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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Next generation of biotech food heading for grocery stores

Fred Gmitter, a geneticist at the University of Florida Citrus Research and Education Center, holds citrus seedlings that are used for gene editing research at the University of Florida in Lake Alfred, Fla., on Sept. 27, 2018. (AP)
Updated 15 November 2018
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Next generation of biotech food heading for grocery stores

  • Scientists even hope gene editing eventually could save species from being wiped out by devastating diseases like citrus greening

WASHINGTON: The next generation of biotech food is headed for the grocery aisles, and first up may be salad dressings or granola bars made with soybean oil genetically tweaked to be good for your heart.
By early next year, the first foods from plants or animals that had their DNA “edited” are expected to begin selling. It’s a different technology than today’s controversial “genetically modified” foods, more like faster breeding that promises to boost nutrition, spur crop growth, and make farm animals hardier and fruits and vegetables last longer.
The US National Academy of Sciences has declared gene editing one of the breakthroughs needed to improve food production so the world can feed billions more people amid a changing climate. Yet governments are wrestling with how to regulate this powerful new tool. And after years of confusion and rancor, will shoppers accept gene-edited foods or view them as GMOs in disguise?
“If the consumer sees the benefit, I think they’ll embrace the products and worry less about the technology,” said Dan Voytas, a University of Minnesota professor and chief science officer for Calyxt Inc., which edited soybeans to make the oil heart-healthy.
Researchers are pursuing more ambitious changes: Wheat with triple the usual fiber, or that’s low in gluten. Mushrooms that don’t brown, and better-producing tomatoes. Drought-tolerant corn, and rice that no longer absorbs soil pollution as it grows. Dairy cows that don’t need to undergo painful de-horning, and pigs immune to a dangerous virus that can sweep through herds.
Scientists even hope gene editing eventually could save species from being wiped out by devastating diseases like citrus greening, a so far unstoppable infection that’s destroying Florida’s famed oranges.
First they must find genes that could make a new generation of trees immune.
“If we can go in and edit the gene, change the DNA sequence ever so slightly by one or two letters, potentially we’d have a way to defeat this disease,” said Fred Gmitter, a geneticist at the University of Florida Citrus Research and Education Center, as he examined diseased trees in a grove near Fort Meade.
GENETICALLY MODIFIED OR EDITED, WHAT’S THE DIFFERENCE?
Farmers have long genetically manipulated crops and animals by selectively breeding to get offspring with certain traits. It’s time-consuming and can bring trade-offs. Modern tomatoes, for example, are larger than their pea-sized wild ancestor, but the generations of cross-breeding made them more fragile and altered their nutrients.
GMOs, or genetically modified organisms, are plants or animals that were mixed with another species’ DNA to introduce a specific trait — meaning they’re “transgenic.” Best known are corn and soybeans mixed with bacterial genes for built-in resistance to pests or weed killers.
Despite international scientific consensus that GMOs are safe to eat, some people remain wary and there is concern they could spur herbicide-resistant weeds.
Now gene-editing tools, with names like CRISPR and TALENs, promise to alter foods more precisely, and at less cost, without necessarily adding foreign DNA. Instead, they act like molecular scissors to alter the letters of an organism’s own genetic alphabet.
The technology can insert new DNA, but most products in development so far switch off a gene, according to University of Missouri professor Nicholas Kalaitzandonakes.
Those new Calyxt soybeans? Voytas’ team inactivated two genes so the beans produce oil with no heart-damaging trans fat and that shares the famed health profile of olive oil without its distinct taste.
The hornless calves? Most dairy Holsteins grow horns that are removed for the safety of farmers and other cows. Recombinetics Inc. swapped part of the gene that makes dairy cows grow horns with the DNA instructions from naturally hornless Angus beef cattle.
“Precision breeding,” is how animal geneticist Alison Van Eenennaam of the University of California, Davis, explains it. “This isn’t going to replace traditional breeding,” but make it easier to add one more trait.
RULES AREN’T CLEAR
The Agriculture Department says extra rules aren’t needed for “plants that could otherwise have been developed through traditional breeding,” clearing the way for development of about two dozen gene-edited crops so far.
In contrast, the Food and Drug Administration in 2017 proposed tighter, drug-like restrictions on gene-edited animals. It promises guidance sometime next year on exactly how it will proceed.
Because of trade, international regulations are “the most important factor in whether genome editing technologies are commercialized,” USDA’s Paul Spencer told a meeting of agriculture economists.
Europe’s highest court ruled last summer that existing European curbs on the sale of transgenic GMOs should apply to gene-edited foods, too.
But at the World Trade Organization this month, the US joined 12 nations including Australia, Canada, Argentina and Brazil in urging other countries to adopt internationally consistent, science-based rules for gene-edited agriculture.
ARE THESE FOODS SAFE?
The biggest concern is what are called off-target edits, unintended changes to DNA that could affect a crop’s nutritional value or an animal’s health, said Jennifer Kuzma of the Genetic Engineering and Society Center at North Carolina State University.
Scientists are looking for any signs of problems. Take the hornless calves munching in a UC-Davis field. One is female and once it begins producing milk, Van Eenennaam will test how similar that milk’s fat and protein composition is to milk from unaltered cows.
“We’re kind of being overly cautious,” she said, noting that if eating beef from naturally hornless Angus cattle is fine, milk from edited Holsteins should be, too.
But to Kuzma, companies will have to be up-front about how these new foods were made and the evidence that they’re healthy. She wants regulators to decide case-by-case which changes are no big deal, and which might need more scrutiny.
“Most gene-edited plants and animals are probably going to be just fine to eat. But you’re only going to do yourself a disservice in the long run if you hide behind the terminology,” Kuzma said.
AVOIDING A BACKLASH
Uncertainty about regulatory and consumer reaction is creating some strange bedfellows. An industry-backed group of food makers and farmers asked university researchers and consumer advocates to help craft guidelines for “responsible use” of gene editing in the food supply.
“Clearly this coalition is in existence because of some of the battle scars from the GMO debates, there’s no question about that,” said Greg Jaffe of the food-safety watchdog Center for Science in the Public Interest, who agreed to join the Center for Food Integrity’s guidelines group. “There’s clearly going to be questions raised about this technology.”
SUSTAINABILITY OR HYPE?
Gene-editing can’t do everything, cautioned Calyxt’s Voytas. There are limitations to how much foods could be changed. Sure, scientists made wheat containing less gluten, but it’s unlikely to ever be totally gluten-free for people who can’t digest that protein, for example — or to make, say, allergy-free peanuts.
Nor is it clear how easily companies will be able to edit different kinds of food, key to their profit.
Despite her concerns about adequate regulation, Kuzma expects about 20 gene-edited crops to hit the US market over five years — and she notes that scientists also are exploring changes to crops, like cassava, that are important in the poorest countries.
“We think it’s going to really revolutionize the industry,” she said.