Heart Disease and Stroke: Myths vs Realities
Heart disease and stroke have been increasing in frequency for the past several decades, and are the top health concerns in our region. People frequently come to see me, concerned about their risk for these diseases. They may have heard about an affected friend or a colleague, or recently read about it online or in the newspaper. Since I hear a lot of popular myths about these diseases in my daily practice, I thought it best to share some facts to clarify the subject.
These diseases are most frequently due to the buildup of cholesterol in the blood vessels of the heart and brain, a process which actually begins in adolescence. Therefore, lifestyle matters throughout life. There are four risk factors that can be controlled: cholesterol, blood pressure, blood sugar, and smoking (which includes cigarettes, sheesha, and midwakh). The two other risk factors are age and family history of early heart disease or stroke. It is important to understand how and when these diseases develop, so that we can help both older and younger people make healthy choices. Most importantly, decreased risk can be achieved through regular exercise, a healthy, balanced diet, and by avoiding or quitting smoking.
Importantly, not everyone should aim for the same cholesterol levels. The two most important types are HDL-cholesterol, which decreases risk, and LDL-cholesterol, which is the kind that builds up in our vessels and causes heart disease and stroke. Good cholesterol can be found in fruits, vegetables, raw nuts, pulses, fish, and olive oil. Bad cholesterol is found in fried and fatty foods, animal fats, and processed foods. The ideal levels vary from person to person based on the risk factors listed above. The more of these that are improved, the lower the risk of heart disease and stroke. I explain to people their heart’s health by finding their “heart age”. I do this by calculating their risk of heart disease, and comparing it to the age of someone without any risk factors. This lets people understand how many years of their life they lose to lifestyle choices such as an unhealthy diet, not exercising adequately, or smoking.
However, not everyone with poor cholesterol levels needs to be on medication. This is due to the fact that the medications can protect people by improving cholesterol, but may also have harmful side-effects. For that reason, the decision of whether or not to start medication has to be made on a case by case basis, through a responsible and informed discussion with a doctor. Regardless of whether or not medication is used, regular exercise, a healthy diet and avoiding or quitting smoking are always necessary.
Finally, for people who do go on medication, there is some good news. They do not need to stay on it forever. Someone who manages to improve their risk factors significantly may be able to stop the medication safely. On the other hand, people who do begin medication, but do not change their lifestyle, will have to stay on the medication, even when their blood tests show much better cholesterol levels. This is because the changes only last so long as someone takes the medication, so that if the medication is stopped, the cholesterol levels return to what they were before treatment.
I hope this article has helped to clear up the issue. Heart disease and stroke are very serious issues, but there is much that can be done to prevent them.