Heart disease is the third most common cause of death in Hong Kong, and it affects more men than women. We sat down with Dr Jason Ko, Consultant in Cardiology at Hong Kong Adventist Hospital, to find out more.
How common is heart disease in Hong Kong?
According to the Census and Statistics Department, Department of Health, heart disease accounted for 13.2 percent of all deaths in 2015; out of those, coronary heart disease accounted for 66.6 percent of deaths. Age-standardised death rates due to coronary heart disease were 36.5 for males, and 16.1 for females, per 100,000 people in 2015. What are some of the warning signs to look out for? There are numerous heart diseases with different presentations. For ischaemia (restriction in blood supply) caused by coronary artery disease, “angina pectoris” is the typical description of such a symptom. Angina pectoris is just a fancy term in Latin that means “pain of the chest”; it’s caused by an imbalance between the blood supply and the oxygen demand of the heart.
The commonest cause is narrowing of the coronary arteries (blood vessels that surround the heart). Typical symptoms include tightening chest pain that originates behind the chest ribs; patients sometimes describe it as an elephant sitting on their chest! The pain, which can be precipitated by physical exertion or emotional stress, can radiate to the jaw or left shoulder, and lasts about one to five minutes; it’s relieved by nitroglycerin. The pain intensity doesn’t change with respiration, coughing or a change in position. Sometimes patients confuse angina with other problems, or vice versa, such as gastric reflux disease, a fast heartbeat, or even coughing chest pain, for example.
Is it easy to treat?
Patients are given sublingual (under the tongue) nitroglycerin for quick pain relief. The definitive treatment, however, is through an operation. The usual treatment is termed “PCI” (percutaneous coronary intervention). This is a procedure to place a stent in the narrowed segment of the coronary artery. Whether the narrowing is easy to treat or not depends on how calcified and tight the lesion is and how extensively the disease has progressed. The most extensive coronary artery disease may require a coronary artery bypass graft, which is a type of open-heart surgery. However, once a patient is labelled as having coronary artery disease, they are going to have to live with it for life; the treatment strategy is to keep the disease from progressing further, or at least not as quickly.
Does the stress of life here contribute to heart attacks and hypertension?
A stressful working lifestyle can indirectly worsen hypertension, which in turn contributes to heart attacks. Stress forces our body to release stress hormones including adrenaline and cortisol. Adrenaline constricts heart vessels, which causes high blood pressure. Cortisol raises both our cholesterol and blood sugar levels, leading to hypertension, hyperlipidaemia and diabetes respectively. All these factors damage the blood vessels including the coronary arteries over time, until one day the blood flow is blocked, resulting in heart attacks.
What can we do to prevent cardiac issues?
#1 Quit smoking: The hazards of smoking need no further introduction. Smoking not only kills you, but also your family and the people who are forced to breathe in your cigarette fumes.
#2 Eat well: Generally, we should choose food low in fat, salt and sugar. Boiled or steamed foods are healthier than fried or grilled. Foods rich in omega 3 such as salmon, trout and herring should be considered. Foods cooked with hydrogenated oil that are high in trans fat, such as biscuits, doughnuts and pie crusts, should be avoided.
#3 Exercise well: To improve overall cardiovascular health, the American Heart Association suggests at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity).
#4 Sleep well: An average of eight hours of sleep a day prevents weight gain by reducing your appetite and better regulating your blood sugar.
#5 Watch your waist size: One indicator of fitness is girth. The World Health Organisation suggests maintaining a waist-to-hip ratio of below 0.85 for women and below 0.9 for men.
#6 Get regular check-ups. Early detection and early treatment for risk factors such as diabetes, hypertension and high cholesterol levels are crucial in preventing coronary artery disease. So, make sure you have regular check-ups, particularly after the age of 40 for men and 50 for women. You can also try out the “My Heart Score” tool (mlc.heart.org) created by the American Heart Association to determine whether a person should visit a doctor for further heart health screening.
Hong Kong Adventist Hospital is at 40 Stubbs Road, Happy Valley | hkah.org.hk
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This article first appeared in the Oct/Nov edition of Expat Living magazine. Subscribe now so you never miss an issue.