Cardiovascular disease remains one of the leading health threats to Jamaicans, yet many people still believe it only affects a select group or presents with obvious warning signs, according to the chairman of the Heart Institute of the Caribbean.

Dr Ernest Madu said one of the biggest misconceptions about heart disease is that individuals without multiple risk factors are not at risk.

“There is this misconception that heart disease affects a certain demographic and not others, because we normally talk about people with risk factors,” he told Observer Online in an interview, adding “But there is a misconception that if you don’t seem to have multiple risk factors, then you’re not at risk, which is a misconception.”

He also noted that many people underestimate how common heart disease truly is.

Dr Madu stressed that cardiovascular disease encompasses a wide range of conditions.

“Because that includes things like heart attacks, heart failure, high blood pressure and diabetes. So when you look at it, it’s expansive with the things that constitute cardiovascular disease. That’s really what we mean when we’re talking about heart disease, but we say it colloquially,” he said.

He said some people assume they are safe if they are not experiencing pain or obvious symptoms.

“And so it is assumed that if your heart doesn’t hurt enough or have not given up, then you’re not at risk or that you don’t have a disease,” he added.

While cancer often generates greater fear, Dr Madu pointed out that more people are at risk for cardiovascular disease. Asked about when individuals should begin seriously monitoring their heart health, Dr Madu said there is no one-size-fits-all approach.

“The way we practice is based on the evidence, it is not one size fits all. I think every man will have to have a conversation with their doctors to determine what their risk profile is to see what type of investigations may be more appropriate for them,” he said.

He explained that genetics and family history play a critical role.

“If people have a family history of what we call premature heart disease, then the screening should start sooner,” Dr Madu said.

Premature heart disease, he added, refers to cases in which individuals suffer heart attacks or sudden death at a relatively young age.

“Usually I will say anyone that has family history of sudden death episodes in a young person or a heart attack in a young person, usually in their 40s and 30s, that will be premature because most people do not have that problem until their 50s,” he said.

Lifestyle habits such as smoking, along with conditions like high blood pressure and diabetes, should also prompt earlier screening.

“So, heart disease affects everyone, but people who have multiple risk factors are more at risk. And for such people, I will recommend that the screening or investigation process begin a lot earlier,” Dr Madu said.

He added that symptoms should never be ignored, regardless of age.

“And of course, if someone is symptomatic, then it doesn’t matter what age. If you’re a teenager and you’re having some shortness of breath or swelling of your legs, then you need to be screened for heart disease,” said the chairman of the Heart Institute of the Caribbean.

Addressing differences between men and women, he said both share the same risk factors, though women benefit from hormonal protection before menopause.

“Men and women have the same risk factors except that the women have protective effects of estrogen when they’re pre-menopausal years,” he said. “When women go into menopause, then their common levels change, and they begin to achieve the same risk profile as men.”

He explained that women typically experience coronary artery disease about a decade later than men.

“That’s why women have about a 10 year gap between the manifestation… then women begin to experience that 10 years later than men. But once they reach that, everyone is exposed to the same level of risk,” he said.

On why men may ignore early warning signs, Dr Madu cited global research showing differences in health-seeking behaviour.

“A lot of studies done across the world show that women have more health-seeking behavior than men. Women tend to utilise health care services more than men,” he said, adding that early detection is critical because “it is a lot easier to prevent or to treat when it’s discovered early than when it is late.”

Among the top risk factors for heart disease in men are high blood pressure, diabetes, sedentary lifestyle, smoking and family history. Dr Madu also pointed to unhealthy eating habits and weight gain.

“When people have abdominal obesity that increases their risk of coronary artery disease,” he said.

Stress, too, plays a significant role in heart health, he cautioned.

“Stress has been shown to play a significant role in virtually all disease processes,” he said, explaining that it increases adrenaline and cortisol levels, raises blood pressure and heart rate, promotes inflammation and can make the blood more prone to clotting.

“So it’s a whole cascade of things that can be thrown out by chronic stress,” he said.