Silent Killer

Prof. K ranga Krishnan

The Strait Times/ANN

         Have you noticed your elderly parents or grandparents gradually withdrawing from activities such as reading, going out or becoming disengaged when family members come to visit?

         Queries about their well-being may bring forth excuses such as fatigue and age. Indeed, natural aging does tire a senior citizen.

         This may be so but it may also be something more serious.

         There is now overwhelming evidence that such lethargy could be due to silent strokes in the brain.

         Many people are unaware of this term, yet millions will have a stroke each year and not know it.

         Moreover, the term "silent" is misleading as it is used simply to refer to the fact that the person is unaware a stroke has occurred as he or she does not have motor, speech or sensory problems.

         New finding suggest that silent strokes are some 20 times more common than non-silent strokes.

         They occur in the young and the old and can lead to an array of symptoms like memory problems, sadness, apathy, urinary problems, falls, pathological laughter or crying.

         Many people are literally walking around with these  silent strokes – originally called unidentified bright objects (UBOs) when spotted on the first magnetic resonance imaging (MRI) scans, as no one knew what they were.

         Globally, about 10 percent of healthy middle-aged people are thought to have had silent strokes are nearly five times more common than regular strokes.

         In the United States alone, some 11 million people are estimated to have endured a silent stroke each year – a shockingly large number. These are not new phenomena, but the greater availability or higher-resolution brain MRI scans means more of these strokes are now being detected. Large population studies have found that as people age, strokes in the brain are common.

         Very often, an MRI-identified stroke either has no symptoms or has symptoms that are not recognized by patients or physicians as caused by a stroke. The symptoms, hence are often missed. But these strokes are not benign.

         Silent strokes are caused by elevated blood pressures, smoking, diabetes mellitus and narrowing of the main blood vessels to the brain. The risk increases with age.

         These strokes mostly occur in parts of the brain (font of the brain and key internal structures of the brain) that depend on a single source of blood supply without alternatives.

         The regions of the brain that are most likely to suffer such strokes do not control motor functions or process sensory information.

         They are more involved with thinking and mood regulation. Hence, a silent stroke is more likely to be missed.

         Genes play a key role in silent strokes. There is a gene variant that causes the brain to produce more protein which protects nerve cells. Thus, genetics may influence not only one's risk but also how much damage one's brain suffers during a stroke.

         Further study can help us better identify people at risk and thus intervene before a stroke happens.

         These strokes are frequently associated with the common functional problems that characterize aging. They are related to memory impairment and dementia.

         In fact, they are the second most common cause of dementia (vascular dementia). They are linked to balance problems and falls in the elderly and may cause the loss of bladder control resulting in urine leakage. They also lead to depression and increase the probability of future strokes and death,

         The term "vascular depression" has been used to describe depression found in such individuals. These strokes are associated with poor response to anti-depressants and the persistence or worsening of depressive symptoms over time.

         The depression worsens if the damage to the brain increases.

         Investigators from Rotterdam have reported that atherosclerosis in mid-life is related to silent strokes 20 years later. These studies suggest that mid-life risk factors such as blood pressure play an important role in influencing the risk silent stroke later in life.

         The time to prevent silent strokes is in middle age.

The Jakarta Post, Wednesday 14 April 2010

Heart of the matter

Consider your heart your body’s central. So keep the traffic in and out of the arteries of this fist-sized organ free-flowing. Discipline and hard work are needed to keep your heart lean and fit, especially when the many tasty temptations and lazy conveniences of modern living can tempt one away from a heart-healthy lifestyle.

            Dr. Ong Hean Yee, consultant cardiologist at Alexandra Hospital, said: “We should not eat so much meat. Only 10 percent of our diet is supposed to be made up meat products.”

            A heart-healthy lifestyle should actually start from young. East Shore Hospital consultant cardiologist Baldev Singh said that the accumulation of fatty deposits in the heart’s arteries can start in childhood.

            Echoing him, Dr. Seow Swee Chong, consultant cardiologist at the National University Hospital’s cardiac department, said: “Autopsy studies have shown that fatty streaks can be found in the arteries of children as young as two years old.”

            These “fatty streaks” are early signs of atherosclerosis, or progressive narrowing and hardening of the arteries due to the build-up of cholesterol, fatty deposits and other cells in the inner artery walls, or intimate.

            Such a build-up eventually leads to coronary artery disease.

            The number of streaks increases with the number of risk factors such as high cholesterol, blood pressure and obesity.

            Cardiologists spoke to advised those aged 35 and above to go for a general health screening to check their cholesterol, blood pressure and sugar levels.

            The trick to keeping your coronary arteries clear and plaque free, they said, is to keep your weight down and eat a healthy, balanced diet.

            Dr. Ng Wai Lin, consultant cardiologist at Raffles Hospital and deputy director of Raffles Heart Centre, said: “A good, well-balanced diet, regular exercise and maintaining an ideal body weight are still the best preventive measures.”

            Koay Saw Lan, head of the department of dietetics and nutrition services at Singapore General Hospital, said: “Healthy food habits can help reduce three of the major risk factors for a heart attack – high blood cholesterol, high blood pressure and excess body weight.”

            A diet low in saturated fats and cholesterol will help to lower LDL cholesterol, known as the bad cholesterol, and using unsaturated fats in place of saturated fats will help to further lower blood cholesterol levels.

