Heart disease is one of the biggest killers of men in Hong Kong, according to the city’s Centre for Health Protection. This is true in the United States, too, where one person dies from cardiovascular disease every 36 seconds, amounting to one in four of all deaths.
Worldwide, nearly 18 million people a year lose their lives to this condition – the number one killer, according to the World Health Organization.
Despite the shocking numbers, news about the heart is, well, broadly heartening on three fronts. Research has helped us better understand how to support this vital organ.
As awareness and education have grown, we have learned what we need to do to prevent heart disease – particularly through lifestyle changes. Advances in technology, drugs and surgical techniques have also made it easier to detect and correct serious heart conditions.
Dr Boon Lim, consultant cardiologist and electrophysiologist at Imperial College London, describes the sub-specialities in the field of cardiology as plumbing (interventional cardiology); electrics (electrophysiology); structural disease (valvular heart disease and cardiomyopathies); imaging (CT/MRI/echocardiography scans) – and “everything else – general cardiology to encompass hypertension, preventive cardiology, and congenital defects”.
In each of these, “there have been, and will continue to be, further developments in techniques and tools, with advancing technology, and drugs with a tendency to incremental small gains with each advancing ‘tool’”, Lim notes.
Dr Adrian Cheong, a partner in a Hong Kong heart clinic, and honorary clinical assistant professor at the Chinese University of Hong Kong, has practised medicine for almost two decades.
“Huge advances have been made in minimally invasive surgery for heart conditions – whether valves or arteries,” he says. He explains that until recently only the aortic valve – which controls the flow of blood out from the heart to the rest of the body – could be replaced under microsurgery. Now, the other three main valves – pulmonary, mitral and tricuspid – all have new devices designed specifically to treat them.
Angioplasty, a minimally invasive procedure to widen narrowed or obstructed arteries or veins, has become much safer and predictable, Cheong adds. “Valve issues in the elderly and infirm can be treated safely.”
New medications are also being developed to ward off heart failure, such as Entresto, a combination of the two drugs sacubitril and valsartan, which relax blood vessels so that blood can flow more easily, which makes it easier for your heart to pump blood to your body. Lim says this new drug “is saving lives and is more effective than long-standing tried-and-tested drugs”.
Cheong lauds new drugs known as PCSK9 inhibitors that help to lower cholesterol levels and the risk of developing heart disease. He describes them as a way to effectively manage atherosclerosis, the build-up of plaque in the veins and arteries.
“The management of heart failure has seen continuous and relentless improvement so much so that a disease with a prognosis worse than cancer can now be treated and most patients can live a relatively normal life,” Cheong says.
This is key, he says, given that “although cancer is now the number one killer in Hong Kong and in many developed countries, heart disease is becoming a chronic disease that requires constant management and can be conquered, rather than one that takes loved ones suddenly.”
Such developments are quite incredible when you consider that the first electrocardiogram machine was first used less than 100 years ago – in 1924 in Los Angeles. It was just 50 years ago, in 1973, that drugs were first used to dilate blood vessels in heart failure patients, revolutionising the way severe heart disease is treated.
More than ever, technology is key to managing heart conditions . As Lim explains: “The development of deep learning algorithms to diagnose arrhythmias [irregular heartbeats] helps promote wellness and health.”
As individuals, we are made more aware of our hearts because we can wear devices that keep reminding us of them: consider AliveCor’s self-monitoring EKG app and fingerprint sensor, which helps to monitor arrhythmias; the Lois smart band monitoring device for detecting shocks from an implantable cardioverter-defibrillator (ICD), a small battery-powered device placed in your chest to detect and stop abnormal heartbeats (arrhythmias); and devices such as the Apple Watch and the Oura Ring .
Lim, described as a world-leading cardiologist and whose book Keeping Your Heart Healthy was published this month, says that despite the cutting-edge science of heart surgery and the development of drug therapies, it is the patient that is the most important factor.
“I have been humbled by the remarkable difference that a patient can make to their own heart health by adopting the right mindset and attitude shift towards illness,” he says.
He advocates the four Es: Education, expectation, empowerment and execution.
Education is about learning and remembering the sense of accomplishment that comes with it. In his new book, he writes, “the elevation in mood and mindfulness is something all of us can experience” and it’s good for our hearts.
He urges his patients to adopt a positive mindset: “Expect a better future.” Optimism, he writes, is good for us – it even “seems to inoculate you, to some degree, from the inflammation commonly caused by stress”.
As for empowerment, Lim urges people to “embrace an attitude that you are the person who must change your life” – and, by extension, your heart health. And finally, he says: “Execute your plans – do something meaningful every day.
“Communicating the effectiveness of the four Es has made the largest difference in improving my patients’ health and well-being.”
Lim also urges patients to breathe properly: “Breathing ‘correctly’ is a fairly potent drug, which serves as an immune modulator, anti-inflammatory and stress-reliever. The perfect prescription for breathing is to slow it right down, to a 5.5-second inhale and 5.5-second exhale.”
Cheong agrees that patients hold the power to manage and mitigate heart disease. Aside from avoiding the usual suspects – a poor diet, lack of exercise and bad habits like smoking – he says we must also “protect our oral health [take good care of our teeth] , target inflammatory sources in our lifestyle, especially diet, and optimise the gut microbiome ”.
1. Learn to check your pulse, to be able to sense when your heart is racing, an indicator of stress. If you have palpitations or irregular rhythms, consider investing in a product like the KardiaMobile or Apple Watch which record medical grade scans that you can share with your doctor.
2. Monitor and control your blood pressure with an accurate upper arm cuff blood pressure monitor. Get high blood pressure treated urgently – it rarely comes with symptoms until it is too late.
3. Learn more about the impact of diet on cardiovascular risk – eating high sugar foods leads to fat storage and promotes inflammation, for example.
4. Work some exercise into your daily routine; exercise can help condition heart muscle, keep your arteries elastic and reduce stress.
5. Aim for seven to nine hours sleep a night . Sleep boosts immunity and productivity and promotes longevity. If you snore or are waking frequently with a start, talk to your doctor about screening for obstructive sleep apnoea which can lead to chronic heart problems.
This article was first published in South China Morning Post.