More than 47 000 South Africans will suffer a heart attack within the next 365 days. At this moment their coronary arteries are clogging up - but most of them don't realise it. Today 33 men and women will suffer a heart attack and die instantly.
Just look at the guys pictured here, standing arm in arm with their mate on his 50th birthday. There's Michael du Toit; Schalk Burger Snr, former Springbok lock and dad of Bok flank Schalk Burger Jnr; Nico Rossouw; Chris Faure, also a rugby player in his heyday; Jannie Olivier; Joe Terblanche, the man whose birthday they were celebrating; and Lourens Steyn.
The photograph was taken two years ago. It was a good day for Joe, who felt fulfilled and contented surrounded by his friends, wife and teenage sons on the farm Welgegund, just off Bainskloof Pass in the Boland. "That day I thought, 'I'm a happy man, I'm healthy and life is treating me well'," Joe says.
What he didn't know on that hot summer day in December 2004 was that five of his arteries were critically clogged. And that 22 months later he would have to undergo a life-saving emergency heart bypass operation. The surgery and the realisation that his heart could fail him at any time dramatically changed his outlook on life.
Today, 11 months after his operation, he's sometimes still scared of going to sleep. He's afraid his heart will stop beating in the middle of the night.
Joe was the first in his circle of friends - including old varsity, rugby and golf pals - who had to undergo coronary artery bypass surgery. But he's definitely not the only one in that birthday photo in whose chest an invisible process was unfolding. According to the law of South African averages, chances are one in three of the friends in the picture already suffers from a heart problem without knowing it.
Most people whose coronary arteries are blocked show no symptoms. Th ey feel great, do things healthy people do and take it for granted that their hearts are healthy. That's exactly what happened to Joe. His heart problems came from nowhere, he says. "I played golf regularly and even took part in the Dads versus Lads hockey game in May last year. A lot of my friends didn't have the stamina for it but I chased that ball like a pro."
An electrocardiogram (ECG) done by his general practitioner shortly before the hockey game showed there was nothing wrong with his heart. Two months later in Johannesburg he had his first warning sign without recognising it. It was a feeling of paralysis in his arm accompanied by his usual heartburn. The numbness subsided after a while so he assumed everything was fine.
But when the same symptoms returned early last August while he was in the gym working out on an exercise bike next to his GP, the doctor advised him to see a cardiologist immediately.
An angiogram showed clear evidence that five of his arteries were blocked. There were too many blockages to consider treatment with stents and, besides, the blockages were huge. If the tiniest clot were to get stuck in any of five places in his coronary arteries he would promptly have a heart attack.
Time was now critical but Joe wanted to go home for the weekend to think about everything and get over the shock. "it was the longest weekend of my life," he remembers, taking off his glasses and slowly rubbing his eyes. "I was scared and worried and thinking about a hundred things. I wanted to see my children grow up and there were still so many things I wanted my wife and I to experience together."
He gazes at the mountains and vineyards outside as if his looking straight through them.
The week after the bypass surgery in Panorama Medi-Clinic in Cape Town passed as if in a dream. Back home some major adjustments were waiting. "You recover quickly yet you're unable to walk five paces. At home there are so many things you want to do but you get to tired. And you're too scared to trust your heart. The nights were the worst.
"It was an emotional rollercoaster. I would go through depression, anxiety, frustration, rage, fear and helplessness- all in one day."
It's usual for most heart patients to experience depression, often resulting in moodiness. This happened to Joe too.
"After a few months I realised I had to relax for the sake of my wife and kids. My temper was frightening," the usually affable man recalls.
His conversations with a life coach, friends and others who were fighting the same battle helped to calm him down. "You have to realise that even if you seem healthy and ready for life after the operation the whole experience has an enormous impact on your emotions. Some things will simply never be the same. But the one thing about me that changed dramatically was my awareness of being alive."
Although Joe's heart problems seemingly appeared from nowhere, he - like many other South Africans - had a family history of heart disease and all the risk factors were present. His 79-year-old father suffers from 'slight diabetes' but two of his father's brothers died from heart attacks.
