February is indeed the Heart Month. Valentine’s Day is celebrated and it has been designated as the Heart Month in the Philippines. The designation aims to remind us that heart disease is still a top killer worldwide, prevention has a big role and for patients already with heart disease adequate treatment can prevent its progression and can prevent or treat complications.
A certain class of drugs was recently added to the standard or foundational treatment of heart failure. Sodium glucose co-transport inhibitors also called SGLT2i were initially used as drugs for blood sugar control among diabetic patients but are now also recommended as treatment for heart failure because stu-dies showed that among patients treated with SGLT2 inhibitors, the risk of dying and hospitalization from complications is significantly reduced.
SGLT2 inhibitors are to be used in conjunction with the recommended dietary restrictions, smoking cessation, rest and relaxation. The other drugs currently recommended for the treatment of heart failure are ACE inhibitors or angiotensin 2 blockers, mineralocorticoid receptor antagonists (spironolactone and eplerenone), and ARNI or angiotensin receptor/neprilysin inhibitor combination (sacubitril/valsartan).
These drugs are all available in the Philippines, but should only be taken under the supervision of a physician. They are used in a stepwise manner based on an individual patient’s unique health condition and comorbidities. Baseline laboratory tests are also assessed and subsequently monitored.
For example, kidney function has to be evaluated to see if these drugs may be used, and if doses have to be adjusted.
One limiting factor to the use of newer drugs is the cost, which puts us back to the basic and most cost effective approach, which is still prevention. While as adults we cannot rewind and undo the sedentary lifestyle we lived or all the fatty and salty food we have already feasted on, there is still hope through renewed low-salt diet low fat, exercise, stress reduction, and other approaches, and of course to follow our doctors’ advice.
To prevent the use of these expensive drugs among our younger relatives or family members, let us not load them with easily accessible fast food, which we all know are laden with fat, salt, and sugar. While ads heavily promote them, fad drinks like smoothies, soda, and other sweetened drinks if taken so often will lay the ground for the use of these beautiful and promising new yet expensive drugs.
To cite an example, one tablet of one of these drugs may cost P150. In developed countries the cost of treatment with sacubitril/valsartan is about $858 for 60 tablets, translated to P47,000 to 50,000. There is a statement that goes, “Let us not kill our arteries.” This may help when we make daily choices.
Which leads us to remember a basic health tenet – that of mind over body. Overthinking, worrying, and over stressing ourselves can cause heart disease. There is what is called the “broken heart syndrome”, which is stress-induced. This can affect young or older adults, men and women alike.
In sudden threatening conditions or acute stress, the stress reaction is triggered so that the fight or flight reaction is elicited to protect a person. The sympathetic nervous system is activated, the adrenal glands release the body chemicals adrenaline and cortisol – a person’s blood pressure increases, the heart and lungs work harder, and there is sudden release of more fat and sugar in the body to provide energy for the life-protective reaction. When the life-threatening situation subsides, release of the chemicals also subsides and the body resumes its normal functioning.
Studies have shown, however, that chronic or prolonged stressors (like difficult work situations, fear of losing one’s job, difficult relationships) and repeated activation of the stress response can lead to chronic inflammation, elevated blood pressure, heart disease. Chronic stress can increase blood sugar and lead to obesity.
Coping with stress or fighting stress can thus help prevent heart disease. And this is something well within our control.
This month, let us remind ourselves that seven hours of sleep, improved diet, mindful breaks, reaching out to friends who help us cope and grow, soothing music, bonding with pets, and other helpful activities can help us avoid heart disease. These are a lot better and more affordable. Self-care that stems from a healthy self-love can help us avoid frequent laboratory tests, medical visits, and the use of lots of medications on top of our usual multivitamins.