Cardio-metabolic illnesses: the slow killers

In today’s article, the first of a two-part series, we will address the most common among them. 

Cardio-metabolic illnesses are diseases that impact cardiovascular and metabolic functions and can lead to serious long-term morbidity and premature mortality. The diseases are often combined and include high blood pressure (hypertension), high blood lipids, obesity and diabetes. They are among the most frequent medical problems in adults over 45 years old and especially the elderly.

Cardio-metabolic illnesses are also referred as “cardiovascular risk factors”, because they favour an excessive and early development of an extensive vascular disorder known as arteriosclerosis, which is the common underlying complication of all these diseases.

Atherosclerosis results from the build-up of cholesterol, fats and calcium deposits on the inner linings of arteries. The accumulation of these substances creates atheromata or atheromatous plaque, which gradually restricts the diameter of the vessels and subsequently impairs the blood flow and the normal functioning of the affected organs. Moreover, the plaque can fissure and trigger a rapid clotting process that can abruptly interrupt blood flow and thus the crucial oxygen and nutrient supply to the cells. A heart attack can result if the clot is in a coronary artery, a stroke (ischemic stroke) if it is in a cerebral artery, and peripheral artery disease if it is in a leg. 

Atherosclerosis primarily damages the heart and the kidneys, the eyes and the brain and may lead to heart and kidney failure, poor eyesight and blindness and weaker cognitive and intellectual function respectively. As a result, atherosclerosis is a major contributor to poor life quality as we grow older. 

Importantly all these diseases evolve silently (without noticeable symptoms) so you need to have regular routine check-ups to detect them. Symptoms occur when the lesions are already severe and often irreversible. 

Hypertension is one of the world’s most common diseases, afflicting close to one billion people worldwide. Blood pressure (BP) is the force of blood pushing against the walls of the vessels, especially the arteries. BP is assessed in millimetres of mercury (mmHg) with two figures. The first or higher number (known as systolic BP) measures the pressure in the arteries when the heart muscle contracts. The second or smaller number (known as diastolic BP) quantifies the pressure in the arteries when the heart is resting between beats and being refilled with blood. Your blood pressure (BP) is normal if it’s below 129/84 mm Hg. High normal blood pressure ranges from 130 to 139 for systolic BP and 85 to 89 for diastolic. You become hypertensive when your BP is higher than or equal to 140/90. Initial treatment focuses on lifestyle modifications, namely the return to healthy body weight, low salt diet and exercise. When BP remains high despite healthier lifestyle, then medications are often required. If you are taking medications, you may consider the self-monitoring of blood pressure at home, known as home blood pressure monitoring (HBPM). 

Obesity, defined as having an excess proportion of total body fat, is increasing worldwide in all age groups. Doctors often use the Body Mass Index (BMI) to determine weight status. BMI is the weight in kilogrammes divided by the square of your height in metres. This ranges from low (less than 19), normal (20-24.9), overweight (25-29.9) and obese (over 30) and extremely obese (over 40). 

Excess weight is primarily a lifestyle issue and one that is essentially related to the quantity of food ingested – not “a diet” issue per se. The goal of weight loss needs to be realistic and achieved over a reasonable period of time. Whatever the chosen medical or surgical option, reduction and then maintenance of an acceptable body weight is a lifetime commitment. Interestingly, a 10 per cent weight loss already leads to significant health benefits so further weight reductions can only bring a more positive outcome. The focus in term of life’s pleasures needs to be realigned to other worthwhile interests such as returning to a more active, physical and outgoing lifestyle.

The second part of this article will appear on September 22.

 

DR GERARD LALANDE is managing director of CEO-Health, |which provides medical referrals for expatriates and customised |executive medical check-ups in Thailand. He can be contacted at [email protected].