Not Hard Choices. By Dato Dr. Rajen M. 27 October 2018

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1 Make Choices Not Hard Choices By Dato Dr. Rajen M. 27 October 2018

2 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?

3 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

4 Five principal causes of death by age group, Malaysia

5 What causes cardiovascular disease? There are many risk factors that contribute to the development of 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)

6 Many of the risk factors for cardiovascular disease cause problems because they lead to Atherosclerosis Deposition of fatty material, cholesterol and other substances in the wall of blood vessels.

7 The rupture of a plaque can lead to stroke or a heart attack

8 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

9 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

10 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

11 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

12 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

13 The Eskimo very few with heart disease. Why? How?

14 OMEGA -3 FATTY ACIDS

15

16 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.

17 ALA Omega-3 fatty acids α- linolenic acid C18:3n-3 Plant source EPA Eicosapentaenoic acid - C20:5n-3 DHA Docosahexanoic acid - C22:6n-3 Marine source 22

18

19 OMEGA 3 : OMEGA 6 OMEGA 3 - ANTI-INFLAMMATORY OMEGA 6 - PRO-INFLAMMATORY

20 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

21 GISSI TRIAL ,323 Italian heart patients for 3 ½ years 4 arms: 1. 1 g/day of EPA +DHA mg. Vit E 3. both 4. no treatment Dr. Roberto Marchioli CIRCULATION Apr 2002;105:1897

22 GISSI TRIAL % 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

23 GISSI TRIAL - 3 Total mortality was lowered by 3th month (RR=0.59) & by 4 th month risk of sudden death was reduced (RR=0.47) Prevent onset of arrhythmias -- uncontrolled and sometimes dangerous irregular heart rhythms.

24 GISSI-PREVENZIONE Parameters Primary end pts. of death nonfatal MI & nonfatal stroke Outcome 15% (p<0.02) All cause mortality 20% (p=0.01) Reduction in sudden cardiac death after 3 months (p=0.01) 45% (p<0.001)

25

26 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

27 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

28 Who needs to take fish oil? Those who are facing Cardiovascular disease High blood pressure High cholesterol Diabetes Arthritis Mental stress and illnesses (Depression)

29 SAFE GRAS (Generally Recognized As Safe) status for intake of 3g/day of EPA+DHA

30 You Can Start Young Omega 3 fish oils improves heart artery function in children with high lipid profile American Heart Association Scientific Conference Nov

31 Safety of Fish Oil Contaminations found in fish Methylmercury Polychlorinated biphenyls (PCB s) Dioxins Heavy metals

32 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.

33

34 What can Mercury do to you?

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36 Fish Oil Contamination In the Kuopio Ischemic Heart study involving 2005 men 60% increase risk of heart attack in men with high mercury content 23 Apr 2002 AHA Asia Pacific Scientific Forum Arsenic linked to atherosclerosis CIRCULATION 2002 Apr

37 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 other heavy metals. Most likely to contain PCB s, DDT, Lindanes and other ocean based contaminants

38 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 other toxins

39 THANK YOU

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