A recent ad to raise awareness about heart health and to encourage people to firstly, have their hearts checked and, take some action, has caused outrage and consternation amongst the general public. So much so that the National Heart Foundation has had them taken out of circulation over the weekend.
The ad in question basically had this theme
“Do you want your family to suffer?” A little child says in the commercial, “Every time I told you I loved you I was lying — you are not my priority.”
There has been a groundswell of opposition against the underlying sentiment of this commercial. Don’t get me wrong, as a cardiologist I’m all for raising awareness about the planet’s most common killer. I have spent the last 25 years of my career focusing on preventative cardiology so it warms my heart, so to speak, when heart health gets significant airplay.
But, it is my view that this advertisement reaches an all new low and I’m surprised that National Heart Foundation approved its release in the first place. I believe it is acceptable to make people feel guilty about drink-driving, speeding or using illegal drugs but should we now be parading obese people in the street, shaming them as well and telling them they don’t love their children. Certainly not, we should be showing some compassion to people who have different metabolic issues and no doubt less self-control when it comes to tempering their eating habits.
But, we must look at the reality of heart disease and, in almost all cases, it is purely genetic. Again, your genes load the gun but your environment pulls the trigger. The most common form of heart disease is atherosclerotic heart disease which is basically the progressive build-up of fats, inflammatory tissue and calcium in the walls of arteries over many decades. If you imagine a doughnut, as an analogy here to arteries, the blood goes through the hole in the middle but the fat & other components builds up in the wall. When the fat and other tissue reaches a critical mass it suddenly ruptures within the channel, inducing a clot to form and blockages occur which may lead to a heart attack or stroke depending on the site of the rupture.
All people with cholesterols above 3 mmol per litre and systolic blood pressures (top reading) above 100 mmHg have a degree of atherosclerosis in the walls of their arteries. But, genetic factors contribute to either more significant build-up of atherosclerosis or a person possesses protective factors to prevent severe disease.
Although my main job is as a cardiologist, I’m also a professional speaker travelling the world talking about how to be healthy and manage stress. One of my slides shows pictures of Winston Churchill & Jim Fixx. Jim wrote “The Complete Book of Running” and had run multiple marathons. He didn’t have an ounce of body fat and dropped dead in a race at age 53. Winston Churchill smoked, drank, was obese and suffered intermittent depression throughout his life, dying at age 91. Clearly genetic factors operated in both cases, with Mr Fixx in the negative sense and in Winston’s case, keeping him alive despite his very poor life habits.
The commonest genetic abnormality in the world is insulin resistance affecting 30% of Caucasians, 50% of Asians and close to 100% of people with darker or olive skin. This genetic abnormality accounts for around 70% of cardiovascular disease. This leads to tendencies for diabetes, hypertension, specific cholesterol abnormalities with a high triglyceride and low HDL, along with a significant tendency to abdominal obesity. 20% of cardiovascular disease is related to Lipoprotein (a) and the remainder due to less common genetic abnormalities such as familial hypercholesterolaemia.
It is my strong suggestion that all males at age 50 and females at age 60, have a coronary calcium score which does not involve injections or dye, is low radiation and inexpensive. It is important to realise that this test is not covered by Medicare. The coronary calcium score is the most predictive test for heart attack risk.
I also suggest that everyone, regardless of age or cardiovascular risk follows the five keys to being healthy:
Depending on risk, you may also need to take long-term medications to control your blood pressure, cholesterol, manage diabetic risk and possibly blood thinning agents.
Clearly, the National Heart Foundation advertisement is trying to shame people into having a cardiac assessment, along with taking better care of their health. Hopefully some good will come out of this, despite the rather abhorrent message.