Young hearts at Risk in Oman
THE NUMBER OF CARDIOVASCULAR-RELATED DEATHS IS RISING GLOBALLY, BUT OMAN HAS ALSO SEEN A SURGE IN THE NUMBER OF YOUNGER PATIENTS WITH HEART DISEASES, PROVING THAT AGE IS NO BARRIER. DEEBA HASAN REPORTS
When 28-year-old Ahmed* was rushed to Sultan Qaboos University (SQU) Hospital’s emergency department, he didn’t realise it at first, but he was actually suffering a full-blown heart attack. He was a victim of coronary heart disease (CHD), despite having none of the known risk factors – at least nothing documented. He was tested shortly after and the diagnostic imaging equipment revealed that one of his major arteries was blocked and he required urgent treatment to save his life.
Many might be shocked to hear of heart complications at such a young age, but Ahmed’s case is not an isolated one, as many young adults around the world are at risk of developing heart disease due to the prevalent lifestyle and diet habits of the 21st century.
“The majority of people mistakenly believe heart disease is a problem only faced by the elderly and the obese. In reality, this is not the case, we know that more health risks come with age, but what many people, especially the younger generation, fail to realise is that we are all at risk,” says Steven Wileman, chief operating officer of Horizon Fitness, who has been working in the health industry for 17 years.
Back at the Cardiology Department of SQU, Dr Hatim al Lawati, a consultant interventional cardiologist, agrees. “The rate at which CHDs are rising among the younger population is alarming. I have seen and treated quite a few cases myself,” he says.
An estimated 16.7 million, or 29.2 per cent, of total global deaths are caused by various forms of cardiovascular disease, many of which are preventable. Out of those deaths, 7.2 million are due to CHD, with about 56 per cent of these deaths occurring before the age of 75 years.
“From what I know about the distribution of coronary diseases in the population, there is definitely a high incidence and prevalence of CHD in the above 40 population in Oman, but from dealing with patients on a day-to-day basis, I think there is a substantial proportion of patients under 40 who have also developed coronary artery disease,” Dr Hatim tells Y.
According to the World Life Expectancy website, which gathers its statistics from the World Health Organization (WHO) and other global health bodies, CHD tops the list among the 20 major causes of death in Oman, followed by hypertension, diabetes and stroke, which also happen to be contributing factors to heart disease. Although it’s true that medical professionals are becoming acutely aware of the dangers of heart disease in younger people and the number of diagnoses is on the rise, Dr Hatim doesn’t believe that this is a new phenomenon. “Previously, we did not suspect the younger people to get inflicted with CHDs; it was mostly about the older people because the more you age, the more you are prone to illnesses. Even back then, there were young people dying due to unknown illnesses and that could have been very much to do with the heart,” he says.
According to WHO data published in 2011, CHD deaths in Oman reached 2,250 or 28.49 per cent of total deaths. The age-adjusted death rate is 181.87 per 100,000 of the population, which puts Oman at 31st in the world.
When it comes to the causes of the CHD, Dr Hatim explains that there is a combination of contributing elements at play. “One of the big factors is lifestyle,” he says. “More people are adopting a sedentary lifestyle; they are not active, don’t exercise much and their diet is not particularly heart healthy. There is more obesity now and as a result, there is more diabetes, more metabolic syndrome and more hypertension, all of which contribute towards CHD.”
Another factor Dr Hatim says is especially prevalent among the younger generation is smoking, which has almost become a statement of coolness for many. “There is more smoking, whether cigarettes or shisha, it has become very fashionable these days,” he says. “We are seeing more CHD in the younger population, but there are certain patients in whom we see quite extensive coronary disease and it might have something to do with their genetic composition – the way their body is genetically programmed to handle cholesterol.”
In a study that was conducted in 2006 at SQU to assess the prevalence, risk factors and in-hospital outcomes of acute coronary syndrome (ACS), an umbrella term for situations where the blood supplied to the heart muscle is suddenly blocked, it was concluded that smoking, along with obesity and family history of coronary artery disease, were strong risk factors in young Omani ACS patients. It is clear there is a need for prevention programmes to control smoking and the obesity epidemic by targeting Oman’s young adults.
“From my experience where I trained, we seldom saw patients below 40 with heart attacks, but to my surprise, here I am dealing with increasingly younger patients, some in their mid-20s, who are suffering full-blown heart attacks and need urgent life-saving treatment,” says Dr Hatim.
