R E P O R T O N T H E C H D R I S K O F A F A M I L Y M E M B E R
by KARIN GOH (212)
1 FACTORS
CHD is believed to start with injury or damage to the inner layer of a coronary artery. Arteries are the blood vessels that carry oxygen-rich blood throughout your body. The muscular walls of the coronary arteries are normally smooth and elastic and are lined with a layer of cells called the endothelium. The endothelium provides a physical barrier between the bloodstream and the coronary artery walls while regulating the function of the artery by releasing chemical signals in response to various stimuli.
Certain factors damage the inner layers of the coronary arteries. These factors include: smoking, high levels of certain fats and cholesterol in the blood, high blood pressure, high levels of sugar in the blood due to insulin resistance or diabetes, blood vessel inflammation.
Coronary artery disease starts when you are very young. Before your teen years, the blood vessel walls begin to show streaks of fat. As you get older, the fat builds up, causing slight injury to your blood vessel walls. Other substances traveling through your blood stream, such as inflammatory cells, cellular waste products, proteins and calcium begin to stick to the vessel walls. The fat and other substances combine to form a material called plaque. The accumulation is the hardening of the arteries, or atherosclerosis.
If pieces break off or rupture, platelets will clump in the area, attempting to repair the blood vessel. This clump can block the artery, reducing or blocking blood flow.
In addition, there are many forms of heart defects since birth including abnormal development of the heart muscle, heart valves, and blood vessels into and out of the heart. Heart defects are common birth abnormalities, present in over 30,000 infants born annually.
2 INTERVIEW QUESTIONS
(Questions are listed under “Article 1. Questions for Interviewee” in Annex)
(Interview responses are listed under “Article 2. Interviewee Responses” in Annex)
3 HOW SUSCEPTIBLE IS THE INDIVIDUAL
As the subject is female and has not menopaused, the chances of her getting CHD now is quite low. Although she is 43 (under 55), she does not have a family member or any family member who has had CHD. This means that she probably does not have a genetic disease or a birth defect that will lead to CHD. None of the people around her smoke, but it should be noted that her husband used to smoke but has quit for more a decade. It should be safe to conclude that the harmful effects that second-hand smoke has on the subject used to be serious, but are greatly reduced now, perhaps even zero. The subject is slightly overweight as her BMI (23.9) is above the healthy level of 23 as given by the Singapore Health Promotion Board, which will cause her to have a bit more risk of CHD compared to others. Elevated triglyceride levels and small LDL particles, and diabetes in women, can be also associated with higher BMI values, thus the concept that increased BMI has an adverse effect on all major CHD risk factors. However, contrary to some research conclusions, this subject does not suffer from high blood cholesterol, high blood pressure, or diabetes. In fact, she does not take any medication on a regular basis. She exercises 2-3 times a week, swimming and occasionally running, Regular exercise means that your heart and blood circulatory system more efficient, lower your cholesterol level, and also keep your blood pressure at a healthy level. This information corroborates with the fact that the subject does not have high blood pressure and cholesterol levels or diabetes. She cooks at home with balanced portions of vegetables, meat and carbohydrates, usually rice. I also don’t use MSG and try to use less salt or sugar. However, she feels she get quite an amount of fats from butter, fried foods, salmon and tuna. This can be quite worrying, as excessive amounts of fat may be start to build-up in the arteries of the heart, leading to CHD. Thankfully, she is not a drinker and has not taken a drink since many years back. Drinking excessive amounts of alcohol causes raised blood pressure which is one of the most important risk factors for having a heart attack or a stroke. Increases in your blood pressure can also be caused by weight gain from excessive drinking. Thus, not drinking allows her to have a pretty low risk as well. In addition, she did not have preeclampsia. Many of the risk factors for preeclampsia and other conditions affecting your blood pressure and heart are similar. They include a family history of high blood pressure, heart disease and diabetes. She does not feel stressed and has a proper attitude towards the severity of CHD. She is serious about changing her habits, which will also help her psychologically to lower any risk of CHD. Thus, considering the subject’s overall condition and situation, her risk of CHD is quite low. If anything, a possible occurrence of CHD will only be due to change in good habits to bad habits after this interview was done.
