Cardiac health a concern for all

Updated 23 December 2012
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Cardiac health a concern for all

Dr. Hani Najm, a cardiac surgeon at the King Abdulaziz Cardiac Center in Riyadh and vice president of the Saudi Heart Association, will highlight his concerns about the heart health of the Saudi population at the 5th Middle East Cardiovascular Disease and Intervention Conference in Dubai on Jan. 28-31. Najm will be speaking extensively on this topic and share the Kingdom’s experience with the international audience at the conference.
In an exclusive interview with Arab News, he also discussed his worries about cardiac health in the Kingdom. He pointed to the lifestyle here as one of the major reasons for the high incidence of cardiac disease.

With the high incidence of lifestyle diseases in Saudi Arabia, cardiac health is a concern for the population. What steps are being taken to educate people on the prevention of cardiac disease?
Cardiovascular diseases have become one of the most alarming disease threats in the Kingdom. Statistics show that a quarter of the population is diabetic, and an even higher percentage suffers from hypertension. Similarly, 6-7 percent suffers from high cholesterol and coronary disease, both of which are a major cardiovascular burden that will require specific preventative measures to combat the risk factors.
Currently, cardiac care in Saudi Arabia is sophisticated and advanced, but we do not have in place the necessary preventative measures that would adequately control the risk factors. More recently, laws have been passed banning smoking tobacco in public areas, and although these laws are being enforced, we may not have seen enough real action so far.
An important factor that could lead to a drop in disease rates and prevention of these conditions is the drive to educate the public about heart disease. This has mainly been conducted by the Saudi Heart Association via media campaigns, education programs, and the distribution of brochures and information packages.
Public awareness should target different sectors of the population – school children, working adults, senior citizens – to educate them on how to control their weight, control carbohydrate and sugar intake, in addition to monitoring and learning how to avoid hypertension.
“Moreover, to successfully implement a public awareness program of this magnitude, there is a need for a more systematic approach to the issue – something currently lacking in Saudi Arabia. The heart health of the general public should be the responsibility of the civil society; however, currently only the medical society is actively tackling this issue from a professional education and scientific perspective at conferences such as the 5th Middle East Cardiovascular Disease and Intervention Conference taking place at Arab Health 2013.
The Saudi Heart Association is hosting outreach programs in malls along with educational lectures; these types of initiatives need to be identified and spread amongst all sectors of society.
Is obesity not a concern for cardiac health, as it is also part of the Saudi lifestyle and a major cause of diabetes?
Obesity in general is associated with multiple medical problems such as diabetes, hypertension and what you call a metabolic syndrome, but if all these associated diseases are not present, then obesity itself is not directly related to cardiac health. This means overweight people without any of the other major risk factors for heart disease may not develop heart disease just because they are overweight.

What are the latest statistics on the incidence of cardiac disease in Saudi Arabia?
We have some statistics that have concluded there is a prevalence of cardiac disease, such as coronary heart disease, in around 6 percent of the population. A quarter of the Saudi population suffers from diabetes, around 27 percent from hypertension, and 35-40 percent suffers from hypercholesterolemia; all of which will add up to an increasing level of cardiac diseases in the Kingdom.
There is an important issue worth mentioning in terms of incidence of cardio disease, which is that 50 percent of the population is still below 25 years of age. There is a high-risk profile, and we expect a rise in cardiovascular illness in the next 15-20 years, when most 25-year-olds will be aged 40-50, and that is when the manifestation of cardiovascular disease occurs.
If we do not control the risk factors in the young population immediately, it won’t matter how many advanced cardiac centers we have, as it will not cover the number of cardiovascular patients.
So, as we can see, the incidences of conditions that may lead to cardiovascular illnesses are on the rise. Unfortunately, there are bad habits within the Saudi society that have been acquired culturally and socially, such as smoking water pipes. This has become prevalent in homes and in public despite control from the government. Cigarette smoking is also prevalent in schools, and the rates are increasing alarmingly.

What are the reasons of extreme hypertension in the Kingdom? Is it because of the lifestyle, food, environment, or other reasons? How can awareness help in diminishing heart problems?
Hypertension is prevalent in the Kingdom for all the reasons mentioned above, in addition that diabetes, which is very closely related to hypertension, is highly common in the people of Saudi Arabia. These are all acquired risk factors for heart diseases, due to the sedentary lifestyle, improper eating habits, as well as the environmental and generic factors that contribute to all this.

