Coronary Artery Disease on Nepalese society

Dr. Rajan Poudel 
MBBS(BS/MD)
Health Care Team Leader at UN CAMMAY Volunteer 2020

Today I want to discuss with you about the changes in the treatment of coronary artery disease. For over a decade we have been fighting with this disease. So what is our current position? where we are standing? Are we winning or losing?

 If we see that almost 60% of Nepalese are suffering from Coronary Artery Disease.40-50% of people can't even reach till hospital after heart stroke.

It is very necessary to have complete knowledge about the disease with which we are fighting.

As I told you heart disease is increasing among the young population in Nepal. The main reason is genetic. From parents, kids get this disease by genetic. So this is the genetic reason, there is an agent called lipoprotein which is more in the blood in Nepali. This is the main reason why in Nepalese we are seeing heart disease. More compared to western people.

Now if we talk about urban vs rural ratio of the occurrence of this disease, then now our scenario of lifestyle is changing so fast, and mobile culture has come, 40% of the rural population has heart disease. In the urban population, it is seen around 50%. It is not a very big difference. If we see the last (30-40)years, this population prevalence was 2%means only 2 people in 100 used to get a heart attack. Nowadays it has become 10% in cities and in the village, it has reached 5%. So this disease is spreading all over the country very fast and making its root stronger. 


There are 8 major reasons for getting heart disease they are diabetes, hypertension, excess of cholesterol, smoking, lack of physical activity, sitting at one place, obesity, lesser intake of fruits and vegetables, and stress in life, these are the main 8 reasons for 90% of heart attack. And 10% heart attacks happens without any reason. That is why when people come to us and say that we have not does anything and everything was normal before but still we have got a heart attack, so 10% people do not have any reason for heart attack. Main reason is genetic in this, might be your parents had it. Hence it passed on to you. As I told you genetics play very important role in Nepalese, amount of lipoprotein A is more in Nepalese compared to other country population. 

In this there are few things which I would like to mention which are very important and encouraging for us, 10 years back out of 20 heart patient 10 patient used to die with heart attack now it has reduced to only 5. Due to latest advancement in medical technology, it has become possible to treat a heart diseases and heart patient can live their normal life for normal lifespan. There are three steps in heart disease, first is prevention, second is diagnosis of it and third is treatment. So what are the latest advances in this, in prevention we see nowadays people are aware ,educated and they know that these are aggravating things and we should avoid it, we should not sit idle, we should have some movement. We should keep patience because with all of these things this disease is getting prevented. 

20 years back or 10 years back we had more reasons but now we are moving towards physical activity more. So this is the reason why heart disease is reducing. 


Prevention :
Under prevention we also do health check ups, I recommend that every person after the age of 35 should go for a preventive health check up whatever deficiencies we have in our body whether it is high blood pressure, diabetes, or high cholesterol we have to stay alert for this, control it to reduce the chance of heart attack.

Diagnosis :
If we talk about diagnosis in diagnosis also so many advances have happened in medical science. Angiography has become very easy, mostly radial angioplasty means through hand which reach to heart’s blood veins earlier it used to happen through legs. So many vascular complications of blood clotting used to happen but now it has become very safe and effective. Cath lab machines have become very advance, through which we can catch minute illness as well. 


Treatment:
Then it comes to treatment means the medication if it. The scenario of treatment has changed a lot. Since last 10 years quality of stent has improved, dissolvable stents have come and person can live his/her normal life. So many good medicine have come, you can treat heart disease well even after one stroke pumping of heart does not increase. Apart from that very good technologies are their such as FFR, IVUS or Rotablation in which we can fight with complex coronary artery diseases or heart diseases. Like through the technique of Rotablation fats, calcium and stones which build up in blood veins we can get rid of this. One more imaging technique has come we call it IVUS, it is a kind of sonography of heart’s blood vein from which we can diagnose, where the possibility of attack is and which part or vessel needs treatment. Chances of bypass have been reduced because the technique of coronary angioplasty and stenting have become so much advanced and patient were getting  benefits with less expensive and less hospital stay and patient are able to live their normal life style. So I hope from this you must have come to know what all techniques are available today. I wish for your good health. 
Thank you so much 🙏🇳🇵
Location: Bharatpur, Nepal

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