Take these facts to heart


By Sarah Muiz -  Pics by Nisal Baduge
Cancer, cardiovascular, respiratory and kidney diseases are the most significant conditions among Non-Communicable Diseases (NCDs). Nevertheless, cardiovascular diseases have been recognised as the main cause of deaths due to NCDs. Hence, September 29 marks the World Heart Day, with the aim to increase public awareness on cardiovascular diseases and how to prevent them. Speaking to the Daily Mirror, Cardiologist Dr. Anidu Pathirana, representing the Institute of Cardiology, National Hospital of Sri Lanka, explained the complications of cardiovascular diseases in a broader perspective. While emphasizing the need to raise more awareness among the public concerning heart diseases, Dr. Pathirana highlighted that cardiovascular diseases could be considered a number one cause leading to premature deaths. Excerpts of the interview are as follows:   


QCould you explain what cardiovascular diseases are and how detrimental they could be? 
Cardiovascular diseases are diseases of the heart and blood vessels connected to the heart. It is largely part of what we refer to as Non-Communicable Diseases (NCDs). The attention has been shifted more towards NCDs under the present context. They have become the leading cause of deaths, exceeding the deaths due to infections and natural catastrophes. There seems to be an increasing tendency for the prevalence of NCDs among people than communicable diseases. This is the primary reason why people are interested in taking preventing measures against them. Most of the deaths that take place at present due to heart diseases are premature deaths which are a serious concern to be dealt with. Even if a person is lucky to survive a disease, the chances are that such a person would be faced with some kind of disability for the rest of his or her life, and will have to depend on long-term medication. As a whole, this also puts a lot of strain on the health economics of a nation.   


QWhat are the main cardiovascular diseases and what causes them? 

Although there are many diseases that affect the heart and blood vessels, the two main diseases are heart attacks caused by diseases affecting the blood vessels supplying blood to the heart and strokes or brain attacks; that again occur due to issues with blood supply to a part of the brain. These two are the most dreaded among cardiovascular diseases. Narrowing of the blood vessels is the main cause leading to these types of conditions. This happens when fatty material, commonly known as cholesterol, gets deposited in the walls of blood vessels causing them to contract.  

Scientists have found out that certain factors increase the chances of cardiovascular diseases. They are called risk factors. Among them, the factors that cannot be changed are ageing, genetic makeup and the male sex who are more vulnerable to heart diseases in comparison to women. However, there are many other risk factors that can be avoided or changed. High blood pressure, high cholesterol levels, diabetes, being exposed to any tobacco product, unhealthy diet, lack of physical activities, being obese and long-term mental imbalance are such risk factors that can be modified for the better. Although when taken in excessive amounts alcohol could be harmful, there are certain beneficial effects of it if taken in very small quantities.   


Even if a person is lucky to survive a disease, the chances are that such a person would be faced with some kind of disability for the rest of his or her life, and will have to depend on long-term medication


QWhat are the vulnerable age groups exposed to these diseases?
The narrowing of the blood vessels is a gradual process that may start very early in life. This could commence as early as adolescence. Narrowing of blood vessels goes on gradually. However, the pace at which this happens can differ from one person to another. If an individual is very much exposed to other risk factors, the speed at which he or she would be vulnerable to cardiovascular diseases is higher than in an ordinary person. 

Therefore, since childhood, people should adhere to healthy lifestyle practices. Most of the aforementioned risk factors like diet, physical activities, mental stress and obesity are lifestyle-driven. Our lifestyle also has bearing-on factors such as cholesterol, diabetes and high blood pressure, which could result in heart diseases eventually. In terms of preventive measures, the best we could do is adopting a healthy lifestyle pattern.   


QDo you think coconut oil is good for health when compared with other oils?
There are mixed feelings with regard to the use of coconut oil according to evidence-based sciences. There isn’t sufficient research conducted on the subject of coconut oil, although whatever the data available contain mixed beliefs concerning its good and bad aspects for health. Coconut oil is mainly made of saturated fat. Generally, there are four types of fats known as saturated, monounsaturated, polyunsaturated and trans. If you want to make a healthy choice based on the fat composition, you have to avoid trans fat completely. Trans fat is found in chemically-processed food. If you find the term ‘partially-hydrogenated’ among the ingredients of a food label, remember that they contain a lot of trans fat. Margarine, biscuits, snacks including potato chips contain a lot of trans fat despite being the modern trend in food consumption.  



Although when taken in excessive amounts alcohol could be harmful, there are certain beneficial effects of it if taken in very small quantities   



On the other hand, we must limit saturated fat derived mainly from animal food products and some plant products (mainly coconut and palm). Since coconut oil contains saturated fat, people believe that we should limit its consumption. However, it should be noted that coconut oil contains fairly heat-stabled saturated fat. This kind of fat, when heated, does not change its chemical composition due to temperature variations, unlike the polyunsaturated and monounsaturated fat. Although not recommended to consume in excessive amounts, coconut oil is considered an important source of calories or energy in our country since our dietary culture is mainly rice and coconut based. In the case of virgin coconut oil, the oil is extracted without increasing the temperature during the manufacturing process. This helps in preserving the chemical nature of the oil without much alteration. Therefore, virgin coconut oil is a better choice in food preparation. Oils are best consumed in raw form directly added to salads without heating and altering their chemical composition   


QWhat are the precautionary measures to be followed to prevent cardiovascular diseases?
It is important that an individual goes for a regular body checkup to ensure that blood pressure, sugar and cholesterol levels are under normal levels because these are direct risk factors contributing to cardiovascular diseases. It is advisable for a person beyond eighteen years of age to get himself or herself a medical checkup done at least once in two years. In case your family members have additional risk factors, it is better to go for a medical checkup every year. Avoid sugary beverages as much as possible, and eat a healthy diet that constitutes mostly of fruits and vegetables. Physical activities will also help in preventing the risk of cardiovascular diseases.   

QDo you have any idea about the number of individuals suffering from heart diseases in Sri Lanka?
In Sri Lanka, statistics are not up-to-date. However, statistics shows that deaths due to NCDs account for more than fifty per cent of deaths worldwide. Therefore, WHO declared that we should do everything possible to reduce premature deaths caused due to NCDs by twenty five per cent by year 2025.   


QHas the National Cardiology Unit conducted any research in this subject area?
As mentioned earlier, an unhealthy diet could be a risk factor contributing to cardiovascular disease. When it comes to diet, it is the portion size that matters more than the type of food consumed. Even healthy food if taken in excess could have unhealthy effects on an individual. A diagram depicting a ‘Healthy Plate’ with the portions/quantities of each food item that should be consumed was introduced recently by the Health Ministry. Their main aim is to cut down the excess consumption of carbohydrates. Accordingly, an individual should not eat more than half of rice in the plate. We are currently focusing on reducing the portion size of the food consumed for heart attack patients. We advise them on the quantity of food they should take in, including what they should eat. This is being conducted as a research for the first time. However, as part of our research, we have applied stringent standards with regard to the starch intake, limiting it to about 1/3 of the plate. We have to wait for the results of the investigation before introducing it to the patients.   


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