(3 of 3)
Some of the most promising research of this kind is being done in Asia. Scientists at the University of Hong Kong (HKU), for example, are currently working on a potentially groundbreaking treatment for heart patients who can't be helped by conventional drugs and who are too ill for surgery. Led by Dr. Tse Hung-fat, the HKU team is using stem cells harvested from a patient's own bone marrow to help restore diseased heart tissue. Clogged or damaged vessels that supply the heart with blood can't repair themselves, which is why bypass surgery is usually the best chance for many patients. But the HKU researchers have found that when the stem cells are injected into the heart muscle via a catheter, patients can develop new blood vessels to replace those that have been blocked or damaged by heart disease.
These are still early days, but some of the results have been remarkable. Before he was enrolled in HKU's stem-cell study, septuagenarian stroke victim Ho Kwong had to take 20 pills a week for his heart disease and couldn't walk more than a few steps without tiring. After undergoing stem-cell therapy, he says, "I'm able to continue my life as it was before. I can go outside with my friends, and I can sing karaoke." The cure isn't complete, because the therapy can't yet regenerate heart muscle, says Tse, but the treatment "means a lot for these kinds of patients. It's important for them in terms of quality of life."
Still, the vast majority of Asians don't have access to such cutting-edge medicine. Closer to the norm is Kaneez Fatima, a frail 45-year-old woman whose defective heart valve has meant repeated visits to the run-down rooms of Nishtar Hospital in Multan, Pakistan. Doctors there say that if Fatima doesn't receive a replacement valve soon, she will die. Her husband, Haji Mohammad Akram, who works in a local textile mill and makes $600 a year, has already sold their house to pay for his wife's medical bills. Three times he's traveled the 400 kilometers to Lahore to try to arrange an operation for his wife at a government hospital, at a cost of one month's salary for each trip, but the waiting list is too long and the red tape has proven exasperating. The procedure would cost $7,000 at a private hospital, which Akram says he can't afford: "There is no money."
That lament is familiar in hospital wards throughout Asia. With health-care resources so scarce, some experts argue that countries like India and China should focus on the persistent threat of infectious diseases, such as tuberculosis, before combating heart disease. But doctors like the World Heart Federation's Poole-Wilson say the high cost of treating people after they become CVD victims and the "double burden" of continued infectious disease is no reason to ignore the problem—it only makes it more important to focus resources on education and prevention.
Many Asians simply don't realize how dangerous heart disease can be for them. "They may be aware in a very piecemeal fashion," says Dr. Sania Nishtar, founder of Pakistan's pioneering medical NGO Heartfile, "but the concerted awareness level, the point that can make a difference, is extremely low." Gill of the International Obesity Task Force tells the story of a driver he hired during a visit to India, who said his health-care strategy was to save his money now so that he could afford the best bypass surgeon around when he had his inevitable heart attack. "I don't think it ever struck him that he could do something about it or change what could happen," Gill says.
That's the kind of skewed thinking that Nishtar is determined to change. An expert in preventative cardiology, Nishtar founded Heartfile in 1998 to promote CVD prevention among Pakistan's most vulnerable populations. In remote villages like Basti Jhandhawala near Lodhran in southern Punjab, Nishtar and her team of doctors spread basic information about cardiovascular disease to locals who quite literally wouldn't know a heart attack if it hit them.
Heartfile has already trained nearly 2,000 health workers and volunteers. It also feeds information on heart disease to the media, and it has worked with Pakistan's Ministry of Health and the who to form a national plan on disease prevention. The impact of these grassroots efforts can be dramatic. After a visit by Heartfile workers, farmer Salim Kahn of Basti Jhandhawala probably saved his 60-year-old father's life last year when the older man woke up with severe pain in his chest and left arm, and Kahn was able to recognize the symptoms as those of a heart attack. "I gave aspirin to my father to thin the blood and immediately rushed him to the hospital," says Kahn, who is now himself a Heartfile activist. His father survived the attack and is doing well.
Too often, however, brutal economics trump the best of intentions. In Basti Jhandhawala, Heartfile workers have urged villagers to abandon fattening vegetable ghee in favor of healthier cooking oil. But cooking oil costs 52 more per kilogram than ghee—a considerable difference in a village where the average income is about $600 a year. "When we ask families to change their diet and have their blood pressure regularly checked, they complain they don't have enough money," says Jamila Perween, a Heartfile-trained health worker. "They listen carefully, but then they say they can't afford it."
Fortunately, most people can at least afford to take a few heart-healthy steps: eat more fruits and vegetables and fewer processed foods and less saturated fat; cut out cigarettes; and exercise more (ideally, 30 minutes of moderate effort a day). Yusuf of McMaster University points to a study of the Amish in North America, who display very low CVD rates despite a diet that appears excessively rich in dairy fat. Research found that the average Amish man took some 18,000 steps a day, compared with 3,000 to 5,000 for the average American. "We have to make sure we find opportunities to expend energy, instead of opportunities not to expend energy," says Yusuf. "If this is done, we can dampen this potential epidemic by half."
They won't be churning butter anytime soon, but perhaps the Okinawans are turning a little bit Amish. Signs posted between every elevator at the Okinawa Prefectural Office read: "Use the stairs, too. Health. Save energy. 10,000 steps a day." Yoshifusa Miyagi doesn't quite make it to 10,000 steps every day, but since his heart attack, he has lost eight kilograms by cutting back on oily foods and fatty beef, reducing his intake of whiskey and Okinawan spirits by 80%, and walking whenever he can. "I tell my friends not to eat junk food or French fries or hamburgers," Miyagi says. "I don't want the same thing to happen to them." Across the region, a consensus is growing that Asia cannot afford to follow the West by allowing its own heart-disease epidemic to spiral out of control. The problem has to be fought here and now—one step at a time.