Dr. Idoko, Patrick Oyigebe is a Consultant Physician/ Cardiologist at the Federal Medical Centre, Makurdi, Benue State, Nigeria. In this Exclusive Interview with TheFact News Magazine, he bears his mind on some of the factors that predispose people to cardiovascular diseases (CVDs), risk factors, prevention and cure. Excerpts:
TheFact News Magazine: Cardiovascular diseases seem to be the leading cause of premature mortality and morbidity. What are these cardiovascular diseases?
Dr. Idoko: Cardiovascular disease is the leading cause of death world wide with about 18 million deaths every year. The leading cardiovascular disease cause of death are Hypertensive heart disease, ischaemic heart disease, Stroke and Cardiomyopathies (disease of the heart muscle). Other cardiovascular diseases include Valvular heart disease, congenital heart diseases and infections of the heart/blood vessels. Hypertension is by far the leading cause and risk factor for Cardiovascular disease with over 1.5 billion people world wide having hypertension. Most of the deaths from cardiovascular diseases are potentially preventable
TheFact News Magazine: We used to know that cardiovascular diseases were diseases of high income countries. Why are they here with us?
Dr. Idoko: It used to be said that Cardiovascular diseases were diseases of affluence and more prevalent in advanced countries. That is not the case anymore. Every society undergoes what we call an epidemiological transition which comes with different types of diseases. We in the developing world are at that level of development or epidemiologic transition that corresponds to increased incidence of cardiovascular disease. Industrialization, changing lifestyle and diet all contribute to this transition and the increasing incidence and prevalence of cardiovascular disease.
TheFact News Magazine: What factors predispose people to cardiovascular diseases?
Dr. Idoko: The factors that predispose to Cardiovascular diseases could be divided into 2 groups: Modifiable and non-modifiable risk factors. Modifiable risk factors are those you can do something about while non-modifiable risk factors are those you cannot do much about. The modifiable risk factors for cardiovascular disease include Hypertension (the leading cardiovascular risk factor world wide), diabetes mellitus, sedentary life style, physical inactivity, excess alcohol use, excess tobacco use, dyslipidaemia and obesity among others. Non- modifiable risk factors include age especially greater than 40, male gender, black race, family history and past history of stroke or a cardiovascular disease, and sickle cell anaemia. Efforts at reducing and preventing cardiovascular disease should be targeted at these.
TheFact News Magazine: What is the trend of such diseases in Nigeria in the past 10years? Are they on the increase?
Dr. Idoko: Cardiovascular diseases are generally on the increase in the developing world including Nigeria. The WHO reported that since 1978, the incidence of stroke decreased by at least 40% in the developed world but increased by 100% in the developing world. It’s estimated that by 2025, there would be 25 million deaths every year from cardiovascular disease and about 2/3rd of these deaths would be in the developing world. Epidemiologic transition in developing countries like Nigeria has seen an increase in cardiovascular disease approaching epidemic proportions.
TheFact News Magazine: What can the government do to alleviate the burdens of these diseases on the citizenry?
Dr. Idoko: Government can always do a lot when it comes to health care because government has primacy when it comes to healthcare and health policy development. Several options are available to government to combat this surge. Government can formulate and strengthen health care polices directed at combating Non-Communicable disease like cardiovascular disease. Government can ensure adequate and widespread health education. Government can increase the number of facilities and man power available to diagnose and treat cardiovascular disease. Government can reduce or remove taxes on drugs needed to treat the major risk factors for cardiovascular disease as well as taxes on health institutions, which will invariably affect what patients pay for health care. Government can also ensure greater number, if not all of its citizens have access to health insurance and this will certainly help diagnoses, treatment and prevention of cardiovascular disease. Government can regulate on having people check their cardiovascular status as they age. Government can bring together key stakeholders to fight the epidemic of cardiovascular diseases. The government can do a lot and we as private citizens also have our job cut out for us.
TheFact News Magazine: The World Health Organisation (WHO) reported that Non-communicable diseases were fast outpacing communicable diseases in Nigeria. Can you explain why?
Dr. Idoko: Non-Communicable diseases are the leading cause of death world wide and even in developing countries, non-communicable diseases are beginning to outnumber infectious diseases. This is normal with epidemiologic transition as a society develops. We have mentioned epidemiologic transition several times during the course of this interview. It’s like an unintended consequence of development. Prevention and early treatment is how we can check mate the scourge.
TheFact News Magazine: WHO also reported that 1 out of every 3 Nigerian was dying from one form of Non-communicable disease or the other. What do you advise should be done to reduce it?
Dr. Idoko: To reduce cardiovascular disease, we have to look at the risk factors and try to control them: especially the modifiable risk factors. People must check their blood pressures often and those who have hypertension must ensure they take their medications religiously and do follow up with a qualified health care professional. Same should be said of those with diabetes mellitus. People should get more physically active and avoid sedentary life styles. Excerise is recommended for a minimum of 30minutes 5 days out of 7 days in a week. Those who drink alcohol in excess should cut down and those who smoke should stop smoking. Healthy diet should be encouraged and this would mean low calorie and low fat diet rich in fruits and vegetables and less of animal protein. Healthy weight should be maintained. We should also cultivate the habit of regular health checks even when we don’t feel ill, so these diseases of present can be addressed early. Recall that cardiovascular diseases are termed silent killers because they may not manifest with symptoms even when they are present in an individual. They may just present as sudden death or with complications. Prevention as they say is better and cheaper than cure.
TheFact News Magazine: Are Nigerian hospitals well equipped to handle cases of Cardiovascular diseases?
Dr. Idoko: Nigerian hospitals and the Nigerian health system like most in developing countries are ill-equipped to manage the epidemic of cardiovascular diseases upon us. The situation is better than before but a lot is still desired and needed. Many tertiary health centers lack even the basic facilities to manage cardiovascular diseases and the dearth in man power is even worse. At the last count there were less than 500 Cardiologists in the whole of Nigeria with many out of the country or on their way out of the country. The Nigerian health sector is in a critical state and a state of emergency has to be declared to resuscitate the Nigerian health sector. It’s not all gloomy! The private sector has stepped in to supplement what government is doing but so much more is needed
TheFact News Magazine: In what ways do you think Doctors are contributing to increasing deaths from Cardiovascular diseases?
Dr. Idoko: To focus on the ways doctors are contributing to increasing deaths from cardiovascular disease in Nigeria is akin to shooting at the dog when attacked by a lion and a dog. The Nigerian doctor is virtually working miracles everyday and to place emphasis on what they are not doing rather than focus on the real problems which fall at the feet of government and individuals, is not only hypocritical but ungrateful I must say. There are bad eggs everywhere and in every system, however the doctor is the least of the problem of cardiovascular disease mortality and morbidites. We have our jobs cut out and we have an epidemic on our hands and we have to focus on our real enemies and encourage our soldiers.