Getting to the heart of CVD

Along the streets in Beijing Central Business District, I see awe-inspiring skyscrapers and hordes of welldressed office workers scurrying by. Most of them look flustered and are either talking or texting into their Blackberries and iPhones. This scene is repeated in every major Asian city that I have been to: Bangkok, Kuala Lumpur, Shanghai, Singapore, Tokyo, and Taipei.

As the region prospers and engages in more and more economic activities, people are working harder and longer, at the expense of their health. So it is no wonder that there is an alarming sustained rise of cardiovascular deaths in Asia Pacific. Out of a total of 58.2 million deaths from diseases, 18 million were from cardiovascular diseases (CVD). This represented 30 percent, which put it as the number one killer. This startling fact, released by the World Health Organization, is what prompted Bayer HealthCare to host a scientific roundtable. The aim is to raise public awareness and highlight potential solutions.

Heavy burden

To compound the problem, the number of CVD deaths is set to rise to 20 million by 2015. Half of the world’s CVD cases will occur in Asia Pacific. Beside death tolls, CVD also places a significant financial burden on the world’s healthcare systems. Direct costs of CVD in Asia are estimated to exceed US$40 billion yearly. It is also estimated that for the 10 years from 2006 to 2015, China will lose US$558 billion in forgone national income due to the combination of heart disease, stroke and diabetes.

Dr Wong Yik Mun, a medical doctor in family practice and congress participant, told PharmaAsia that he believes the high incidence of CVD deaths in Asia is due to changing lifestyles. The most important behavioral risk factors are unhealthy diet, physical inactivity and tobacco use but Asians are engaging in just that. As they get affluent, they eat better but not healthier; they consume more fast food, which is high in cholesterol; they exercise less, become sedentary and end up being obese. In addition, nearly three quarters of China’s men are smokers.

Moreover the expectation to earn more money to sustain the affluent lifestyles leads to more stress. And while stress is not a direct risk factor for CVD, it has been shown that stress causes people to smoke more, drink excessively and eat unhealthily which are all risk factors for heart diseases. All these factors are result of signs of the times: globalisation, urbanisation and commercialisation. While we cannot hold back the pace of progression, we can certainly find effective ways to prevent and treat CDV.

Cardiology experts agree that the combination of high mortality rate and grave financial burden poses a serious socioeconomic problem. And one of the proposed solutions was to use low-dose aspirin therapy. There is a body of scientific evidence supporting low-dose aspirin’s role in reducing CVD risk and lessening the associated economic burden.

The inspiration of aspirin

Low-dose aspirin (acetylsalicyclic acid) belongs to a class of drugs called antiplatelet agents. Aspirin prevents CVD events through inhibition of platelet aggregation. As a result, it helps prevent the precipitating event, ie blood clot, in ischemic heart attacks and strokes. The effectiveness of low-dose aspirin in the prevention of a first CVD event is supported by six prospective, randomised clinical trials conducted by independent researchers, as well as a collective meta-analysis of these trials.

In these six trials, nearly 100,000 patients (47,293 on aspirin and 45,618 on placebo or control) were studied for a total of 700,000 person-years. Robust and consistent findings across all of these studies demonstrate that aspirin significantly reduces the risk of a first heart attack across the CVD risk continuum. The findings also show a favorable benefit/risk ratio beginning in the moderate-risk population.

Most people can take low-dose aspirin without undue concerns of side effects when taken as directed by qualified physicians. As with short-term use, the most common side effects associated with long-term aspirin use are gastrointestinal–related, usually minor and resolved without medical intervention. More serious effects, such as significant bleeding, are rare.

While no one dose of low-dose aspirin is appropriate for every individual or for every indication, generally only a oncedaily low dose of aspirin is needed to maintain clinical effects. Available evidence supporting aspirin therapy in both primary and secondary prevention of CVD events demonstrates aspirin is well-tolerated at doses of 50-325mg.

In preventing heart attacks, Dr Wong explains that aspirin in low doses affects the blood clotting mechanism in the body. It does this by reducing platelet clumping. Platelets are important in blood clotting but clumping causes the formation of clots, which block blood vessels leading to heart attacks, strokes and angina. Low-dose aspirin helps the blood to become thinner and thus flow easier through the arteries, veins and capillaries. By doing so, clumping is reduced, together with the risk of heart attacks.

Dr Wong adds that low-dose aspirin is also prescribed to patients after a first heart attack to prevent a second attack. It is also given after angioplasty and stenting as well as after a heart bypass operation.

In addition, aspirin is also found to be a more economical and cost-effective therapy than other available prescription treatments.

Of course, on top of seeking medical treatment, one has to take a holistic approach in preventing CVD. Dr Wong advocates lifestyle modifications like healthy food intake, maintaining a healthy body weight, regular physical activities and avoid smoking.

To me, one easy way for busy executives working in major cities to take care of their cardiovascular health is to get away from the office during lunchtime to enjoy a breath of fresh air. And listen to mother when she says eat more fruits and vegetables.