How well is the Kingdom doing in terms of offering world-class cardiology care for its patients?
Cardiac surgery in general follows very strict detrimental factors for outcome. This means the outcome of surgery is measured either by major outcomes such as death, or minor outcomes such as morbidity or complications. These outcomes are measured very carefully in heart surgery, and these are what we call ‘code risk-adjusted outcome’, so it is a risk-adjusted outcome based on the population.
In Saudi Arabia, in particular at King Abdulaziz Cardiac Center, we use international benchmarks for cardiac surgery such as the STS (Society of Thoracic Surgery) Database, an American system; and the EACTS (European Association of Cardio Thoracic Surgery) Database. These produce a very robust number of statistics to benchmark the outcome of cardiac surgery across the world.
We have also started a nationwide cardiac surgery database that we are enrolling across all cardiac surgeries done in the country in order to benchmark the entire database of Saudi Arabia against what is happening in the rest of the world.

Does Saudi Arabia attract mostly foreign cardiac surgeons or does the country have the mechanisms to educate and train local surgeons?
Over the last 30 years, the government has made a tremendous effort to send young, bright Saudi doctors abroad to continue their education. All these doctors have returned with advanced sophisticated training from North America and Europe, and they now form a robust corps of cardiac surgeons as well as cardiologists, resulting in the most advanced cardiovascular care in Saudi Arabia.
Now, in addition to the presence of these physicians trained abroad and matured through this system, we have also local training. Certification for both cardiac surgery and cardiology is provided to allow for local certification in advanced subspecialties in cardiac surgery and imaging as well as cardiac catheterization.

What future developments do you foresee for Saudi Arabia in terms of its cardiology services?
I see an acute need for the organization of cardiovascular services, in particular the streamlining of cardiac services that are offered by different caregivers, i.e., the Ministry of Health, National Guard, private sector, universities, and so on. In order to lower the mortality rate for cardiac disease, we need to coordinate the services offered by different caregivers, so that a patient who is suffering from a heart attack can get to the closest hospital and receive intervention during the ‘golden hour’ (first 90 minutes) after the heart attack.
There have been some proposed solutions to network and integrate the advanced cardiac care in the Kingdom that are currently being discussed.

Why is it important for cardiology physicians to attend educational conferences and keep up with the latest research in the field?
As medical professionals, we need to keep up with the latest technologies, studies, and research papers that address our practices. This is a continuation of our education and training, because clinical trials as well as the way we manage patients change based on new sciences.
The only way to be able to acquire such knowledge is through meetings conducted in the region, such as the 5th Middle East Cardiovascular Disease and Intervention Conference at Arab Health 2013, where global leaders from all over the world are invited to give briefs of studies, consensus statements, and guidelines for the management of patients.
Physicians can attend the event and will be able to transfer the knowledge from the West to East. Additionally, there is regionally produced research that can be shared amongst the Middle Eastern countries as well as with the Western representatives.

Besides awareness, what should people do to avoid the problem of cardiovascular diseases?
The problem with awareness is that people are aware, but they do not act on what they know. If you asked people if exercise is good for your health, they would say ‘yes’; nevertheless, they do not exercise. Smoking is bad for your health – they would also say ‘yes, it is bad’ – but they will continue to smoke. The bottom line is: First, the actual piece of knowledge of cardiovascular disease prevention should get to the public, but then practicing this becomes very difficult. Based on my experience, most people, at least in Saudi Arabia, may know that piece of knowledge of what helps to prevent cardiac diseases, but they do not practice it.

