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Same Bottle, Different Drink

September 16th, 2015

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Same Bottle, Different Drink

My patients often ask me what causes coronary artery disease (narrowed artery). This sounds like a simple question but it’s very difficult to answer… because I don’t know! I mean, we doctors have not found the exact cause. Logically speaking, if there’s a cause, there’s an effect. For instance, if you butthead the wall, of course your head will hurt. However, coronary artery disease is not like that. Not every smoker gets narrowed artery and not every coronary artery disease patient smokes (and so many keep smoking). Still, most smokers have narrowed artery and many coronary artery disease patients just happen to be a smoker!

Does that confuse you? Let’s just say coronary artery disease doesn’t have an exact cause that we know yet. Cardiologists know just the risk factors which increase the chance of getting it.

These risk factors

-         Gender (men have higher risks than women at certain age)

-         Smoking

-         Blood pressure

-         Diabetes

-         High LDL cholesterol level and/or low HDL cholesterol level

-         Family history of coronary artery disease or sudden death

-         Menopause

-         Age

These are only what we call conventional risk factors.  There are many new risk factors being discovered.

Patients also often ask whether stress triggers this disease. I must say stress, in fact, does not directly cause coronary artery disease or increase the chance. However, stress is linked with heart disease because it causes symptoms similar to heart disease and aggravates the risk factors. When you are stressed out, your heart works harder and the stress might cause high blood pressure. People who are overstressed do not exercise (and those who exercise do not get too much stress because of the endorphins). Sometimes people smoke when they feel stressed. All in all, the effect of stress triggers the disease, not the stress itself.

Another link is obesity, which might appear irrelevant to the disease, but obesity related diseases have been widespread these days (especially abdominal obesity). Such diseases are caused by metabolic syndrome and cause:

-      Abnormal level of triglyceride, high small LDL cholesterol level and low HDL cholesterol level

-        High blood pressure

-        Insulin resistance which might or might not be related to high glucose level

-        Thick blood which might cause clogging in the artery

- Chronic inflammation of the blood vessels

What’s more, most of these are more common among both men and women who are overweight and have rather distinctive characteristic – big belly (well, muffin top, if you want an endearing term). If you measure the waistline (in case you can’t identify where your waist is, look for your belly button and work around there) and it exceeds 102 centimeters for men and 88 centimeters for women. Such characteristic is referred to in the medical world as “abdominal obesity”. These patients might have accumulated fat in the liver or cyst in the ovary.  This finding is now widely accepted to be another risk factor for coronary artery narrowing.

Recently there has been a sharp increase of these patients after obesity became more widespread. Obesity has plagued several nations worldwide, both developing and developed. That also includes Thailand since we now have a large variety of food choices and food is available 24/7. Whoever says there’s food shortage certainly has never been to Thailand! We even have food at gas station and most of the shopping centers offer an immense food court. Worse yet, in the house, food is not located just in the kitchen. Most Thai homes have food in every room!! How can we not be overweight?

To treat such obesity, I guess you already know the deal. The safest bet is losing weight, especially abdominal fat. Cholesterol lowering medication, blood pressure pills or glucose level curbing pills can help to a certain extent but those are just solutions, not prevention. Those symptoms are because of being obese.

There is no medication to fight against abdominal fat yet and the best solution is to watch what you eat. Eat when you are “hungry” not when you “want” to eat and stop when you are “not hungry” instead of when you are “full”. It is also important to exercise. In this case I won’t have to give you examples because there are loads of obese patients aged from 20 to 80, both male and female, who have come to see me because of coronary artery disease and blood-related abnormalities resulting from obesity and abdominal fat.

I usually pass these patients to cardiologists specialized in restoring and improving cardiac health as well as dieticians who can give advice about eating right so these patients can exercise and eat better.  You can be surprised to see that these obese people, some elderly, can exercise.  Of course, they need to have strong will to get better first.

If you feel that you eat just the right amount but still are overweight despite burning lots of calories in your daily life but do not exercise seriously, maybe you should consult a dietician or a doctor to make sure you’re going in the right direction.  Some foods you think they are healthy and do not contain a lot of calorie in fact are not.  For example, a glass of freshly squeezed orange juice will have similar calorie to a can of soda!!!

That would be much better than consulting a cardiologist when your artery is already narrowed because that would be tidying up the loose ends… which might also happen to be how your life ends!

Enjoy good food that is healthy and don’t forget to enjoy working out!

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.

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