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Many of us have suffered from an emotionally broken heart at some point in our lifetime – unrequited love, a death of a loved one or shattered dreams can all leave us feeling broken hearted. But what would a physically broken heart feel like? Hopefully, very few of us will ever have to find out. A heart attack, caused by an interruption of blood flow to the muscles of your heart, can quite literally “break” the structure and function of your heart.

Cardiovascular disease or CVD, comprising of heart attack and stroke, is the leading cause of death in the world. 1 In South Africa, more than 230 people die each day from CVD. 2 Although there are some risk factors, such as your gender, age, race or family history that you cannot change, there are many others (called modifiable risk factors) that you can control through lifestyle changes and medication. 3 In fact, according to the Heart and Stroke Foundation of South Africa, 80 % of heart disease and strokes can be prevented. 4 These modifiable risk factors include, amongst others, high blood pressure, diabetes and high cholesterol. 3

High blood pressure

man being tested for high blood pressure

South Africa has one of the highest rates of high blood pressure worldwide – 1 in 3 adults are affected. 5,6 The numbers are even higher in older adults (> 50 years) – 8 out 10 have high blood pressure. 6

High BP can damage your body for many years before symptoms develop 7 so it is important to regularly get your blood pressure checked. 6 Roughly half the people with untreated hypertension die due to heart attack 7 so it is also very important to get it under control. 6,7

High blood pressure “breaks” or damages your heart in the following ways: 7

  • It damages the cells lining your blood vessels. Fats in your bloodstream collect in the damaged areas to create fatty plaques or atheromas. The blood vessels become stiffer and limit blood flow to the heart muscle, which can die and cause a heart attack.
  • It forces your heart to work harder than necessary in order to pump blood to the rest of your body. This causes parts of your heart to thicken or stiffen. These changes then limit your heart’s ability to pump blood and can lead to a heart attack or heart failure
  • Over time, the strain on your heart caused by high blood pressure can cause your heart muscle to weaken and work less efficiently. Eventually, your overworked heart begins to wear out or fail.

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diabetes spelled out with digital testing machine

In 2016, the International Diabetes Federation estimated that 7 % of South Africans between the ages of 21 and 79 years had diabetes – alarmingly this prevalence had increased 155 % over the past 6 years! 8 Considering that people with diabetes develop heart disease at a younger age and are nearly twice as likely to die from a heart attack or stroke as people without diabetes, it is very important to recognise and treat the condition early. 9 Diabetes also raises your risk of “silent” heart disease – that is heart disease with no signs or symptoms- as the condition can damage the nerves and therefore can blunt heart  pain. 10

Diabetes “breaks” or damages your heart in the following ways: 11

  • Promotes the development of fatty plaques in the blood vessels
  • Damages nervous system that controls regulation of blood flow to the heart
  • Creates a state of chronic, low-level inflammation that negatively affects the heart
  • Promotes production of AGEs, which can cause injury to the heart and blood vessels
  • Enhances activation of platelets and clotting factors in the blood, which promotes the formation of blood clots that can block arteries supplying the heart.
  • Can directly damage the muscles of the heart, making them stiff and weaker

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High cholesterol

cholesterol dial indicating high

High cholesterol is one of the most important modifiable risk factors for heart attacks and strokes. 12 In fact, a third of heart attacks are thought to be due to high cholesterol. 12 In South Africa, 1 in 3 females and 1 in 5 males (15 – 65 years) have high cholesterol. 13

High cholesterol “breaks” or damages your heart in the following ways:

  • It is one of the main triggers of fatty plaques or atheromas developing in the blood vessels. The blood vessels become stiffer and limit blood flow to the heart muscle, which can die and cause a heart attack. 14,15
  • These fatty plaques can also rupture and clots can break off and obstruct the blood vessels supplying blood to the heart, resulting in a heart attack 15

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References: 1. Gersh BJ, Sliwa K, Mayosi BM, Yusuf S. The epidemic of cardiovascular disease in the developing world: global implications. Eur Heart J. 2010 Mar;31:642-648. 2. Statistics South Africa. Mortality and causes of death in South Africa, 2016: Findings from death notification. [online] 2016 [cited 2018 Nov 15]. Available from: URL: 3. Li YQ, Wright SCD. Risk factors for cardiovascular disease in the Ga-Rankuwa community. Curationis 2007;30(4):79-87. 4. The Heart and Stroke Foundation of South Africa. Healthy Eating. [online] [cited 2018 Nov 15]. Available from: 5. Gómez-Olivé FX, Alix SA, Madex F, Kyobutungik C, Nonterah E, Micklesfield L, et al. Stark Regional and Sex Differences in the Prevalence and Awareness of Hypertension: An H3Africa AWI-Gen Study Across 6 Sites in Sub-Saharan Africa. Global Heart. 2017 Jun;12(2):81-90. 6. The Heart and Stroke Foundation of South Africa. Measure your Pressure this May. [online] 2017 May 15 [cited 2018 Nov 15]. Available from: 7. Mayo Clinic. High blood pressure dangers: Hypertension’s effect on your body. [online] 2016 Nov 23 [cited 2018 Nov 15]. Available from: URL: 8. Centre for Diabetes and Endocrinology (CDE). Diabetes in South Africa: Assessing the Data with Fear and Trembling. 9. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetes, Heart Disease and Stroke. [online] 2017 Feb [cited 2018 Nov 15]. Available from: URL: 10. National Heart, Lung, and Blood Institute. Diabetic Heart Disease. [online] [cited 2018 Nov 15]. Available from: URL: httpsL// 11. Dokken BB. The Pathophyisiology of Cardiovascular Disease and Diabetes: Beyond Blood Pressure and Lipids. Diabetes Spectr 2008;21(3):160-165. 12. The South African National Health and Nutrition Examination Survey. [online] 2013 [cited 2018 Feb 9]. Available from: URL: 13. Bergheanu SC, Bodde MC, Jukema JW. Pathophysiology and treatment of atherosclerosis. Neth Heart J 2017;25:231-242. 14. Aziz M, Yadav KS. Pathogenesis of Atherosclerosis: A Review. Med Clin Rev 2016;2(3):22.

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