Make Choices Not Hard Choices By Dato Dr. Rajen - - PowerPoint PPT Presentation

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

• f 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

• ther 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 & veggies Whole-grain, high fiber Oily fish Lean meats Reduce added sugars Little or no 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

EPA

• Eicosapentaenoic acid - C20:5n-3

DHA

• Docosahexanoic acid - C22:6n-3

22

Plant source Marine source

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 4th 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
• f 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

• Arsenic linked to atherosclerosis

23 Apr 2002 AHA Asia Pacific Scientific Forum 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

• ther 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
• ther toxins

THANK YOU