Heart failure in the young – a growing health concern

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February is traditionally the month for love – that is, for expressing your love to your partner on Valentine’s Day. But there is also another heart-shaped theme taking place in February in countries around the world that aims to remind us of just how important our cardiovascular health is.

That’s right, it’s Heart Month. An idea instigated in response to the stark fact that cardiovascular disease (CVD), more commonly known as heart disease, is the world’s number one killer.

The risk of CVD increases with age and, indeed, heart attacks and other symptoms of the disease are generally associated with the older population. But statistics are showing increasingly that this is not always the case. An alarming number of heart disease cases now occur in younger people. An estimate by the Harvard Medical School put the figure at up to 10% of all heart attacks now occurring under the age of 45.

Several other studies have produced further evidence of this worrying trend of younger people being affected. A research group made up of scientists from 15 different medical centres investigated the risk of both CVD and atherosclerosis (the build-up of fatty material inside arteries) in 2,876 mostly male subjects aged between 15 and 34. The subjects were all deceased – victims of accidents, homicides and suicides – and were examined soon after death. The scientists found fatty streaks of atherosclerosis in subjects as young as 15 and becoming more prevalent in the over-20s.

Heart disease is mistakenly assumed to be a threat mainly to men. This is not the case. America’s Center for Disease Control and Prevention reports that heart disease affects around the same number of women as men each year. And female victims are also getting younger.

For a case study that highlights this trend towards increasing incidences of heart disease among the under-50s, we need look no further than right here on our own doorstep. Recent figures put the mean age of heart attack victims in the UAE at between 45 and 50, that’s 20 years younger than the global average.

Dr Wael Al Mahmeed, vice-president of the Emirates Cardiac Society, puts this alarming statistic down to the high incidence of heart attack among people aged 25 to 30. And while some of these cases are caused by genetic conditions, Dr Mahmeed contends that, ‘patients are getting younger because the risk factors are so high in the Gulf, with diabetes, hypertension, high cholesterol and smoking’.

Why are some young people now at higher risk of heart disease?

Diabetes, hypertension (high blood pressure) and high cholesterol are a particular problem here in the UAE, as is the associated condition of obesity. These conditions are being found increasingly in young people and research points to a familiar list of risk factors: Smoking, poor diet and a sedentary lifestyle.

Smoking is prevalent in the UAE. The 2015 WHO Report on the Global Tobacco Epidemic, stated that 12.5% of the young population (aged between 13 and 15) in the UAE and 20.5% of the adult population are smokers. That’s one smoker for every eight children aged 13 to 15.

The 2015 WHO Report on the Global Tobacco Epidemic, stated that 12.5% of the young population (aged between 13 and 15) in the UAE and 20.5% of the adult population are smokers.

Smoking causes considerable damage to blood vessels, leading to the build-up of plaque, which narrows and hardens the arteries, causing hypertension and restricting the flow of blood to the brain and heart, causing stroke and heart attack respectively. When this build-up takes place within the heart itself it causes coronary heart disease (CHD), which can result in heart attack and heart failure.

A study published in the American Journal of Public Health in 2014 found that 88% of cases of the disease among people aged 40 to 49 were attributable to smoking. In another study carried out by the Coronary Artery Risk Development in Young Adults (CARDIA), researchers looked into the impact of lifestyle factors on over 5,000 people aged 18 to 30, monitoring them for up to 15 years with regular CT scans. Over that time they found that smoking 10 cigarettes a day increased the likelihood of coronary artery disease (CAD) by 50%.

The evidence against smoking is damning, but not far behind comes poor diet. As the so-called Western diet has spread around the world, it has been followed by some very unfavourable statistics. In 2014, the WHO published the Noncommunicable Diseases (NCD) Country Profiles Report, showing that over 30% of the UAE population is now obese. And a 2016 study conducted by United Arab Emirates University, in conjunction with the UAE Ministry of Health, concluded that there was ‘a steady rise in obesity’ in children aged between three and 18.

