Blood clotting is 10-times more likely to occur in Pakistani heart patients who have medicated stents, compared with the other older bare-metal variety.

KHALID BUTT, Bureau Chief, Lahore
Dec 25 - 31, 2006

Prof Dr Naeem Tareen, senior Cardiologist and Diplomate of American Board of Cardiology has urged the Ministry of Health to put the drug-coated heart devices known as stents on its 'watch list' like the Federal Drug Authority, USA, as serious complications are being noticed among the cardiac patients who have medicated stents.

Talking to PAGE, Prof Dr Naeem Tareen, who is former Chief at the world renowned St.Paul Hospital, Dallas, Texas, New York, said that blood clotting is 10-times more likely to occur in Pakistani heart patients who have medicated stents, compared with the other older bare-metal variety. The irrational application of medicated and non-medicated stunts on cardiac patients is not only causing certain complications for them but also resulting into deaths in those who give up medication. This was due to blood clotting among the cardiac patients who have medicated stents, Tareen added.

Prof Dr Naeem Tareen, who now was practicing at Surgimed Hospital, Lahore says "with the present data available and with the high rate of non-compliance with medications, I cannot imagine any Cardiologist putting in drug coated stents in Pakistani population". senior Cardiologist and former Chief Executive of Multan Institute of Cardiology. Prof Naeem Tareen, who is also Diplomate of American Board of Cardiology, said that instances have been noticed that stunts were used on cardiac patients without looking into pros and cons of its impact on them. Answering a question, he said that heart diseases are on rise among women due to multiple factors. "Obesity is a worldwide health issue and the scope of this is not limited to the developed world only", he added. He further said that cardiovascular disease is the leading cause of death in Pakistan. Giving reference of World Health Organisation's (WHO) worldwide figures, he stated that a heart attack occurs in every three seconds, and a stroke in every four.

He observed that, "Cardiovascular disease is responsible for 18 million deaths around the world, 80-percent of which occur in the developing countries. Being overweight or obese, particularly if weight is carried around the abdomen, is a leading risk factor for heart disease and stroke, reducing the likely age of a first heart attack by between four and eight years. Nevertheless, maintaining a healthy weight and body shape dramatically reduces this risk", he said. "Obesity is on the rise in the world due to sedentary lifestyles coupled with inappropriate eating habits. In Pakistan, we need to change our mindset, and become a physically active and health conscious nation", he asserted.

Prof Tareen emphasised that daily physical activities and workout, intake of fat, grains, protein, and vegetables and salt should be carefully planned. To another question, he said tobacco use is the most important risk factor for heart attack and stroke and over 30 other serious diseases including lung cancer. He pointed out that the use of tobacco in all its forms, including the use in paan and gutka, is extremely dangerous for heart and lungs. Inhalation of second hand smoke also needs to be discouraged, he said.

He further said that tobacco smoking causes one-fifth of cardiovascular diseases worldwide and if the current trends continue, 10 million people will die from tobacco-related diseases by 2030, out of which 70 % of deaths will occur in developing countries. He said that environmental factors, genetic make-up and habits form a milieu which makes people prone to heart attacks. Risk of heart attacks can be reduced with confidence by remaining active through exercise, maintaining an appropriate weight, taking a diet rich in fruits, vegetables and fish and low in refined carbohydrates and saturated fats, and finally by abstaining from harmful acquired habits like smoking, he advised. To a question, he said one of the major problems confronted to us is that we used to import latest machinery from abroad but due to lacking trained technicians, either machinery turned outdated or rendered useless. Likewise, when any senior medical professional come from abroad to serve the countrymen he/she had to face discrimination and bureaucratic hurdles which resulted in utter disappointment from them, he said. He urged the government to introduce "Open Staff Policy" under which trained doctors and technicians would have a choice to serve in any health institution of their liking where they would be able to work without any bureaucratic hurdles, he said. He was of the view that fruits of reforms taken by Chief Minister Punjab in health sector are not reaching to the people due to bureaucratic hurdles.

Prof Dr Naeem Tareen, who is fellow American College of Cardiology Board certified in Cardiology, claimed that there is not a single Cardiologist serving in government hospital, who is certified by the American Board. Had there was any American Board certified Cardiologist in government hospitals or PIC, one of the important personalities of the province needs not to undergo treatment from private sector hospital, he posed a question. About surge in cardiovascular diseases in the country, he said that heart diseases have increased in Pakistan at an alarming ratio due to unhealthy lifestyle, smoking, diabetes mellitus, high blood pressure, high cholesterol level, lack of exercise and obesity. "The recent studies have shown that every fourth person who has suffered heart attack in Pakistan is below 40 years of age, which is very disturbing. If awareness campaign is not launched at mass level, there is strong apprehension that the cardiac diseases may also hit the teenagers, mainly on account of excessive use of internet and taking high cholesterol diets', he feared.

Elaborating Prof Dr Naeem Tareen said most of the heart diseases, including Coronary Artery Disease (CAD) which is the most common form of cardiac disease, are preventable provided a clear approach about healthy lifestyle is adopted and implemented by people. CAD is responsible for millions of deaths worldwide every year, and out of these, majority of deaths occur in developing countries, which are high-risk countries as for as cardiovascular disease is concerned, he said. According to him, people in the third world countries are not much health conscious, as they used to lead unhealthy lifestyle mainly due to lacking awareness. In the developing countries, millions of patients remain alive yet hopelessly crippled. ''Narrowing of the arteries supplying blood to the heart causes Coronary Artery Disease.

This narrowing is caused by the deposition of cholesterol rich material in the blood vessels. However, formation of a clot on top of these blockages leads to heart attack and 50 percent of those who suffer heart attack on this account do not survive'', he said. Highlighting risk factors regarding formation of blockages in the arteries, Tareen said the risk factor for CAD must be modified towards prevention and control of disease. The risk factors of formation of blockage in the arteries include: age, male gender, positive family history, diabetes mellitus, high blood pressure, high cholesterol levels, smoking, lack of exercise and obesity.