There are three broad categories of heart diseases: Congenital heart disease, Rheumatic heart disease and Ischemic heart disease. Congenitals are the ones that come by birth and the prevalence of this kind of disease is universally similar in terms of incidences. Valvular disease or rheumatic heart disease arises from complications of throat infection. The third category is called Ischemic heart disease, which arises from deficient blood supply to the cardiac muscles. The blood supply becomes blocked by the deposition of fats in the blood vessels. The incidence of this kind of heart ailment is ever increasing as a result of dietary factors, stress, pollution, and smoking diseases such as hypertension, obesity, and diabetes mellitus.
No doubt, cardiac disease is becoming frequent in Nigeria and is currently a major cause of morbidity and mortality. Several factors that increase the risk of coronary heart disease and heart attacks have been identified by extensive clinical and statistical research. In a survey of cardiac risk factors in the population aged 25-26, high prevalence of hypertension smoking (mostly men) and obesity (mostly women) was revealed. The Nigerian Hypertension Society (NHS) estimates that 32 percent of the Nigerian population suffers from hypertension. It further states that at least one in three deaths worldwide are cardio vascular related. Indeed, the rising incidences of obesity, diabetes and sedentary lifestyles that may cause high blood pressure threaten to keep heart diseases on top of the list as the leading cause of death and disability throughout the world.
Several risk factors exposing a person to cardiac disease have been identified. While some can be controlled or modified others cannot. The more risk factors a person has, the greater the chances of developing coronary heart disease. For example, Okafor has a very high total cholesterol (6.8MlmollL) and Chidinma has an elevated blood pressure of 162/100mmhg. Both are obviously at the risk of suffering a heart attack or stroke if they do not lower their cholesterol and blood pressure respectively. Mildly elevated cholesterol and blood pressure levels may not pose a threat to Charles but together they significantly increase his risk of developing heart disease later in life. As a matter of fact, studies have shown that Charles with his blood pressure and cholesterol levels has a similar risk of suffering a heart attack within ten years as Okafor and Chidinma.
An outlook of the Nigerian economy reveals a predominantly poor population most of whom are agrarian. Many find it hard to make earns meet and indeed live from hard to mouth. The lifestyles of the people are greatly affected by the economic index of the country, the purchasing power of these individuals and, to a larger extent, the vicissitudes of social life and societal value system. Some of the cardiac diseases interestingly affect indigent patients. For example, Rheumatic heart disease, an inflammatory disease of the heart is a disease of ghettos. Its incidence is very high in crowded and poor sanitary conditions. Paradoxically, the treatment of this disease is more expensive than the one that affect the risk. For example, in rheumatic heart disease, the valve is damaged. Some of them can be repaired at low cost, but majority of them would need expensive total replacement. Studies have shown that rheumatic heart disease affect the poor, ischemic heart disease affects the more affluent people and congenital heart disease does not discriminate between the rich and poor.
As a result of the present economic situation in Nigeria, many resort to petty trading, manual labour, working overtime, and other rigorous activities to earn a living. These activities build up stress in the individual. Of course, individual response to stress maybe a contributing factor. Scientists have noted a relationship between coronary heart disease risk and stress in a person’s life, their health behaviors and socio economic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.
Medical evidence has shown that in most cases of heart patients in their early thirties, poor nutrition was responsible for their blood pressure levels soaring.
The air quality in Nigeria is no more pristine and is deteriorating rapidly. Vehicular traffic, industrial emissaries, the construction boom which is taking place in many of the metropolitan areas increase the levels of ambient particulates, smoke particles and dust in the atmosphere. Similarly, due to erratic power supply, business owners who can afford it and buoyant Nigerians alike purchase generator sets. These sets also increase the air pollution substantially when their cumulative output is considered. Furthermore, smoker’s risk of developing coronary heart disease is 2-4 times that of non-smokers.