In 2014, the WHO published the Noncommunicable Diseases (NCD) Country Profiles Report, showing that over 30% of the UAE population is now obese.

Poor diet takes its toll on the heart as well as the waistline. Refined sugar passes into the bloodstream much faster than natural sugars, causing spikes in blood sugar levels, which in time can impair glucose tolerance and ultimately lead to insulin resistance, resulting in Type 2 diabetes, a condition that has been connected to CVD.

Sugar has also been linked to raised cholesterol. Research published last year in the journal Progress in Cardiovascular Diseases found that a high sugar diet, even if only consumed for a matter of weeks, can lead to high levels of LDL (sometimes referred to as ‘bad cholesterol’). Excess levels of LDL seep into the lining of the arteries, forming small crystals, which grow and develop into larger fatty deposits. In someone with a healthy diet, these fatty deposits cause little to no harm and are usually broken down by HDL (good cholesterol). However, if LDL levels remain too high for too long, they can grow into plaques, which may eventually block the entire artery or rupture, causing a blood clot.

This is what makes processed trans-fats – often present in foods like biscuits, cakes, pies, chips and other fried foods – one of the biggest culprits here too, as they are known to both lower HDL levels and raise LDL levels. In the CARDIA study I referenced earlier, each 30 mg/dL rise in LDL cholesterol increased the risk of CAD by 50%.

In addition to the things we consume, scientists are now looking more and more at the way we spend our time – specifically, the amount of time we spend sitting down. This offers another clue as to the growing incidence of CVD in young people. Television and computers, for both work and play, have led to a more sedentary lifestyle and there is increasing evidence that this is harmful to heart health.

A study published in the journal Circulation: Heart Failure found a direct correlation between physical activity and the risk of heart failure. The theory is that when we sit still for long periods our bodies go into a sort of ‘standby mode’, which has the effect of slowing our metabolism. With metabolism slowed, refined sugars and saturated fats are not broken down as quickly, leading to fatty build-ups in the arteries and ultimately to heart disease.

What you can do to protect your young heart

There is a simple formula to protect your heart. Stop smoking, eat a healthy diet and take regular exercise. But if it really was that simple, wouldn’t we all be doing it?

We need better education about how to lead a healthy lifestyle and more help to follow these basic principles. Many people struggle to find time in the day to get up and get active. The average adult of working age now spends between nine and 13 hours a day sitting down.

The average adult of working age now spends between nine and 13 hours a day sitting down.

And anyone who has tried to quit smoking or cut the refined sugar and trans-fats out of their diet will know how hard that can be. Indeed, there is growing evidence that these foodstuffs are actually addictive, causing a similar response in the brain’s reward centres as drugs like nicotine and cocaine.

But it is essential that we try to make a change in order to reverse this worrying trend. You don’t have to make wholesale changes to your lifestyle overnight – small changes can make a big difference. Try to replace sugary snacks with fruit, aim to take at least 30 minutes of moderate exercise, such as walking, five times a week and if you’re a smoker, find a method to quit. Different methods work for different people.

It is extra important that we address these issues in the young, so that the behaviours that lead to poor diet, smoking and lack of exercise are not allowed to set in. First and foremost, be aware of the food you eat and the exercise you take and make Heart Month the time when you show more love to your own heart.

Mark Janowski

About Mark Janowski

Dr. Mark Janowski (MD, USA) completed his medical training at Georgetown University Hospital in Washington, DC in 2001. As a fully licensed internal medicine specialist, he focuses on the diagnosis and management of hypertension, diabetes, hormone disorders, gastrointestinal issues, cardiac issues, weight control, depression and anxiety. He is also experienced in bio-identical hormone replacement for men and women, and in conducting comprehensive medical check-ups to detect and reverse early heart disease and diabetes, as well as to reduce stroke risk. You can read more about our programmes HERE
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