4 WHAT ARE SOME PREVENTIVE MEASURES
You can prevent and control coronary heart disease (CHD) by taking action to control your risk factors with heart-healthy lifestyle changes and medicines. Examples of risk factors you can control include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factors—such as age, gender, and family history—can’t be controlled.
This particular subject should:
• Heart-healthy eating
o Eat less fried food, desserts and use margarine instead of butter whenever applicable or possible
• Maintaining a healthy weight
o Keep a weight journal and be conscious about her mass
She should also go for check-ups more regularly as the doctor may want to test her for any conditions, or major change in blood pressure or cholesterol levels. Other than that, she should continue to maintain good habits she has now, such as not drinking excessively, managing her stress levels and not smoking.
A P P E N D I X
Article 1. Questions for Interviewee
1. Are you male or female?
2. How old are you?
3. Have you menopaused yet?
4. Do you have a family member or family history of someone having CHD? (Has someone in your immediate family had a heart attack, a stroke, heart surgery, or any heart disease?
a. Yes, before they were 55 years old.
b. Yes, over the age of 55.
c. No.
5. Do you or anyone you live with smoke?
6. Are you overweight?
7. Do you have high blood cholesterol level?
8. Do you have high blood pressure?
9. Are you diabetic?
10. If your answer is positive/yes for any of the questions from 7-9, do you take medication?
a. Yes, I take medication for it, but it is not well controlled.
b. Yes, I take medication and it is well controlled.
c. No, I have never had any of those conditions.
11. Do you exercise regularly?
a. No, I am too busy and never have the time.
b. Yes, but only once or twice a week.
c. Yes, at least 5 times a week for 30 minutes each session
12. What is your regular diet made of?
a. Mostly eating at restaurants and ordering take out.
b. I cook at home but I don’t pay attention to the label.
c. Balanced portions with lots of vegetables.
13. How much fat do you get in your diet?
a. Lots, I eat butter, fried foods and desserts often.
b. Not a lot, I replace butter with margarine, and opt for low fat when possible.
c. Lots, from salmon and tuna, olive oil and nuts.
14. Are you feeling stressed?
15. Are you an alcoholic or a heavy drinker?
16. Do you have preeclampsia?
17. Which of these are true regarding heart disease?
a. If you have heart disease, you need to relax, and it is okay to have high blood pressure when you’re older.
b. You can lower your heart disease risk with vitamin supplements and stress reduction.
c. If you smoke, you can reduce your risk of heart disease by quitting, even if you have smoked for decades.
Article 2. Interviewee Responses
1. I am female.
2. 43 years old
3. I have not menopaused.
4. No, I don’t have a family member or family history of someone having CHD but a non-blood related relative, my brother-in-law had recently underwent heart surgery.
5. None of the people around me smoke, but my husband used to smoke. However, it has been more than a decade since he stopped smoking.
6. My mass is 59kg and my height is 1.57m, so my BMI is 23.9. Under the Singapore BMI standards, it is borderline overweight, unhealthy.
7. I don’t have high blood cholesterol level.
8. I don’t have high blood pressure.
9. I don’t have diabetes.
10. I’m not taking any medication now.
11. Yes, I exercise regularly 2-3 times a week, sometimes swimming and sometimes running.
12. I cook at home with balanced portions of vegetables, meat and carbohydrates, usually rice. I also don’t use MSG and try to use less salt or sugar.
13. I get quite an amount of fats from butter, fried foods, salmon and tuna
14. I don’t think I’m feeling particularly stressed now.
15. I am not alcoholic nor heavy drinker. In fact it has been a few years since my last drink.
16. No, I don’t have preeclampsia.
17. I believe that both option a and b are true.
a. You can lower your heart disease risk with vitamin supplements and stress reduction.
b. If you smoke, you can reduce your risk of heart disease by quitting, even if you have smoked for decades.