Lifestyle change vital to prevent heart disease

Taking care of one’s heart is not just for the month of February. It should be a lifelong concern.

Studies showed that heart diseases not only afflict the elderly and people in their 30s and 40s, but also a growing number of young Filipinos who in a few more years will be likely candidates for heart attacks.

As Dr. Antonio Sibulo Jr., director of the Heart Institute of the St. Luke’s Medical Center points out, "Unless one changes one’s living and eating habits, the certainty of getting coronary heart diseases is there. A person’s lifestyle definitely affects the health of the heart. So, why wait for a heart attack if one can prevent it."

Most prone to contract heart diseases are males rather than females (comparative age group with women having the advantage of hormones protecting their hearts) but once a woman reaches 60 or enters the menopausal stage, the chances of having heart diseases are a lot greater than the male. As part of the aging process, the elderly  (60 years old and above) are at a greater risk due to the stiffening of the blood vessels.

But the young also suffers from numerous kinds of heart diseases. Asked as to the youngest patients he had treated, Sibulo mentions the cases of two young men aged 25 and 29. The latter had suffered a massive heart attack that necessitated inserting a coronary stent in the heart blood vessels to open the arteries instead of an open heart surgery.

The four major health risks in cardiovascular diseases are high cholesterol, smoking, hypertension and diabetes. The minor risk factors are sedentary living, lack of exercise, obesity, stress, and gender.

Sibulo cites the Westernization of the Filipino diet as the main culprit in the elevation of cholesterol among so many people. Having meals rich in fatty foods like those found in fastfood joints and eating a lot of meat are sure ways of registering high cholesterol reading. The normal total cholesterol level is 200mg/dl and lower.

Paying attention to one’s good cholesterol (normal values for HDL is > 40 mg/dl for men, and 50 to 55 mg/dl for women) will certainly help. An individual’s LDL, widely known as bad cholesterol, should not exceed 130mg/dl.

Recent studies in patients with coronary heart disease and diabetes have shown the benefits of lowering LDL levels to less than 70 mg/dl, arresting coronary plaque progression, and in some patients regression was even demonstrated.

Sibulo says, "The next US National Cholesterol and Education Program Guidelines would include so much lower target levels for high-risk patients to improve clinical outcomes."

Hypertension, which is defined as a blood pressure (BP) of 140/90 mm Hg and above, poses greater threat for those fond of eating food with high salt content. Filipinos, in general, consume 10 grams of salt daily while the recommended amount is only five to six grams per day.

Adding salt while eating can easily increase dietary salt to 15 grams per day. A high salt intake causes increased blood volume and to some extent increased body salt content and may lead to stiffness of the blood vessels. This would increase peripheral vascular resistance and is the hemodynamic hallmark of hypertension.

Today around 20 percent of our population suffers from hypertension. The optimal BP is 120/80 and below. But then there is a category called pre-hypertension for those with a BP between 120/80 and 140/90 mm Hg.

Immediate course of action are lifestyle changes such as reducing salt intake, quitting smoking, exercising and losing weight if obese.

 So much literature has been written about smoking’s ill-effects on people’s health. According to a large community study in the US more popularly known as the Framinghan study, the risk of smokers in having heart ailments is 1.5 times compared to non-smokers and the risk remains even if one has already quit smoking for two successive years. So it is important to stop smoking early.

Sibulo stresses that nothing beats a healthy lifestyle. "You cannot go wrong with fish and vegetables as an integral part of your diet. If you have to eat meat, be sure that it is lean and just the size of a deck of cards. As for eggs, it is okay to have one egg twice or even thrice a week provided it is your only source of cholesterol for the day. No more dairy products. No more meat!"

On herbal medicine like eating massive amounts of garlic, he did not totally dismiss its efficacy. He says there is still no published evidence yet about its uses in heart disease prevention. As long as it is just used as a supplement and not taking the place of conventional medicine, there may be no harm in doing so.

People using the excuse of eating lots of chocolate due to the cardiovascular benefits of its flavonoid contents, should remember that only the dark bitter ones with no milk and sugar added will do. 

As for exercise, in particular those patients with heart disease as well as people with simply the aforementioned heart risk factors, Sibulo, who set up the St. Luke’s Cardiac Rehabilitation Department in 1989, is proud to say that its gym is available to various kinds of clients – those who are healthy and have no known history of heart disease but are prone to heart problems, are suffering from certain heart ailments and those who just survived a heart attack and/or heart surgery.

It boasts of a highly trained health personnel and equipment such as telemetry monitoring (remote cardiac monitor) while patients exercise.

Healthy individuals with no heart affliction are advised to do regular 30 to 40 minutes of workout three times a week with moderate intensity. It should be intense enough to break a sweat and personally perceived as somewhat hard exercise but not to the point of exhaustion. It should be an enjoyable workout to promote adherence to the program for a long time.

For heart patients, the program can be a little more complex. They have to go through a process before certain types of exercise can be prescribed and this is done in consultation with a cardiologist.

"Parents should take the lead in setting the example to their children on what healthy living is. We only have one heart and we should take good care of it," Sibulo says.

For more information, call 723-0101.

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Dr. Antonio Sibulo Jr. is an examiner of the Philippine Specialty Board of Adult Cardiology. He was former president of the ASEAN Federation of Cardiology, Philippine Heart Association, and Cardiac Rehabilitation Society of the Philippines. He has written and co-published several scientific studies here and abroad.