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April - May 2004


The Silent Killer: Heart Disease

by Sarah Roberts

Prevention must be an important element of any initiative aimed at enhancing the treatment of Heart Disease. Heart Disease remains the primary cause of premature death in the Western World, despite the sustained best efforts of governments to reduce its incidence. In the UK the highest recorded rates of heart disease mortality are in people of South Asian descent. South Asian men have an age standardised mortality rate about 40 per cent higher than the whole population, and for women the figure is 51 per cent. Three main reasons are given to explain the reasons behind the high incidences of heart disease in South Asians. These are:
Excess Exposure To Risk Factors

As a general rule South Asians have low HDL cholesterol, elevated triglycerides, and diabetes is far more common.

Greater Susceptibility
Specific risk factors: There is a school of thought which believes there are specific risk factors which are as yet unidentified. It has been suggested that the use of ghee and other cooking oils, racism, insulin resistance and specific lipid abnormalities could all play a role

Competing Causes

There are fewer competing causes of death in middle aged South Asians: cancer rates are comparatively low for example.
Advances in medicine have resulted in the mortality rates from Heart Attacks falling and the morbidity rising, which in the UK increases the strain on the NHS budgets due to the long term treatment costs of Heart Disease.
Heart Disease is often silent with the first symptom for many Heart Attack sufferers being the Heart Attack itself. The heart is so well designed that it can tolerate extensive disease of the coronary arteries before it begins to show signs of functional compromise. As a consequence, the presence of silent Heart Disease that is symptom-less can be missed by ECG tests and other diagnostic tools currently available to the general medical practitioner in the surgery.
A new diagnostic technology that is ideal for the early detection and prevention of Heart Disease has been introduced to the UK over the last two years by the European Scanning Centre (Harley Street) Ltd. It is called Electron Beam Computed Tomography (EBCT) and it over comes the considerable challenge of accurately imaging in a reproducible manner the continuously distorting and moving heart. Furthermore, it is very patient friendly as it is safe, non-invasive, very quick, open and comfortable. The patient does not even have to get undressed. The technology has been developed over the last ten years in America, where it is now widely established and well proven with over 350 supporting scientific papers published.
As with so many diseases, the earlier that Heart Disease can be detected, the more that can be done to prevent it from becoming a problem. As the picture above illustrates, EBCT can detect Heart Disease non-invasively many years before the other noninvasive technologies, when the disease is still in its early stages. It does so by detecting the grains of Calcium that are laid down early in the inflammatory process that leads to the thickening of the walls of the coronary arteries. If such Heart Disease becomes advanced, the walls of these crucial arteries become so inflamed, thickened and filled with cholesterol (fat) that they loose their elasticity and can no longer accommodate the pulse of pressure pushing to the heart muscle the blood carrying the vital oxygen and the nutrients. Heart muscle never stops pumping, so any interruption of this supply leads to the heart muscle progressively dieing, at first reversibly, like 'pins and needles', and then irreversibly. It is this that causes the heart to stop pumping efficiently, causing acute pain and the resultant Heart Attack
An EBCT machine has no moving parts, unlike the conventional mechanical CT scanners, so it can image slices of the heart at 3 mm intervals at incredible speeds of between 50 and 100 milliseconds. The electron beam is triggered at exactly the same (r) point in each consecutive heart beat. The computer puts together each precise image to give a 3D picture of the heart of astonishing clarity, as if the heart was standing still. At this speed, the entire heart can be imaged within the holding of a breath.

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More articles by Sarah Roberts

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