Slaying the atherosclerotic dragon

If nothing is done, we have to brace ourselves for a cardiovascular epidemic in the next two decades. Even teenagers will probably be having heart attacks and strokes already. Children will be taking pills to control their high blood pressure. We can laugh at this scenario now, but if we don’t take it seriously, wait another 10 to 20 years, and see if we can still afford to laugh.

Hypertension, cholesterol problems, diabetes and other risk factors still continue to be inadequately controlled, even in First World countries like the United Sates and Europe. The statistics, of course, are more staggering, somewhat depressing, in developing countries like the Philippines where health priorities may not be properly reflected by the health budget allocated by the government.

So, the private sector has to heed the call of the government to do its reasonable share in addressing major health concerns, and the unabated increase in the prevalence of cardiovascular diseases is one problem which requires prompt and urgent attention.

All the cardiovascular risk factors converge into one final common pathway. They all "conspire" to develop atherosclerosis which is the progressive narrowing of the arteries throughout the body.

As if planned by an ingenious evil schemer which will make the war plans of the most brilliant military strategist like kid’s play, atherosclerosis slowly but effectively cuts the food supply to all the vital "installations" and "capitals" in the body, such as the heart, brain and kidneys.

Eventually, all these vital "installations" give up and atherosclerosis, the conqueror, sows terror in the conquered body in the form of heart attacks, strokes, kidney failure and a long list of complications. The individual finally succumbs to death… and atherosclerosis once again reigns supreme, and goes around for the next population of victims to be conquered.

Health experts can no longer take this atherosclerotic insult sitting down. The Philippine Society of Hypertension (PSH) and the Philippine Lipid Society (PLS), both non-profit organizations, are spearheading 24 medical and healthcare organizations, including the Department of Health, in this alliance against atherosclerosis.

The alliance has organized a big convention on Feb. 10-12 at the EDSA Shangri-La Hotel. About 1,500 delegates are expected to participate in the convention with the theme, "Hand in Hand in Health." (Interested physicians and healthcare professionals may contact the secretariat at 631-7970, 687-2841 and 687-7073 for registration.)

"We hope that everyone attending this convention will go home not only with new knowledge and insights into the prevention and control of atherosclerosis, but more importantly, with firmer commitment in achieving this goal," Dr. Gregorio Patacsil Jr., PSH president, and Dr. Dante Morales, PLS president, say in their joint message inviting all who are interested in waging this concerted fight against atherosclerosis.

Health Secretary Manuel Dayrit compares atherosclerosis to a multi-headed dragon which is simply too formidable to slay by a sole gallant knight, no matter how extraordinary the knight’s valor and skills are. The multiple heads are the various risk factors, particularly high blood pressure, cholesterol, diabetes, smoking and obesity. The atherosclerotic dragon can only be defeated by cutting all its ugly heads.

Dr. Rafael Castillo, past president of the Philippine Health Association and current president of the Charter Research Foundation, says, "The fact that atherosclerotic cardiovascular diseases have gone up the list in the last two decades to become the leading causes of deaths in the Philippines and worldwide, suggests that there was something wrong in the general strategy used by doctors and healthcare givers in addressing the problem."

Castillo adds that time was when patients were treated on a piece-meal basis, depending on their risk factors. High blood pressure, cholesterol, diabetes and obesity were managed separately. But doctors soon realized that treating several but leaving one major risk factor uncontrolled, may not significantly improve the patient’s cardiovascular outlook in terms of reducing heart attack, stroke and peripheral arterial disease. Hence, the desired bottom line of preventing heart-related deaths is not effectively achieved.

Doctors are now advised to make a comprehensive or thorough assessment of the patient to identify those who are at high risk. This is called a global risk assessment, and it guides the physician on what medicines to prescribe. A patient, for example, may just have a high-normal BP like 130/88, but he should be started already on treatment if he has diabetes or if protein (albumin) is detected in the urine. This patient is already labeled as high-risk compared to another patient who may have a higher BP of 160/100 but with no other risk factors. This other patient is still considered as low-risk.

Risk assessment is therefore based on the total picture and not solely on the severity of any single risk factor.

Health experts agree that treatment should be focused on improving the health function of the blood vessels, no matter what the primary problem is. The patients may be surprised why they are prescribed an antihypertensive agent when their BP is normal, or a cholesterol-lowering drug when their blood cholesterol is with in normal limits.

High-risk individuals, particularly diabetics, may benefit from these medications because of the beneficial effects on the blood vessels.

These shifting paradigms in medicine are the result of continuing research, which may make practices 10 years ago already archaic and irrelevant. Keeping healthcare professionals updated on recent scientific developments and stimulating discussion on how to apply them to the local population are the primary objectives of the annual joint convention of the PSH and PLS.

Atherosclerotic cardiovascular disease requires a concerted multi-specialty approach to lick the problem, hopefully for good. It is therefore important for all these specialists coming from various fields of specialization to convene regularly and compare data and insights on how best to cut the many heads of the atherosclerotic dragon.

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(CHARTER is the acronym for Clinical Hypertension and Atherosclerosis Research on Therapies Epidemiology and Risk-management, a non-stocks non-profit research foundation which promotes healthy lifestyle changes in the prevention of many common medical problems. It is based at the Manila Adventist Medical Center (MAMC). Free membership is open to health-conscious medical, paramedical and lay individuals. The author is a consultant in internal medicine at MAMC, and a member of the board of trustees of CHARTER. For an archive of health-related topics and to register as a member, log on to www.chartermamc.org.)