have upset stomach once you start taking it. This is because your stomach is used to being empty early in the morning.

Try eating in small portions first and slowly increase the portion size according to your requirements.


Source: Weekend, 9 Aug 2008

BREASTFEEDING: Workplace & Employment

By

Dr Onn Fei Wen

Senior Medical Officer

Obstetrics & Gynaecology, RIPAS Hospital

World Breastfeeding Week (WBW) 2008 will be celebrated today (2 August 2008) until August 7.

The objectives this year are:

- Expand awareness of the need for and the value of providing support to a breastfeeding mother
- To disseminate updated information about the support for breastfeeding mothers
- To create optimal conditions for the provision of mother support in all circles of support.
The official Olympic symbols of five interlocking coloured rings are ideal for describing the five circles of support for breastfeeding.

These circles illustrate the potential influences on a mother's decision to breastfeed and to have a positive breastfeeding experience.

The circles of support are:

Family and social network
Workplace and employment
Government and legislation
Healthcare
Response to crisis or emergency all surrounding the woman in the centre circle.

This article will emphasise on the influence of the workplace and employment where employed women face challenges and need support to succeed at working and breastfeeding.

Women work for a variety of reasons, including financial and social rewards.

Today, working women are the rule, rather than the exception.

Most women return to work at a time when they could still be breastfeeding. It is certainly possible to successfully combine breastfeeding and employment.

A supportive workplace can make a big difference.

The benefits are far reaching for the babies, mothers and employers.

Creating a breastfeeding-friendly workplace

Some of the benefits:

Benefits to the employer:

Breastfeeding women are less likely to be absent from work to tend to a sick baby
Breastfeeding women are more likely to return to work (less staff turnover), enabling employers to keep trained, experienced and motivated workers

These women have improved work satisfaction, hence, improved productivity and morale
Companies who establish Mother-Friendly Workplace initiatives improve their corporate image and are viewed as progressive employers who are supportive of families.

Benefits to the baby:

- Breastfeeding meets a baby's nutritional and emotional needs for the first six months, and continues to contribute to the baby's nutritional and emotional health into the second year and beyond
- They have stronger immune system which means they have fewer infections, less frequent food allergies, and less severe illnesses, resulting in fewer hospitalisations
- Decreased risk of SIDS (Sudden Infant Death Syndrome)
- Improved IQ

Benefits for the mother:

Breastfeeding confirms a mother's unique ability to feed her infant in the best way possible. This in turn can be empowering

Breastfeeding offers satisfaction for the mother that she is providing her child with the best milk available to promote optimum infant health

Breastfeeding strengthens the bond between mother and child ahich is important for women whose job separates them from their children

Breastfeeding helps moms to get into shape faster and decreases their future risks of breast and ovarian cancers.

Creating a breastfeeding-friendly workplace for employees is easy

It is essential that the employee be offered:

Flexible time schedule to accommodate pumping or breastfeeding

A comfortable area to breastfeed. Many mothers appreciate a quiet space with a comfortable chair, a table and hand washing facilities nearby. Appropriate signage can also be offered

Mothers who pump may require access to an electrical outlet if using an electric pump

Mothers who express or pump their milk may need access to refrigeration.

It is suggested that the employee be offered:

Option of part time or job sharing
Extended maternity leave
On site or nearby day care
Working from home whenever possible
Support/ information from breastfeeding resource personnel

- Ministry of Health Public Awareness Programme

Source: Weekend, 2 Aug 2008