We have all heard of this threat. It has most likely affected someone in our family or our friends. Unfortunately it started its stealthy incursion many years before it manifested itself with chest pains, temporary weakness on one side of the body, painful leg muscles on walking, a stroke or sudden death from a massive heart attack. Because the problem began with very gradual narrowing of arteries, due to the build-up of plaque just under the surface of the arterial lumen, it is very difficult to discover without very invasive and costly procedures.
Atherosclerosis is the most common cause of death globally. According to the World Health Orgamisation (WHO), 17,9 million people die annually from cardiovascular disease, 80% of which caused by atherosclerosis. In South Africa 215 people die each day from cardiovascular disease. Strokes are two times more prevalent than heart attacks.
The early changes to major arteries have been identified at younger and younger ages. Already back in the early 1950’s, up to 70% of young American soldiers who died in the Korean War were found to have evidence of atherosclerosis, their average age being just 22 years. Studies done recently on young children who died in motor vehicle accidents in the US have found high incidences of atherosclerotic streaks, and early plaques. A common association with early atherosclerosis is childhood obesity.
Although there are well-known genetic conditions causing high blood cholesterol – the main underlying factor causing atherosclerosis – very few people can blame their genes. Having worked in rural Africa as a young doctor, I never saw a patient with a heart attack or stroke from atherosclerosis. But now, 40 years later, at that same hospital in Lesotho, manifestations of atherosclerosis are quite common.
Certainly genetics has not changed in the population. So what has changed?
The most important factor is diet. Thanks to globalisation and marketing, people all around the world are eating far more highly- or ultra-processed foods, far more meat, and far more sugar and saturated fats than our ancestors. Another important factor is a more sedentary lifestyle, associated with modern gadgets, office work, sitting in front of the computer and being entertained for hours on end in front of the TV.
Smoking and alcohol are strong co-factors, but thankfully fewer people are smoking these days.
Because of the high prevalence of atherosclerosis managing the pandemic is big business in terms of medications and surgical interventions. Globally, US$14,7 billion was spent on statins in 2022, and growing . . .
The global market for interventional cardiology in 2022 was almost identical.
There is no doubt these treatments have saved many lives, but at enormous cost. Is there another approach, which is far cheaper, and not only addresses cardiovascular disease, but all the other common chronic diseases plaguing society at the same time?
Watch this space in future articles, as we confront this health enemy no 1.
V This health column is written by Dr Dave Glass, a retired obstetrician/gynaecologist living in Somerset West for just over a year. He is also chairperson of the South African Lifestyle Medicine Association (Salma).
V Glass, with an MBChB, FCOG(SA) and DipIBLM, has a passion for preventing and addressing the root causes of chronic diseases such as diabetes, heart disease, auto-immune diseases, obesity, dementia and cancer.