Among the more encouraging information revealed by new research is that heart disease can be stopped in time even if you were born with the worst genes imaginable.
There are several things you can do to prevent the faulty heart genes form being switched on, Cape Town geneticist Dr Maritha Kotzè says.
An estimated 40% of South Africans have one or more faulty heart genes which can be activated by smoking or unhealthy habits. Smoking can even increase the chances of a heart attack in people with healthy heart genes.
According to Kotzè the danger is even greater when several risk factors are combined. In a new report on heart disease Dr Krisela Steyn, researcher at the Medical Research Counsil (MRC), reveals the risk of heart disease doesn't increase threefold if you have three risk factors (for example smoking, high cholesterol and high blood pressure) but nine fold.
Joe started smoking cigars during his varsity years. After the angiogram revealed the shocking news he quit.
For the past six years he's been taking medicine for high blood pressure and high blood cholesterol. "I didn't get a big enough fright at the time. I didn't realise my coronary arteries were busy clogging up.
"If a doctor tells you your blood cholesterol is higher than normal and gives you a tablet for your cholesterol and another for your high blood pressure; you take those pills and think that's part of life. I never even thought of giving up smoking or changing my lifestyle. It never occurred to me that I might be on my way to a heart attack."
It was only after the angiograms showed the exact extent of clogging in Joe's coronary arteries that he began to change his lifestyle. "These days I try to eat fewer fatty stews, cut all the fat off my lamb chops and enjoy fruit instead of a koeksister. It's the small things that can make a difference."
Knowing about heart genes can save your life
A handful of genes play a role in the health of your heart.
Knowing a patient's genes is akin to your doctor donning new glasses that enable him to see right into your cells so that he can choose the correct "medicine", is how Cape Town geneticist Dr Maritha Kotzè describes information research.
Statins, the group of cholesterol-lowering drugs may be able to save the life of someone who has one type of heart gene but be of little use to someone who has who has another type.
A diet low in trans fat and saturated fats produces significant results in the second instance.
Some of the most important heart genes discovered so far are the FH and ApoE4 genes, as well as the thrombosis risk factor and the iron overload gene.
FH is especially common among Jews, Indians and white Afrikaans-speaking South Africans. Between one in 70 and one in 100 people in these groups has a defective FH gene. Your chances of suffering a heart attack if you have this gene are five to ten times higher than anyone else's.
On average men who have a defective FH gene suffer a heart attack by the age of 45 and die if they don't receive the right treatment. An alarming 30% to 40% of all South Africans carry a mutated ApoE4 heart gene which increases the risk of a heart attack by 40%.
Most South Africans don't realise they have these genes nor that certain factors can switch them on. The changes in the arteries happen unnoticed.
Who benefits from a heart gene test?
It's not necessary for all people to have their heart genes tested but for the following people it's imperative because determining the correct treatment in time can save lives:
- People who have a personal or family history of heart problems
- People who have high cholesterol levels or type 2 diabetes and anyone who is overweight, has a chronic inflammatory disease or high blood pressure and smokes
- People with a family history of Alzheimer's disease, since this illness is linked to heart genes.
- People who have a personal or family history of venous thrombosis, women who have repeatedly suffered miscarriages and women who are considering hormone replacement therapy.
Switch off your risk
If you are among the estimated 40% of the population born with bad heart genes you can prevent them from being "switched on". In addition, if you were born with healthy heart genes you can protect your coronary arteries from being damaged by changing some of your habits.
Many of the factors listed below lead to low-level inflammation of the artery walls and these red and swollen walls become highly susceptible to damage caused by any of the other factors.
Here is your nine-point plan, compiled from information collected by Harvard University researchers and heart specialists at the Mayo Clinic in the US, as well as South African researchers.