Once a patient’s arteries have been unblocked there’s still a long way to go, as they must then live a restricted life to ensure their heart remains safe from any repeat episodes. “Even when the patients have been treated for all the blockages, they need to understand that their life will never be the same again,” warns Dr Hatim. “They need to be very careful of the kind of lifestyle they adopt afterwards by watching their eating habits and exercising, in addition to taking medication to combat further deposits in the arteries.”
Quite often, an individual can seem perfectly healthy on the surface, but below the skin, in the blood vessels, arteries and veins, deadly problems are developing. This is something Wileman points out, saying, “Today’s society is obsessed with weight and Body Mass Index [BMI]. People think ‘I have a good BMI, so I am not at risk’ and we all have that friend or colleague that lives off fast food yet remains indefinitely thin, but the truth is, that individual most probably has greater levels of hidden fat.
“In young adults, visceral fat poses a greater atherosclerosis burden, resulting in a higher risk of heart attack or stroke in the long run. The fact is, we are all at risk and adopting a healthy lifestyle choice at an early age can improve life expectancy,” he adds.
The results of a study titled Some Risk Factors for Coronary Heart Disease among Omani Males, published in the Sultan Qaboos University Medical Journal, found that heart disease has no geographic, gender or socio-economic boundaries and the WHO has drawn attention to the fact that CHD is a modern epidemic.
In Oman, chronic non-communicable diseases related to lifestyle, such as coronary heart disease, hypertension, diabetes and cancer, are now emerging as new health challenges for the country. The SQU study further emphasised that hypertension, diabetes, sedentary occupations and smoking have been reported to be the major cardiovascular risk factors.
According to Dr Abdul Hakeem, a doctor at SQU Hospital’s Critical Care and Internal Medicine Department, a “witnessed” cardiac arrest is easier to recover from and the chances of survival are higher compared with an “unwitnessed” arrest. This is because if cardiopulmonary resuscitation (CPR) and chest compressions are given at the right time, the blood flow to the brain won’t stop. However, if they are not given on time, the heart and the lungs can be fixed, but not the brain.
“Apart from us creating awareness among the people in Oman, places like the gyms should be equipped with Automated External Defibrillators and the instructors should all be certified to administer CPR and basic life support because you don’t know when to expect it,” Dr Abdul says.
The impact that CHD is creating on the community is a huge concern, according to Dr Hatim. “Because younger people are getting affected by CHD, it is certainly impacting our community in a big way as the age group between 20 to 40 happens to be the most productive and when they get inflicted with heart diseases, it takes a lot of their time away from both work and family,” he says.
So what can be done? Apparently it can be as simple as a reassessment of our priorities in life. “Ask yourself how much you invest on cream to look younger, that shampoo and conditioner for silky smooth hair and that five-litre super-cool sports car,” says Wileman. “Now ask when was the last time you invested in your heart? We need to change that, and it’s as easy as 22 minutes of moderate exercise every day. Climb the stairs, park further away from the office, carry your shopping to the car instead of using a trolley; anything, just be active and increase that heart rate. This way you’re looking after your heart in the long run.”
Hani* is a 30-year-old smoker who had no history of significant medical illnesses. One evening he developed a discomfort in his chest, which lingered throughout the night until 9am the following day, when it intensified significantly.
He became short of breath and started sweating heavily. At 11am he was taken to the local health centre where his electrocardiogram showed that he was having a massive heart attack involving the front wall of his heart muscle.
He received preliminary treatment and was rushed to the SQU Hospital. Upon arrival he was quickly referred to the cardiology team on site, who referred him to the catheterisation laboratory for an urgent, life-saving procedure.
Within 20 minutes of contacting the cardiology team, his coronary arteries were expertly instrumented and an occlusive red clot was extracted from his blocked left anterior descending coronary artery, restoring blood flow to the heart muscle.
The patient survived the event and the remainder of his hospital stay was uneventful. He was given medication to help with the healing process because his heart had sustained some damage and was now weaker as a result of the heart attack.
He was discharged from the hospital three days later. After a month, he returned to the hospital for a follow up and was doing well. Now, moderate physical exertion causes him shortness of breath, which is interfering with his ability to resume his work duties.
*Names changed to protect patient’s privacy
- 49 per cent of all deaths from non-communicable diseases in Oman are due to cardiovascular diseases
- Cardiovascular diseases are the number one cause of death globally
- In 2012, cardiovascular diseases caused 31 per cent of all global deaths
- Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol
- By 2030, more than 23 million will die annually from cardiovascular diseases
- 50 per cent of women and more than a third of men in the Eastern Mediterranean region are insufficiently active