What is heart attack?

You may often hear about heart attack; however do you know the cause of this disease? This disease occurs when the blood vessels are narrowed due to blockage from fat and cholesterol plug resulting to injury to the vessels wall. Blood flow is obstructed and unable to reach the heart.

This condition is known as Atherosclerosis which causes Coronary Artery Disease (CAD). It is a slow process and may be left undetected for many years until the condition becomes clinically manifested Atherosclerosis resulting in CAD leads to coronary events example chest pain and heart attack thus claiming many lives. Atherosclerosis actually is the cause of disease vessel, the number one killer in the world. In Malaysia, more people die due to atherosclerosis compared to cancer. In Malaysia, about 9% or 4000 from 50 000 patients admitted to the government hospitals died due to atherosclerosis in 2004 compared to death due to cancer was about 7%.

Blood flowing in the arteries bring oxygen for energy. This support the vital functions of organs like heart and brain. Cholesterol plug in artery narrows its lumen and impair blood flow. Sometimes this plug can rupture causing blood clot formation. If this occurs in the heart, then it will compromise blood flow and cause heart attack. The organs which do not receive adequate blood supply will die. If it happens in the brain, it will cause stroke. Iif it happens in the peripheral organs then it will cause organ damage, loss of function and eventually organ failure due Peripheral Artery Disease.

Unfortunately, many people do not know that death due to atherosclerosis could be avoided. Atherosclerosis caused 50% of patients’ death due to heart attack. If they survive, 2/3 will be discharged from the hospital with significant morbidity and 1/3 will develop paralysis due to stroke

What are the risk factors contributing to heart attack?

Atherosclerosis is on the rise in Malaysia and Asia mostly due to rich lifestyle. The number of people with obesity, diabetes and high blood pressure is also increasing, which are important risk factors. Lack of exercise, poor diet and smoking also contribute to atherosclerosis risk.

What is cholesterol?

Cholesterol is a type of fat (called lipid) which is required by body to work properly. Your body can both produce cholesterol and obtain it from dietary sources. There are ‘good’ and ‘bad’ cholesterol.

What is ‘bad’ cholesterol?

People often fear cholestero. However the truth is that it is a vital part of the body’s chemistry. Cholesterol is found in every human and animal cell. In addition to the cholesterol obtained from eating animal based foods, our body also has the ability to make all the cholesterol that is needed for various functions.

Maintaining normal level of cholesterol is important to attain maximum benefits. Cholesterol is used to make bile that is produced by the liver. It is fundamentally used to protect the nerves and to make new cell tissues. It is alsi used to produce certain hormones which are required for the normal development and functioning of the human body

Cholesterol is naturally waxy substance made by our liver and is a combination of lipid and steroid. It is minimally soluble in water. Certain lipoproteins are required to transport cholesterol across the blood vessels.

Types of lipoproteins :

1. Low density lipoprotein (LDL)
2. Triglycerides is a major component of very low density lipoprotein (VLDL)
3. High density lipoprotein (HDL)

Low Density Lipoproteins (Bad Cholesterol)

Low Density Lipoproteins also known as (LDL) or “bad cholesterols” because this type of cholesterol is deposited on the artery walls. This causes the formation of a hard thick substance called cholesterol plaque. Lower levels of LDL cholesterol reflect a lower risk of heart disease. Elevated levels are associated with an increased risk of coronary heart disease.

Does lowering LDL cholesterol prevent coronary heart diseases?

Lowering LDL Cholesterol reduces risk of heart disease. Hence, drugs are recommended for secondary prevention in patients with heart disease. It is also recommended for primary prevention in people with risk factors but no documented heart disease.

Other than medications, making certain lifestyle changes such as exercising regularly, following a diet that is low in saturated fat and cholesterol. Losing excess weight can help lower cholesterol levels.

High Density Lipoproteins (Good Cholesterol)

High Density Lipoproteins also known as (HDL) or good cholesterol because they perform the function of removing cholesterol from the blood vessels and carrying them back to the liver. They also help in preventing accumulation of cholesterol in the blood vessels. Exercising regularly and having a healthy diet would help to increasing HDL levels.[/02]

Triglycerides

The triglycerides are a form of fat made by the body. Higher levels of triglycerides can be due to obesity, physical inactivity, cigarette smoking and alcohol consumption among others. People with high triglycerides generally have high total cholesterol level including a high LDL level and a low HDL level. Most individuals who have diabetes or heart disease generally have higher triglycerides levels.