1. If you smoke, stop immediately.
This applies whether you smoke cigars, regular cigarettes or low-tar or "light" cigarettes. Smoking is one of the main factors that can switch on all high-risk heart genes. Smoke also damages the inside walls of blood vessels so badly it can lead to artery blockage. If you stop smoking your risk of a heart attack decreases within three years. Smokers older than 60 can add five to seven years to their life by giving up smoking. Passive smoking is also an important risk factor.
It has at least 20 health benefits. Exercise strengthens and opens the heart arteries, serves as a destressor and combats weight gain. Keeping fi t can reduce your risk of heart disease by a third. Being unfit is even more dangerous for your heart than being overweight. Try to exercise for at least two hours a week.
3. Control your weight.
The fatter you get, the thicker the layer of fat around your heart and other organs. People who have an apple shaped body - those guys sporting a paunch - run a greater risk of heart disease than people with a pear-shaped body.
4. Get into the habit, early on, of eating only foods low in saturated or trans fats.
This will prevent a certain heart gene from being switched on.
5. Eat fish and other foods rich in omega-3 fats at least three times a week.
Choose herring, mackerel, tuna, sardines, trout, salmon or other oily fish. These "good" fats can decrease your risk of blood clots and deep-vein thrombosis. What's more, they satisfy your appetite more quickly.
6. Eat more fresh vegetables and fruit, especially citrus fruit, spinach and other green leafy vegetables that are high in vitamin B and folic acid.
This helps to protect the hearts of those with very high cholesterol. (Someone who has already had a heart attack or who suffers from diabetes will not benefit from folic acid taken in the form of supplements.)
7. Eat more high-fibre foods such as oats porridge.
10g of rough fibre a day can reduce your risk of a heart attack by 20%.
8. Know your counts and keep them in check.
If you can lower your blood pressure from 140/90 mmHg to 120/80 mmHg you will halve your risk of having a stroke. For every fraction your bad LDL cholesterol level is lowered your risk of a heart attack decreases too. If the side effects of one type of blood pressure medicine bother you speak to your doctor about trying another. Don't simply stop using your medicine.
9. Learn to handle stress.
It seems ongoing stress eventually causes the blood vessel walls to become more susceptible to damage.
Women's treatment woes
Women suffering from heart disease receive poorer treatment than men do. The disparity in treatment between men and women claims the lives of many women who deserve swifter and better medical treatment, Cape Town heart surgeon Dr Susan Vosloo says.
Several studies have shown women's heart disease is allowed to progress too far because neither patient nor doctor is mindful of heart problems in women. The symptoms in women are often vague. Too many cases of heart attacks among women are wrongly diagnosed as gastrointestinal problems or depression. Doctors also tend to allow heart problems in women to go on for too long before prescribing aspirin or other preventive drugs
Even if a woman suffers from chest pains, chances are she won't be rushed to the emergency ward as men usually are. And often when a woman does arrive at the emergency ward, doctors don't give her an immediate ECG. Sometimes they don't do an ECG at all.
It also takes longer for a doctor to prescribe anticoagulant therapy (blood-thinning medicine) for a woman who has had a heart attack than for a man.
Which women are at greater risk of heart disease?
- Who smoke have a heart attack 19 years earlier on average than those who don't.
- Suffering from diabetes are two to three times more at risk of having a heart attack.
- Who are on the Pill and smoke and are older than 35 have a higher risk of developing heart disease.
- Who are inactive.
- Who are overweight (that means two in every five South African women).
- Who are receiving hormone replacement therapy (HRT).
Two glasses of wine a day can be good for your heart health but could increase the risk of contracting Alzheimer's disease for people with high cholesterol by 400%.
911 If you feel a tightness in your chest, are suddenly tired or have a heartburn-like sensation in your stomach and chest, especially after a workout, it could be angina or a heart attack.
You should not wait to see which it is. Administering an anticoagulant within three to four hours could save your life and increase your chances of recovering without damage to the heart, Cape Town cardiologist Dr Elwyn Lloyd says.
[This story originally appeared in YOU Pulse magazine. Buy the latest copy, on newsstand now, for more fascinating stories in the world of health and wellness.]
(Mari Hudson, YOU Pulse; Spring, September 2007)