Echocardiogram in progress
Stress test in progress 
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
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