Who needs screening for cholesterol?

Any individual can develop high cholesterol levels regardless of age or sex. There are no signs and symptoms that would help an individual to diagnose high cholesterol levels. Only a routine blood examination will help you detect the level of cholesterol in your blood.

It is suggested that people above 35 should get at least one Medical Checkup annually. If you have high cholesterol, it should be repeated every 2 to 6 months preferably after intervention. It is now recognized internationally that diabetes is cardiovascular risk equivalent independent of precedent cardiac events. Therefore it is recommended all diabetes patients to screen cholesterol levels at least once a year. Health care providers should offer this screening to all diabetes patients annually without fail. Screening should be more frequent in high risk groups who have constituted interventional measures.

What are the desirable levels?

Total cholesterol – below 200 mg (5.1 mmol/L)

LDL cholesterol – below 70 mg (1.8 mmol/L) for people with heart disease, below 100 mg (2.6 mmol/L) for people with risk factors (including diabetes) and below 130 mg (3.4 mmol/L) for normal people with no risk factors.”

Women generally have higher HDL levels than men and are protected by their hormones till menopause. Their HDL levels and risk for heart disease becomes the same as males after menopause.

What are the symptoms of high cholesterol?

Most people with high cholesterol have no signs or symptoms. You and your doctor will not be able to detect it; among the symptoms which may be manifested include :

• Angina or chest pain or discomfort due to atherosclerosis of coronary blood vessels
• Intermittent claudication or pain over the feet while walking a certain distance. This is because of atherosclerosis of blood vessels in the feet.
• Blood clot or hemorrhage of the blood vessels in the brain because of narrowing or ruptured vessels leading to stroke or mini stroke.
• Heart attack caused by ruptured plaque and subsequent coronary thrombosis and obstruction of blood flow to the heart muscle. Yellow deposits over the skin especially around the eyes called Xanthelasma. The yellow deposits are due to fat deposition and usually indicates high cholesterol in the blood. Xanthoma is commonly seen especially among those with familial hypercholesterolemia.

How can any individual prevent high cholesterol?

Hereditary and diet have a significant influence on a person’s HDL, LDL and total cholesterol level. Diet that is high in saturated fats and cholesterol raise the levels of LDL cholesterol in the blood. Most individuals can prevent high cholesterol by adhering to the following recommendations:

• Quit smoking
• Eat less of dairy products.
• Eat high fiber (vegetables, oats, beans and fruits), low fat (avoid red meats and egg yolks) and low carbohydrate (avoid refine sugars) diet.
• Lose Weight (Optimize Body Mass Index. Concentrate on reducing fat over abdomen).
• Exercise 30 minutes a day for at least 5 days a week.
• Take medications whenever recommended by the doctor.
• Medication for lowering of cholesterol should be taken only after consulting the physician.

A combination of high levels of total and LDL cholesterol with low levels of HDL cholesterol is undesirable while a combination of low levels of total and LDL cholesterol and high levels of HDL cholesterol is encouraged.

The following are some of the support options and resources available:

1. Health clinics with Non-Communicable Disease Program organize support groups for their clients – check with your nearby health clinic or district health office for availability
2. Nutrition Society of Malaysia (NSM). http://www.nutriweb.org.my
3. National Heart Foundation http://www.malaysianheart.org National Heart Association of Malaysia Level 1, Heart House Academy Building 210 Jalan Tun Razak 50400 Kuala Lumpur MALAYSIA Tel No.: 603-4023 1500 Fax No.: 603-4023 9400 Email: secretariat@malaysianheart.org

Conclusion

Coronary artery disease and high cholesterol management in primary care is based on behavioral change, biomedical and psychological factors and reinforcement on adherence to evidence based drug and non-drug therapies. Your primary care physicians are in a unique position to provide on-going advice, support and counseling to ensure effective prevention and management being implemented so that burden of heart disease imposes on society can be reduced with resulting savings on health care costs and improvement in the quality of life of the patients and their family. Disability from the disease can be prevented resulting in increased economic productivity of the population.