More often than not, societal pressures, job losses etc drive people into alcohol. Excessive alcohol intake usually gives rise to a feeling of temporary Dutch courage. A sour reality being that drinking too much alcohol can raise blood pressure, which increases the heart’s workload, and can lead to heart failure/stroke. It could also cause irregular heartbeat. Similarly, owing to work pressure and tight schedules, most Nigerians have less time for exercise, these leads to obesity especially in women. Indeed, excess weight increases the heart load. It also raises blood pressure and blood cholesterol.
Heart disease is the number one killer of women. A woman has a 50% chance of dying from her first heart event compared with a 30% chance for a man. Heart diseases are causing much havoc in the world, killing millions of people every year without warning or recognized symptoms and Nigeria is no exception. Unfortunately, heart related diseases have not been given its deserved attention despite its devastating nature. Sadly, many people may not consider themselves at risk. The world hypertension day (May 13, 2006) offered Nigerians another opportunity to be reminded of not only hypertension, but also other cardiovascular health in general. Urgent steps therefore have to be taken. What management options are consequently available?
Adverse risk factors maybe managed with respect to the natural history of the disease process. Three phases maybe identified: efforts to prevent the occurrence of adverse risk factors, management of established adverse risk factors before the occurrence of clinically manifested cardiac diseases and the management of risk factors after the disease development.
The most effective measures for the management of adverse risk factors will be aimed at the prevention of the occurrence of cardiac disease. This generally must start early in childhood. It involves establishing good health habits, proper nutrition in childhood without the intake of excess calories, engaging in vigorous but non-violent sports and prevention of Cigarette smoking.
The food and beverage industry will play a prominent role in reducing the high incidence of cardiac diseases by coming up with healthy food and beverages to Nigerians. Food and snacks with high salt content, high saturated fats content and refined carbohydrate must be discouraged. Maintenance of an ideal weight should be the starting point of any prudent diet. Moderate reduction of the amount of fat especially saturated fat coupled with a prudent decrease in the intake of cholesterol lowers the blood level of cholesterol by (5-15%). This can be achieved by replacing saturated fat with polyunsaturated vegetable fats and oils such as corn, cotton seeds, and soybeans.
Public enlightenment through the mass media is another veritable tool in preventing and managing heart diseases. Enlightenment should not only be carried out by health care professionals but also by every stakeholder in heart disease treatment and control- e.g. pharmaceutical companies, non-governmental organizations. Free screening exercises should also be conducted for members of the public. Enlightenment campaign should focus on cardiac disease risk factors mainly dietary factors, hypertension, smoking and physical activity. Efforts should be made to create a supportive physical and behavioral environment in keeping with the principles of social learning theory.
There are not many centers that deal with the treatment of heart diseases; among the available ones some are in the private sector and others in the public sectors. The level of cardiac manpower available in the country is low and the cost of cardiac medicare is not within the reach of the common Nigerian. Thus, the Nigerian government both at the federal and state level should as a matter of necessity make money available for the health sector especially in the procurement of heart treatment facilities.
Drug therapy is not left out in the management of cardiac disease. A number of hypolyridemic drugs are available for the treatment.
The age long saying that prevention is better than cure cannot be over emphasized. In fact, scientific evidence clearly demonstrates that treatment practices need to focus more on primary prevention rather than on managing individual risk factors in isolation.
REFERENCES
1. Environment Health perspective vol 110, Number 3, March 2003, available at http://www-ehponline.org/members/2002/110p.307-317htm (accessed 15th May 2006.)
2. Socioeconomic Differences in Avoidable Mortality in Sweden 1986-1990, International Journal of Epidemiology, vol 25, No23 June 1996 pg. 560.
3. The Seychelles Heart study II: Methods and Basic findings available at http://www. seychelles.net / study / at Issue /org 2.htm (accessed on 15th May 2006.)
4. UNESCUP Ministerial Conference on Environment and Development on Asia and the pacific 2000-held in Kitakyusha Japan 31 August-5 September 2000 pg 1-5
5. Women and Heart disease, the Time Magazine, August 11, 2003 pg 47.
6. World Hypertension Day: who tames the silent Killer, The Saturday Newspaper, May 13 2006, this day vol 11, No. 4039 pg.15
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