Make Choices Not Hard Choices By Dato’ Dr. Rajen M. 27 October 2018
Key Facts of Cardiovascular Disease 1. What is the burden of cardiovascular disease in Malaysia? 2. What causes cardiovascular disease? 3. What is Cholesterol? 4. What are triglycerides? 5. How are smoking and heart disease linked? 6. What is the connection between raised blood pressure and heart disease? 7. Does diet play a part in the development of heart disease?
What is the burden of cardiovascular disease in Malaysia? • No.1 killer in Malaysia • 1 in 5 Malaysians will die of heart disease • Maybe “silent” in some sufferers • 38,000 new cases of heart disease every year
Five principal causes of death by age group, Malaysia
What causes cardiovascular disease? There are many risk factors that contribute to the development of cardiovascular disease. Most people who develop cardiovascular disease because of a combination of factors below: • Poor diet • Smoking • High blood pressure • High cholesterol • Overweight and obesity • Physical inactivity • Diabetes (high blood sugar)
• Many of the risk factors for cardiovascular disease cause problems because they lead to Atherosclerosis Deposition of fatty material, cholesterol and other substances in the wall of blood vessels.
The rupture of a plaque can lead to stroke or a heart attack
What is Cholesterol? • Is a waxy, fat-like substance used by the body to build cell walls and make several essential hormones • Your liver produces cholesterol • You absorb it from the animal fats you eat • Cholesterol is carried through the blood by particles called lipoproteins – Low density lipoproteins (LDL) A.K.A Bad cholesterol – High density lipoproteins (HDL) A.K.A Good cholesterol
What are triglycerides? • Triglycerides are fats found in the blood that are important for muscle energy • They travel through the blood in lipoproteins • As triglyceride levels rise, HDL cholesterol levels fall • High levels of triglyceride increase the risk for heart disease • Conditions that may cause high triglycerides: – Obesity – Poorly controlled diabetes – Drinking too much alcohol – Hypothyroidism – Kidney disease
How are smoking and heart disease linked? • Smoking damages the lining of blood vessels, increases fatty deposits in the arteries, increases blood clotting, adversely affects blood lipid levels, and promotes coronary artery spasm • Nicotine accelerates the heart rate and raises blood pressure
Does diet play a part in the development of heart disease? Heart disease No. 1 killer, eating an overall healthy diet reduces a majority of the controllable risk factors for these diseases. Maintain a healthy weight Maintain healthy cholesterol levels Maintain a normal blood pressure Maintain normal blood glucose levels
Recommendations to reduce your risk: Fruits & Whole-grain, Oily fish veggies high fiber Reduce Little or no Lean meats added sugars salt If alcohol, moderation
The Eskimo very few with heart disease. Why? How?
OMEGA -3 FATTY ACIDS
Omega-3 fatty acids •Omega-3 fatty acids are a group of polyunsaturated fatty acids found in fish and certain plants. •Omega-3 fatty acids are just as important to your health as vitamins, playing a crucial role in cardiovascular health and brain function, as well as normal growth and development. •For infants, seniors, and everyone in between, the health benefits of Omega-3 fatty acids abound.
Omega-3 fatty acids ALA • α - linolenic acid – C18:3n-3 Plant source EPA • Eicosapentaenoic acid - C20:5n-3 Marine source DHA • Docosahexanoic acid - C22:6n-3 22
OMEGA 3 : OMEGA 6 • OMEGA 3 - ANTI-INFLAMMATORY • OMEGA 6 - PRO-INFLAMMATORY
What does Omega-3 do? • Reduce risk of heart attacks and strokes • Reduce blood thickness (viscosity) • Relax blood vessels (vasodilation) • Lower blood pressure • Reduce risk of blood clots in coronary arteries (thrombosis) • Protect against heartbeat abnormalities (arrhythmia, ventricular tachycardia, fibrillation) • Reduce triglycerides (blood fat levels) • Protect against hardening of the arteries (atherosclerosis) • Protect against plaque rupture
GISSI TRIAL - 1 • 11,323 Italian heart patients for 3 ½ years • 4 arms: 1. 1 g/day of EPA +DHA 2. 300 mg. Vit E 3. both 4. no treatment Dr. Roberto Marchioli CIRCULATION Apr 2002;105:1897
GISSI TRIAL - 2 • 15% reduction in primary end pts. of death non-fatal MI & non-fatal stroke • 20% reduction in all cause mortality • 45% reduction in sudden cardiac death after 3 mths (p=0.01) Dr. Roberto Marchioli GISSI CIRCULATION Apr 2002;105:1897
GISSI TRIAL - 3 • Total mortality was lowered by 3th month (RR=0.59) & by 4 th month risk of sudden death was reduced (RR=0.47) • Prevent onset of arrhythmias -- uncontrolled and sometimes dangerous irregular heart rhythms.
GISSI-PREVENZIONE Parameters Outcome Primary end pts. of death 15% (p<0.02) nonfatal MI & nonfatal stroke All cause mortality 20% (p=0.01) Reduction in sudden cardiac 45% (p<0.001) death after 3 months (p=0.01)
Omega-3 Fatty acids Mechanism of Action • Omega 3 fish oil affect ion channels to reduce the risk of arrhythmia by stabilizing the cardiomyocytes electrically Dr Alexander Leaf et al, Circulation AHA 3 June 2003
American Heart Association Scientific Statement 18 Nov 2002 • Based on the RCT Studies; • Recommends 1g of EPA & DHA for heart disease • Recommends 2-4 g of EPA & DHA for Triglycerides • Can also reduce Blood Pressure, Cholesterol, Stroke
Who needs to take fish oil? • Those who are facing… – Cardiovascular disease – High blood pressure – High cholesterol – Diabetes – Arthritis – Mental stress and illnesses (Depression)
SAFE • GRAS (Generally Recognized As Safe) status for intake of 3g/day of EPA+DHA
You Can Start Young • Omega 3 fish oils improves heart artery function in children with high lipid profile American Heart Association Scientific Conference Nov 18 2002
Safety of Fish Oil • Contaminations found in fish – Methylmercury – Polychlorinated biphenyls (PCB’s) – Dioxins – Heavy metals
• Methyl mercury released from factories into rivers/seas accumulate in aquatic organisms via their gills or intestine directly, or though their food chain. • Humans take in methyl mercury by eating polluted fish. This process is called bioaccumulation.
What can Mercury do to you?
Fish Oil Contamination • In the Kuopio Ischemic Heart study involving 2005 men 60% increase risk of heart attack in men with high mercury content 23 Apr 2002 AHA Asia Pacific Scientific Forum • Arsenic linked to atherosclerosis CIRCULATION 2002 Apr
Fish Oil Contamination • An American study conducted by Green Peace in 1995 showed 21 out of 22 brands were contaminated with toxins • A local analysis showed 10 leading brands of Fish and Fish liver oils were contaminated with arsenic, mercury, lead, cadmium, antimony and other heavy metals. Most likely to contain PCB’s, DDT, Lindanes and other ocean based contaminants
Not All Fish Oil Created Equally Molecularly Distilled • Make sure the fish oil has been molecularly distilled • Gently removes toxins from the sensitive fish oil • No mercury, arsenic, lead, dioxins, PCBs and other toxins
THANK YOU
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