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Ramadan offers ‘golden opportunity’ to get in shape, say Saudi fitness experts

The holy month of Ramadan is the perfect time to get into shape. Photos show clockwise from top: Sohaib Mubarak, Rayan Bashawri, Mashael Fagerah and Reham Kamal. (Photos/Supplied)
Updated 21 May 2019
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Ramadan offers ‘golden opportunity’ to get in shape, say Saudi fitness experts

  • Many Muslims take advantage of the holy month of fasting to keep fit
  • For fat burning, it is better to work out an hour before breaking fast, since the insulin level is low, but for building lean, toned muscles, it is better to work out two hours after breaking fast because the insulin level is high

JEDDAH: Saudi fitness experts have urged Muslims to use Ramadan as a “golden opportunity” to start a new healthy lifestyle.
The holy month of fasting is the perfect time to get into shape, say some of the Kingdom’s top trainers.
With regular exercise, Ramadan can offer a new start for many worshippers both spiritually and physically. RK Fit gym owner, Reham Kamal, told Arab News that working out while fasting was healthy because the body used stored fat as energy, resulting in more fat burning.
The 32-year-old Saudi coach recommended low- to medium-impact workouts while fasting to avoid dehydration and advised trying calisthenics, a form of exercise consisting of a variety of movements which work large muscle groups, such as running, standing, grasping and pushing.
Kamal said: “Ramadan is a great opportunity to lose weight. We shouldn’t eat too much when breaking our fast. Sadly, in our culture, people take this month as an opportunity to fill the table.
“They aren’t seeing the golden opportunity to get into shape, because fasting has numerous health benefits, not only weight loss. It promotes blood-sugar control by reducing insulin resistance, increases growth hormone secretion, which is vital for growth, metabolism, weight loss and muscle strength, and aids weight loss by limiting calorie intake and boosting metabolism.
“For fat burning, it is better to work out an hour before breaking your fast, since the insulin level is low, but for building lean, toned muscles, it is better to work out two hours after breaking fast because the insulin level is high,” she added.

HIGHLIGHTS

The holy month of Ramadan is a new start for many, both spiritually and physically.

Exercising while fasting has benefits: It promotes blood sugar control by reducing insulin resistance, increases growth hormone secretion which is vital for growth, metabolism, weight loss and muscle strength, and aids weight loss by limiting calorie intake and boosting metabolism.

Mashael Fagerah, 35, owner of House of Agility, a studio offering high-intensity interval training (HIIT) and circuit training, said: “You can do everything you normally do during fasting especially if you are used to working out. But if you are a beginner, I would recommend starting carefully with low-impact training.”
She told Arab News that many Muslims took advantage of Ramadan to keep fit.
“Whether before iftar, before sahoor or between them, if you have the time for a workout just do it,” added Fagerah. “At the end of the day, it is better than doing nothing.”
Saudi personal trainer and co-founder of Swish bootcamp, Sohaib Mubarak, 29, said it was important to choose the right kind of fitness regime. “When you haven’t had anything to drink or eat your body is low in fuel and dehydrated. Therefore, performing high-intensity training would harm your body and your health.
“Also, studies show that the difference in results is insignificant between exercising in a fasted or a fed state,” he added. 
Mubarak recommended low-intensity cardio for a short period of time. “That is 60 percent to 70 percent of maximum heart rate. By doing that you won’t sweat much and get dehydrated.”
He said people often wrongly related not eating to weight loss, when infact they should focus more on maintaining a healthy lifestyle rather than watching the weighing scales.
“In my opinion Ramadan is like any other month, because losing weight and having a good shape is about changing your eating habits and lifestyle for life not only for one month. One month is not enough to create a tremendous transformation. It’s all about consistency,” Mubarak told Arab News.
Saudi fitness trainer and owner of B. Bros gym, Rayan Bashawri, 27, stressed the importance of listening to the body’s needs and capabilities.
“So many studies have been done about fasted training or training on an empty stomach, and it shows different thoughts depending on what kind of athlete you are or what kind of sport you are doing.
“But my opinion is to listen to your body and do what feels right for you. It’s not healthier to do fasted training but it’s not bad for you either. You can reach your goal either way,” he told Arab News.
The number of people taking out gym subscriptions often shoots up during Ramadan.
Bashawri said: “Right after Ramadan is the time when people travel, and it’s a beach season as well, so obviously everyone wants to look good. The ages of those hitting the gym at this time of the year are from 18-30.”
Fasting was a great opportunity to lose weight, but Bashawri noted that staying up late and sleeping during the day was not ideal. He also warned people not to over-exert themselves if exercising during fasting as it could cause injury and dehydration.