            Sources of unsaturated fats include soybeans, most nuts and seeds and fatty fish like salmon and tuna. When cooking, use methods that require little or no fat such as broiling, poaching or steaming.

            Singh explained: “Fat is fat. You eat it, you’ll grow fat.”

            Fiber too helps lower blood cholesterol when eaten regularly as part of a diet low in saturated fat and cholesterol. Foods high in soluble fiber include oats, beans, peas and citrus fruits.

            Regular exercise keeps your cardiovascular engine humming too. Aerobic exercises like brisk walking, swimming, cycling and jogging are recommended by Dr. Tan Swee Yanw, consultant at the department of cardiology at the National Heart Centre Singapore.

            Vigorous intensity exercises like jogging should be done at least three times a week for at least 20 minutes each time while exercises of moderate intensity like brisk walking should be done at least five times a week for at least 30 minutes each time.

            Given the worldwide epidemic of childhood obesity, doctors spoken to recommended that overweight children be put on diet and exercise plans.

            A childhood obesity study in The New England Journal Of Medicine last December found that a higher body mass index in childhood is associated with an increased risk of coronary heart disease in adulthood.

            Cardiologists here say that truncal obesity, or belly fat, is deadly for the heart. Men’s waists should not measure more than 90 cm while women’s waist sizes should not exceed 80cm.

            Dr. Lim Soo Teik, head and senior consultant at the department of cardiology at the National Heart Centre Singapore, said: “Having belly fat means your body is more resistant to insulin action and this results in higher proportions of  bad cholesterol and lower levels of good cholesterol.”

            Ong said: “The sooner you get rid of belly fat, the better. If you’ve been obese for 40 years, your body and heart will have been damaged by obesity for 40 years.”

June Cheong/ANN/Straits Times

The Jakarta Post/Friday, October 3, 2008

Know your risk for heart disease

Globally, cardiovascular disease (heart diseases) are the number one cause of death and projected to remain so. Heart disease and stroke cause 17,5 million deaths as HIV/AIDS, tuberculosis, malaria and diabetes plus all forms of cancer and chronic respiratory disease combined. Eighty percent of the victims are from low-and middle- income countries like Bangladesh although it is largely preventable. With simple and affordable steps we can reduce the major risk factors which hasten the heart disease to develop.
Cardiovascular disease (CVDs) include coronary heart disease (stroke), raised blood pressure (hypertension), peripheral artery disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity and unhealthy diet. Other factors include high cholesterol level, hypertension, diabetes mellitus, stress, obesity, family history of heart disease.



When to get your heart checked
Sudden death by cardiac arrest can never be totally prevented, but don’t panic just yet. National University Hospital’s consultant cardiologist Seow Swee Chong said: “Despite the media publicity, the true incidence of sudden death is low.
“Sending low-risk individuals for a whole battery of sophisticated tests is probably unnecessary and not cost effective.” He added that a physical examination with an electrocardiogram (ECG), together with a detailed medical history, is adequate for most.
Men are more prone to hear-related ailments. And older men, in particular, are usually concerned with heart health.
However, the recent deaths of two national servicemen highlight the need for even young people to get their hearts checked.
Raffles Hospital’s consultant cardiologist Antono Sutandar recommends those below 40 years old to go for a blood test and ECG as well as screening tests for conditions such as hypertension and diabetes once every one to two years.
Dr. Goh Ping Ping, chief and senior consultant of Changi General Hospital’s cardiology department, said: “The tests for heart disease really detect disease that has been preset for some time and has progressed significantly.
“For the general population, it makes more sense to detect and treat risk factors like high blood pressure, diabetes and obesity to prevent the development of heart disease,”. Such non-invasive tests are relatively cheap, widely available in polyclinics and GP clinics and should be done annually.
Dr. Goh said: “The key to preventing coronary artery disease is through lifestyle modification. It is never too early to start adopting a heart-healthy lifestyle.”
Exercising regularly, maintaining a healthy weight, quitting smoking and eating a healthy, balanced diet are the mainstays of a lifestyle beneficial to heart health.
Middle-aged men, post-menopausal women, smokers and Indians are most susceptible to coronary artery or heart disease.
The ECG is usually the first test used by doctors to screen for heart disease. It gives an overview of the heart and can also pick up some of the congenital heart disorders that may result in sudden cardiac death.
If there are symptoms that point to coronary artery disease, an exercise stress test, which is 70 percent accurate, is then conducted to see how the heart responds to physical exertion.
More sensitive and specific tests like echocardiograms and carotid intimal thickness can be conducted if the results of the ECG and exercise stress tests prove abnormal.
The former is done at rest before exercise and again at peak heart rate and uses ultrasound to take images of the heart’s internal structures, size and movement. The latter utilizes ultrasound to assess the blood flow of the arteries that supply blood from the heart through the neck to the brain.
Of course, there can be too much of a good thing. The New York Times raised the alarm recently on American’s penchant fro medical innovations and blanket testing.
The paper reported that more than 150,000 Americans spent more than US$100 million on CT scans last year, a new technology dogged by lack of evidence of its medical benefits to patients.
Dr. Sutandar, who does not recommend the CT scan for most, said that the ECG stress test is sufficient if one’s results are normal.

-June Cheong/ANN/Strait Times-
The Jakarta Post/ Friday, November 14th, 2008