WHILE men can take steps to decrease their risk of developing coronary heart disease, Dr Claudine Lewis, cardiologist at the Cornwall Regional Hospital, does not think they are visiting their doctors early enough for routine check-ups.

In an interview with the Jamaica Observer recently, Dr Lewis said most men will go to the doctor only when they have a problem, and by then it is often too late.

“To lower your risk of coronary heart disease, it is important to start with a check-up with your family doctor from as early as age 20 years old,” the cardiologist said. “This check-up will include testing your blood pressure to detect hypertension; looking at your weight and assessing you for obesity; testing your blood sugar, cholesterol, kidney, and liver function.”

She said if the listed tests are okay, then the patient is good to live a healthy lifestyle and return for another check-up in five years.

“If any aspect of your check-up is not good, your doctor will assess your risk of developing heart disease and design a plan specifically for you to help you lower this risk,” she said.

With the prevalence of coronary heart disease in Jamaica being 110/100,000 when compared to 69/100,000 in the United Kingdom and 80/100,000 in the United States, heart disease accounts for approximately 17 per cent of all deaths in Jamaica.

“This figure is just for coronary heart disease, that is, heart disease related to blocked coronary arteries,” Dr Lewis explained, adding that combining stroke and coronary heart disease – which are usually considered together under the umbrella term cardiovascular disease because the causes and risk factors are the same – accounts for 27 per cent.

“Cardiovascular disease ranks as the leading cause of death (among men), followed by all cancers in number two position,” Dr Lewis shared.

She told Your Health Your Wealth that the risk factors for coronary heart disease are: hypertension, diabetes, cigarette smoking, physical inactivity or obesity, high cholesterol, as well as family history of early coronary heart disease – that is, having a first-degree relative who suffered a heart attack or stroke before age 45.

The cardiologist said that coronary heart disease can be silent.

“Coronary heart disease will only cause symptoms when the coronary artery is at least 70 per cent blocked. However, one can have an artery that is 20 per cent blocked and this will cause no symptoms, but the plaque that is in the artery can break or rupture.

“When the plaque breaks, the body tries to heal it by forming a clot,” Dr Lewis explained. “It is this clot that is formed suddenly that blocks off the artery and leads to a heart attack.”

The cardiologist noted that it is important that men are aware of this.

“This is why it is important to see your doctor for regular check-ups, so that the doctor can test for the risk factors for heart disease and assess your overall risk of developing a heart attack and put measures in place to decrease that risk,” she insisted. “There is no single test that can tell a person if they will have a heart attack.”

Dr Lewis said the symptom of a heart attack is usually chest pain, which is typically described as a heavy sensation in the chest, behind the breastplate, and can sometimes go to the jaw, or even into the arm. She also said that in older people, the pain may not be typical, it can feel like cramping sensation and in up to 20 per cent of cases, there may be only shortness of breath that is sudden in onset without chest pain.

“Sometimes that pain may not be in the chest, but in the upper part of the abdomen, right below the breastplate, and may be confused with indigestion,” Dr Lewis reasoned. “If any person over 40 years old has chest pain or indigestion for more than 10 minutes, they should go to an emergency room right away to have it investigated for a possible heart attack.”

The cardiologist said Jamaicans are in the habit of “watching” their symptoms, but insisted that this can be deadly.

Besides the symptoms of heart attack, Dr Lewis said coronary heart disease can cause chest pain or shortness of breath with activity, such as walking, or running or exercising. This, she said, is referred to as angina, which usually signifies that the artery is at least 70 per cent blocked.

The heart specialist said treatment options are available locally.

Treatment options include medication and in some cases, it may require a “minor procedure called coronary angiogram”. She told Your Health Your Wealth that a coronary angiogram is a specialised X-ray of the heart that shows if one has blocked coronary arteries, and can give details of the number of blocked arteries and how severe.

“This procedure is done under local anaesthetic (injected at the access site, in the groin or wrist) and last approximately one hour,” Dr Lewis said.

“If blockages are confirmed on the coronary angiogram, these can be opened up by putting a small balloon inside the blocked area using a procedure called coronary angioplasty,”she said, adding that both are available locally.

She continued: “In some cases of severe or multiple blockages, the patient may be referred for what is called bypass surgery. This is open-heart surgery requiring major surgery. The surgeon uses veins or arteries from other parts of the body to bypass the blocked artery and improve the circulation to the heart.”

She said bypass surgery is available in Jamaica at the University Hospital of the West Indies, but disclosed that there is a waiting list.