The Right Corporate Cardiovascular Health PlanBy Fernando Castilleja | Tue, 05/03/2022 - 09:00
Recently I had to treat a man with an acute myocardial infarction in the emergency room of a private hospital in Monterrey. With good luck, the patient arrived at an institution where the care protocols allowed him to have access to a coronary catheterization lab in less than 20 minutes and before an hour had passed, the group of interventional cardiologists were able to successfully find the occluded coronary artery, perform a balloon angioplasty and place a stent. The man walked out of the hospital a couple of days later with a treatment that he will have to follow for life to avoid coronary re-occlusion, control his cholesterol level and prevent – secondarily – a reinfarction.
This case seems to be the most common in private medicine in Mexico except for some particularities: the man is 42 years old and the symptom of his heart attack was an episode of sudden death while running in his sports club. Has anyone heard a similar story? This topic in the context of public health will be discussed in another article.
In Mexico, cardiovascular diseases rank second as a cause of death, only behind COVID-19. Obesity, diabetes mellitus, high blood pressure, metabolic syndrome and alterations in lipids, in addition to harmful habits such as smoking, sedentary lifestyle and poor diet, have been recognized for decades as predisposing factors for atherosclerosis, that is, the occlusion of the arteries of the body by plaques of cholesterol, calcium and inflammatory cells that can give rise, under certain conditions, to partial or total occlusions that generate as a result the lack of irrigation – circulation of oxygenated blood and glucose – toward the tissues. This affectation of the circulation is not limited to the cardiac arteries but can affect any other arterial blood vessel and produce cerebral vascular disease with infarction, limb ischemia or dysfunction of organs such as the intestine.
The modern lifestyle where work and social stress loads coupled with the lack of balance between free time for physical exercise, balanced diet and recreational activities has triggered an increase in predisposing factors for ischemic heart disease. Now, in the genesis of cardiovascular disease, it is not only classical risk factors that play a role, since genetics influences by nearly 50 percent the probability of developing coronary occlusions due to cholesterol. Unfortunately, the hereditary burden is not studied in a conventional way, despite the fact that genetic tests in saliva or blood exist on the market, and are increasingly accessible, in addition to bioinformatic tools to predictively estimate the risks of developing the disease at 10 years. With the combination of the epidemiological factors and the genetic component, a composite cardiovascular risk can be calculated that can help determine which factors can be modified a priori and thus have a direct impact in reducing the cases of acute myocardial infarction or other vascular diseases.
An extremely interesting aspect has to do with the age at presentation of cases of ischemic heart disease. Decades ago, the average age for a cardiovascular event was after 65 years and with a clear predominance of the male gender. Today, the age of presentation is earlier and also increasingly common in women, and below 50 years of age it is more catastrophic since these patients do not have the collateral circulation of older adults; therefore, their coronary flow reserve is lower and the risk of death is higher.
In this context, where the incidence of ischemic heart disease is higher at younger ages, it is necessary to highlight that genetic risk factors come from birth but their expression, that is, the ability to generate or not the disease, happens from certain triggers known as epigenetic factors and that occur in the most productive age of life. These epigenetic factors are intrinsically related to lifestyle. And it is clear that today's lifestyle is determined by the pace of work.
One can infer that more than at home, it is at or around the workplace – where you spend most of your time – is the place where lifestyle can be modified with greater impact in terms of physical activity, diet, stress control and limitation of harmful habits, such as smoking.
A corporate cardiovascular health program must go beyond measuring the classic factors and doing little or nothing. Considering the genetics of the population that works in organizations in addition to effectively executing patient and group-centered interventions according to risk factors is much more cost-efficient than searching for the best hospitals to treat heart attacks. Design of nutritional programs in the company, hours of physical activation defined by risk factors, step counters and incentives for compliance with health indicators, such as diabetes or hypertension control, smoking clinics as well as body composition-weight monitoring and health coaching to achieve objectives are among the strategies that multinational tech and manufacturing companies around the world are carrying out in their population to increase the productivity of their associates and reduce the occupational hazards in corporations, not only to fulfill the NOM 030.
Considering that both genetic and classic risk factors can be detectable long before the development of cardiovascular disease, how many myocardial infarctions can we accept as normal or expected? I think neither you nor I want to be part of that statistic.