By Dr. CHRISTOPHER J. MORGAN
Heart disease and stroke make up two of the three leading causes of death in Canada. Every seven minutes, someone in Canada dies of heart disease or stroke. The leading cause of hospitalization in Canada continues to be heart disease and stroke, accounting for 16.9 per cent of total hospitalizations.
Hypertension (high blood pressure) is often the precursor that leads to these troubles. When we allow our “heart health” to severely deteriorate, we may find ourselves in the emergency department, or in the ICU (intensive care unit) of a hospital, or being referred to a cardiologist, a health professional who intimately understands the health impact of cardiac (heart) problems or conditions.
To gain a cardiologist perspective on the topic of heart health in the Black community, I engaged Dr. Paul Galiwango who completed both his medical degree and internal medicine and cardiology residency at the University of Toronto (2002). He then went on to do a one-year fellowship in Advanced Cardiac Imaging at the University of Ottawa Heart Institute. Dr. Galiwango has been on staff as a cardiologist at Rouge Valley Health System since 2008, and currently serves as the director of the Cardiac Diagnostics Lab, and co-director of the Cardiac CT Angiography program.
Can you describe the main function of the heart and the most common heart disorders?
The right side of the heart receives oxygen-poor blood and delivers it to the lungs to be oxygenated. The left side of the heart receives this oxygen-rich blood, and pumps it out to the rest of the body. The most common disorders of the heart are 1. coronary artery disease (which causes angina and heart attacks); 2. congestive heart failure and 3. atrial fibrillation.
What are the risk factors for some of the more common heart disorders?
The major risk factors for heart disease are 1. high blood pressure (a.k.a. hypertension); 2. Diabetes; 3. cigarette smoking; 4. elevated cholesterol and 5. a strong family history of heart disease. Other risk factors include obesity and physical inactivity.
What are some of the early signs and symptoms of someone who may be developing a heart problem?
The hallmark signs of coronary artery disease are chest pain/pressure that worsens with exertion and improves upon rest. The chest pain may radiate into the left arm or jaw. Not infrequently, though, instead of chest pain, people may feel stomach discomfort, which they may confuse with gas or heartburn. So if you are having stomach discomfort that is worse with activity or associated with shortness of breath, it is important to alert your doctor, as this may be a symptom of heart disease.
Congestive heart failure typically causes shortness of breath, which is often worse at night. People may notice they have to elevate their head and sleep with many pillows at night, due to trouble breathing when they lie flat. Increasing swelling of the ankles can also be a sign of heart failure.
Atrial fibrillation causes the heart to beat in a rapid and irregular manner. Patients with this condition often have a sensation of their heart ‘fluttering’ or feeling like their heart is skipping beats.
As a cardiologist (heart specialist), when does someone typically come under your care and what types of treatment and care do you provide?
With respect to my office, patients are typically referred to me if they have symptoms suggestive of heart disease, and therefore need further investigations and management. I also see many patients who are already known to have cardiac disease and therefore need continuing evaluation, management and therapy. I also see many patients who have significant risk factors for heart disease, even if they may not display any symptoms.
The patients I care for in the hospital are typically more sick and need more urgent evaluation and treatment. These tend to be patients suffering from heart attacks, severe heart failure, and unstable arrhythmias. Many of these patients will undergo specialized tests and procedures such as angiograms (which allow us to visualize the arteries of the heart and detect blockages), angioplasties (where blocked arteries are opened with tiny balloons), and echocardiograms (where ultrasound waves allow us to evaluate the heart’s muscle and valves).
What are the best preventative and lifestyle measures we can take to keep our hearts healthy?
1) Regular physical activity. At a minimum, the cardiology community advises at least 30 minutes of aerobic activity (i.e., brisk walking) five times per week.
2) Follow a heart-healthy diet. This consists of minimal red meat (while favouring fish and poultry), whole grains, and avoiding salt. Of course, fast food and fried foods should be avoided.
3) Avoid excessive alcohol. Try to avoid having more than two drinks per day. Furthermore, women should have no more than nine drinks per week, and men no more than 14. Alcohol in excess leads to high blood pressure, which increases the risk for heart disease and strokes.
4) Achieve and maintain a healthy body weight.
You are aware of the evidence that people of African descent may be at greater risk of developing heart problems compared to other groups. What direction should our research efforts take in order to better expose and understand the nature of these differences and hopefully lead to improved prevention and treatment strategies?
Hypertension is the principal condition that leads to worsening cardiovascular outcomes in the Black community. We tend to see heart failure and strokes at a younger age in our population, as this largely stems from poorly controlled hypertension.
Further research is needed pertaining to understanding the mechanistic factors that cause hypertension to manifest in such an aggressive fashion in our community, and on the most effective therapeutic strategies. I also think we need outcome data to see if perhaps using stricter target values for blood pressure in Blacks (like we do in patients with diabetes and/or kidney disease) would lead to reduced morbidity and mortality. Research focused on ways to increase the public awareness on the risks of hypertension, as well as novel methods to improve the adoption and maintenance of beneficial lifestyle choices in our community, would also be of value. Finally, the tracking of health outcomes, stratified by race/ethnicity, would help us identify disparities in outcomes, and areas needing targeting.
In your professional opinion, what public health strategies need to be in place in order to lessen the impact of heart disease, heart attack and stroke in the Black community?
People of African descent tend to be particularly sensitive to the effect of salt on aggravating high blood pressure. The term “sodium-sensitive hypertension” pertains to this. Sodium-rich, highly caloric foods are ubiquitous in school cafeterias and vending machines and influence the dietary patterns of youth during their formative years, which many will carry on into their adult years. A public health initiative to revamp the dietary options in our schools (such as has been undertaken in Great Britain) would be of great value. Furthermore, mandating that restaurants display the caloric content of food items (such as has been done in New York) would also help people make healthy, informed choices.
Do you have any further recommendations or advice you would like to share with the community?
I would like to underscore the point that hypertension, which is a major cause of cardiovascular morbidity and mortality in our community, has no symptoms. Therefore it is critical that you see your family doctor, at least yearly, to get your blood pressure checked. This will allow hypertension to be detected and treated before it causes damaging effects. On a similar note, since we are so susceptible to the effects of salt on blood pressure, I advise members of the Black community to avoid adding salt to their food during cooking, and at the table.
Thank you Dr. Galiwango for your insights and comments.
If you wish to contact Dr. Paul Galiwango, his office is located at 325 Milner Avenue, Suite 410, in Scarborough, ON. He can be reached at (416) 284-4744 ext. 200.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and wellbeing of the Black community. He can be reached at (416) 447-7600 or email@example.com.