(MENAFN- Arab Times) KUWAIT CITY April 5: A Cardiovascular Faculty of Experts gathered at the Radisson Blu Hotel last week to shed light on the cardiovascular diseases which have emerged as the leading cause of death in Kuwait and most countries in the Middle East over the past few decades organised by Boehringer Ingelheim. Attendees were given the opportunity to learn from and discuss the various cardiovascular topics from burden of hypertension moving to more complicated cases like a trial fibrillation and deep venous thrombosis with international speakers as well as regional experts that included Prof. Bryan Williams Chair of Medicine at University College London and Director of the NIHR UCLH/UCL Biomedical Research Centre and Bassam Bulbanat Consultant of Cardiology at the Sabah Al Ahmad Cardiac Center in Kuwait. In speaking with the Arab Times Williams shared that hypertension is the most important predictable risk factor for premature death stroke and heart disease.
The increasing levels of obesity in the Gulf has led to an elevated incidence of hypertension affecting 35 percent of the population much higher than the West where the incidence is typically marked at 25 percent going up to half the population for those over 65. In view of this alarming statistic Prof Williams urges the need for screening programmes and immediate treatment. He recommends a screening every five years for adults with normal blood pressure and a yearly check up for those with borderline cases. Cardiac imaging today enables us to see changes in structure to the heart and to the blood vessels at the onset of relatively mild high blood pressure which worsens as a patient's blood pressure increases. 'The imaging that is being done now is quite exciting. I use MRI in my clinic and we can see changes in the heart we never realised were there. If you can afford and access it MRI is the best technique to look at the heart but echocardiography is also a good technique' he said adding that while echocardiography hinges on good reliability of the operator the MRI only need a good machine and software. He also pointed out that unfortunately treatment for hypertension is not given often enough and when treatment is given patients aren't controlled.
He underscores the need for two separate drugs for most people. The intake of salt should be less than 6g a day. In many western countries the typical intake is between 10g-12g a day. He estimated the salt intake in Kuwait to be much higher than 12g probably 15g a day. The only way the government can limit salt intake is to regulate the food industry he noted adding that salt is an important contributor to high blood pressure but not the only cause. 'There are plenty of patients I see with high blood pressure who are put on a low salt diet and they stick to it and it still doesn't lower their blood pressure. So most people need drugs to control their blood pressure. But it is important to try and eat a low-salt diet.' Responding to what impact dietary intervention alone would have on a hypertensive patient he shared 'If a person is obese and manages to get himself back to a normal weight that could be quite effective in reducing blood pressure. For every kg shed a patient can lose 1 mm of blood pressure but only up to 10 mm. This means that if your blood pressure is 100 mm above target than weight reduction alone is not going to be sufficient.'
Serve
Williams drew attention to important ways in which pharmaceutical companies can better serve the healthcare industry like working with GPs to enhance screening for hypertension. But more importantly the industry should leverage the skills that they can bring to marketing the message that high blood pressure is a risk factor and that treatments are available that can reduce that risk. The treatment of hypertension has seen a lot of advances. He shared that today there are excellent drugs available besides the older beta blockers and diuretics even in the more modern drugs angiotensin blockers are now a cleaner version of ace inhibitors. 'We have done so well now and the drugs are so good now that we may not see many more being developed' he remarked expressing that drug companies will find it hard to produce a blockbuster drug with many good options present in the market. He reiterated that there are no excuse for people to not have blood pressure control today as there are very good drugs available. He also stated that there have been dramatic advances in acceptability and functionality of blood pressure monitoring devices. 'Patients are buying their own devices. In the next five-ten years we will see bigger advances with digital technology and iPhones and everything else. This of course will have to be backed up by education.'
