Heart disease affects the population of Puerto Rico in multiple ways: their physical and emotional health, quality of life, social and work relationships, and their wallet. February is heart health awareness month so we’ll take the opportunity to discuss some of the conditions that affect the heart and how we can prevent them.
What is heart disease?
This term includes various conditions that affect the heart, blood vessels, and the cardiovascular system, such as congenital defects, atherosclerosis (fat deposits in the arteries), heart attacks, and cardiac failure. Coronary heart disease is the most common type of heart disease within the general classification. Each condition has a particular etiology and treatment, although there are several risk factors in common across the majority of cardiovascular conditions. Some statistics and reports, but not all, include diseases that connect the heart and the brain, also known as cerebrovascular diseases, such as strokes, for example.
In Puerto Rico, heart disease is the leading cause of death with nearly 140 deaths per 100,000 people. This rate is higher in the United States, with 166 non-Hispanic whites and 206 non-Hispanic Blacks per 100,000 people. Despite the fact that Puerto Rico has a lower death rate from heart disease than the United States, the condition occurs at a similar proportion: between 8-12% of the population in the island and 12% of the population in the United States have been diagnosed with a heart condition.
What are the risk factors for heart disease?
There are various factors that increase the risk of having heart disease. Let’s explore some of the more common ones affecting the Puerto Rican population. Let’s start with the factors that we cannot change:
Age - over time, fat deposits accumulate in the blood vessels. There’s an increased risk of developing heart disease after age 45 for men and age 55 in women. For the latter, the risk increases after menopause. In Puerto Rico, the demographics have changed since the early 2000s due to increased migration and decreases in birth rates. This has caused a shift in the island’s population; now, close to 15% of the people are older than 65 years old.
Having close relatives (parents or siblings) who had heart disease at an early age can increase the risk because it suggests a genetic predisposition. However, a study among Latinos showed that following a healthy lifestyle could blunt this predisposition and counterbalance the risk for a heart attack.
Having certain clinical conditions could trigger cardiovascular complications. Nonetheless, these conditions could be generally prevented, or at least kept under control.
High blood pressure (hypertension) is a strong risk factor. It is recommended to keep a normal blood pressure, that is, less than 120/80 mmHg. In Puerto Rico, 34% of adults report having high blood pressure, although it is estimated that the percentage is higher but there are many people who have not been diagnosed. It is very important to follow the recommendations given by a doctor or health professional to control blood pressure, especially medication treatment.
The lipid panel test that the doctor orders is part of the risk assessment for heart disease. Commonly, three measures are examined:
Total cholesterol (recommended value: less than 200 mg/dL)
LDL (or “bad” cholesterol, recommended value: less than 100 mg/dL)
HDL (or “good” cholesterol, recommended value: more than 60 mg/dL).
Often, triglycerides are also measured, which normal value is less than 150 mg/dL. C- reactive protein (not a lipid) is sometimes measured because it has recently been identified as a risk factor given that its high levels indicate inflammation in the blood vessels.
People with diabetes or pre-diabetes have 2 to 4 times higher probability of having heart disease than people who do not have these conditions. Over time, the high levels of sugar in the blood can damage the blood vessels. This is alarming in Puerto Rico’s case given the increase in diabetes cases in previous years. The island has the highest percent of adults with diabetes (14%) among all the states and territories of the union.
Being overweight or obese puts our metabolism at risk and can lead to other conditions, such as diabetes or elevated lipids, which eventually impact the development of heart disease. Maintaining a recommended weight for your height should be a priority. Obesity and overweight conditions need urgent attention in the island given that 67% (that is, 7 out of 10) Puerto Ricans are overweight. In addition, fat accumulation around the waist circumference, independent from weight, is also a risk marker for heart disease.
An important point is that many times these conditions coexist, increasing the risk for heart disease even further. Metabolic syndrome refers to the combination of at least 3 of 5 risk factors: hypertension, high triglycerides, low HDL, elevated blood sugar, and elevated waist circumference.
What can we do?
All of the risk factors mentioned above (except for age and genetics) have one thing in common: they could be prevented or controlled with a healthy lifestyle.
The scientific evidence is definitive: a diet that contains high-fiber foods (e.g. oatmeal, whole wheat bread, beans, legumes), fruits and vegetables, and healthy fats (e.g. olive oil, tuna, nuts), and that moderates foods that contain salt (e.g. cured meats, canned foods, fast food), saturated fats (e.g. red and processed meats, fritters), sugars (e.g. soda or juice, sweets, pastries), and alcohol (no more than 2 drinks per day for men and 1 drink per day for women) are key in the prevention and control of heart disease.
Similarly, regular physical activity – such as walking, running, swimming, dancing – promotes and maintains a healthy cardiovascular function. Additionally, if you smoke, stop doing so. Smoking is a prevailing risk factor for coronary heart disease. In Puerto Rico, 15% of the population still reports smoking. Call the smoking cessation line ¡Déjalo Ya! for free assistance.
There are prevention factors with emerging evidence that are being studied more, such as maintaining healthy sleeping habits (7-9 hours of sleep per day and treatment against sleep apnea) and a stress-free and anger-free life, something that we surely need to work on more in the island.
It is important to inform yourself and talk to your doctor or health professional about how to follow a healthy lifestyle and keep a close eye on your clinical risk factors for heart disease. If you do not have health insurance, contact Mi Salud for assistance. Puerto Ricans have a good heart – let’s take care of it!