Attack
Dr Bassam Bulbanat who also heads the accreditation team of the medical department and cardiology division at Al-Amiri Hospital and works as a surveyor for the Ministry of Health stated that according to WHO 2011 statistics the cardiovascular diseases and heart related deaths account for about 27 percent of Kuwait's population. Studies looking at the incidence of death in patients who are admitted with acute coronary syndromes heart related diseases and heart attacks have found that in-hospital mortality ranges between 3- 4 percent. Compared to European counterparts Kuwait's mortality are a bit lower but more troubling on account of a lower age population rather than the disease being less severe. It has been discovered that patients being admitted to hospitals here are seven years younger than their European counterparts.
The most common condition is that of coronary heart disease followed by heart failure. To develop coronary artery disease several risk factors come in to play such as Type 2 diabetes high blood pressure smoking cholesterol obesity family history and others. Unfortunately statistics paint a dire picture in this regard. Kuwait ranks fourth in the world for obesity Dr Bulbanat pointed out adding 'What is bothersome is that 50 percent of our ladies are obese.
Even the ladies who are supposed to be protected by their hormones are at risk because of obesity and can be affected by coronary artery disease at a younger age as compared to their counterparts across the globe.' Moreover Kuwait ranked in the top ten with regard to the prevalence of Type 2 diabetes with the incidence amounting to a shocking 23 percent. Kuwait also occupies the 8th position globally with regard to the increase in consumption of cigarettes from 1990 to 2012 and the prevalence of hypertension is close to 40 percent among the advanced age group. 'All of the bad receptors which account for coronary artery disease are here.' he warned.
Studies have shown that citizens are at higher risk on account of their higher propensity to obesity while expatriates are put at risk on account of cigarettes and stress. He shared that several campaigns have been conducted to raise public awareness but these activities should be carried on for several years before penetration and progress can be measures. While the best screening test for coronary artery disease is patient history.
Dr Bulbanat elaborates on why early screening programmes may not be a bright idea for this he refers study published in the Lancet in 2009. In this study 1200 patients were randomised the first group performed a stress test with nuclear imaging and the doctors were allowed to treat those patients according to the results of that test even though they may not complain of any problems with the heart. The treating doctors would be allowed to do a cardiac catheterisation and on seeing a problem in the heart was permitted to insert a stent balloon or even proceed to a bypass surgery even though the patient is not complaining.
The second group followed routine procedure the group did not undergo any tests. In time if patients started to complain tests were conducted. On comparing data after five years no difference was observed between the two groups. 'If you are going to introduce any action you have to prove to the other parties that this act is going to produce benefit the society either by decreasing morbidity or mortality. But unfortunately even if you screen patients you cannot be sure that you can help them.' The economic burden of cardiovascular diseases is high it is estimated that close to KD 900 million was spent last year with the majority of the funds consisting of expenses incurred by Kuwaiti patients receiving treatment abroad.
He stressed that the Ministry of Health had taken positive steps in recent history decreased the salt in bread made by government owned Kuwait Flour Mills to decrease the incidence of hypertension. But imposing stricter regulation on the food industry is a very tough issue. He stresses that it is imperative that Kuwait try and decrease the prevalence of diabetes and encourage people to reduce excess weight. 'If we do this we will significantly decrease the common morbidities and risk factor profile. We have to come up with innovative ways to encourage activity through green house concepts.' The Boehringer Ingelheim group is one of the world's 20 leading pharmaceutical companies. Headquartered in Ingelheim Germany it operates globally with 142 affiliates and more than 47400 employees. Since it was founded in 1885 the family-owned company has been committed to researching developing manufacturing and marketing novel products of high therapeutic value for human and veterinary medicine. BI entered the Middle East and North Africa (MENA) market over 60 years ago when it launched two of its drugs in Egypt. Today it has sales operations in 20 countries with the company's support functions consolidated at the head office in Dubai Healthcare City. It has four scientific offices in the MENA region located in UAE Egypt Algeria and KSA and operates through 37 agents and locally produces some medicines through third party in Egypt. The company is also working on a local production project in Algeria while it secondary produces in KSA in partnership with Tabouk and Cigala covering 26 products. Its primary markets are Algeria Egypt Lebanon KSA and UAE
By: Cinatra Fernandes Arab Times Staff
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