As the Philippines moves towards globalization, Filipinos grapple with its effects. One of them is the rise of non-communicable diseases or NCDs. Ischemic or coronary heart disease (CHD) is one of the most prevalent NCDs, dubbed as the "silent killer" because it can be undetected for decades. At the turn of the millennium, only 4 out of the 10 leading causes of death in the Philippines were caused by non-communicable diseases like diabetes mellitus, COPD, and other vascular diseases.
However, in 2020, 7 out of the ten leading causes of death were due to NCDs. Since 1985, the leading cause of death in the Philippines has been ischemic heart disease 101,110 Filipinos died because of ischemic heart diseases in 2020, accounting for 17.1% of the total reported deaths in the country. This value increased by 7.8% when compared to data from 2019.
This disease doesn’t choose its victims either. In the past, CHD was commonly attributed to the elderly. Nowadays, because of sedentary lifestyles and poor eating habits, young people can also develop risk factors for CHD. Additionally, lower-income classes may not have the purchasing power to buy fruits and vegetables and resort to cheap and filling fast food thereby exposing themselves to the health risks that come with eating this food.
What is Coronary Heart Disease?
There are several heart diseases, including problems with the heart’s valves, the heart’s rhythm (or arrhythmia), or the heart’s muscles (or cardiomyopathy). However, out of all these, coronary heart disease is the most common.
Coronary arteries are blood vessels that provide oxygen and nutrients to the heart. Coronary heart disease occurs when these vessels cannot perform these functions properly.
Plaque buildup on the walls of coronary arteries, which can start as early as childhood, is what causes CHD. Further damage caused by various factors such as high cholesterol, diabetes, high blood pressure, smoking, and a sedentary lifestyle can worsen it.
Over time, plaques build up inside the blood vessels and have a fatty-waxy consistency. Plaques are made of fat, cholesterol, calcium, clotting factors, and waste products from cells. Normally, blood vessels are smooth and elastic, but plaques make them hard and narrow. As a result, less blood gets to flow through them. When the blood vessels are at this stage, they’re “atherosclerotic” or hardened.
Eventually, the plaque can get so big that it ruptures. As a natural response, the body tries to repair the wound with a blood clot. This clot can end up blocking the entire artery and halt blood flow to the heart; as a result, cutting off the oxygen supply to the heart. This state is called cardiac ischemia. It often happens when a person is eating, stressed, exerting effort or exercising, or exposed to cold. It can also sometimes occur even when a person is resting. Cardiac ischemia often leads to a heart attack or myocardial infarction (MI).
The most common indicator of CHD is chest pain or angina, and most people don’t know they have CHD until they get a heart attack. CHD can also weaken the heart over the years until the heart can’t pump blood anymore, leading to heart failure. As mentioned, some factors can make people more likely to have CHD. There are non-modifiable factors such as age, gender, family history, and genetics.
There are also modifiable factors—ones you can change by leading a healthy lifestyle. Obesity, diabetes, high blood pressure, high cholesterol, high stress, a sedentary lifestyle, and smoking are some of these factors. Because CHD is primarily related to modifiable lifestyle factors, prevention and treatment involve these factors.
The Philippine Heart Center has a short lecture about the disease.
Preventing CHD
Any doctor will tell a patient at risk for CHD: “stop smoking, moderate drinking, eat healthy, and exercise, simple as that.” But those orders are easier said than done. In an interview with the Philippine News Agency, Dr. Gino Quizon, a cardiologist at Medical Center Manila, says that "it is easier to be unhealthy, and it is such an effort to live a healthy lifestyle”. In short, lifestyle choices over the years and even decades are the main culprits to developing CHD.
It helps to adapt your behaviors to the lifestyle changes you need to do. For example, 30 minutes of exercise per day doesn’t always mean going to the gym. It can be gardening, housework, or taking the stairs instead of the elevator. There are also different ways to lower blood pressure, including getting good quality sleep and reducing stress.
Another sneaky culprit is excess sodium intake which can increase blood pressure, consequently increasing CHD risk. Simple choices like going for a “low sodium” option or not adding table salt to a meal can get a long way. Doctors recommend no more than 2.4 grams or half a teaspoon of salt per day for patients with hypertension.
It cannot be stressed enough that smoking cessation (stopping) is already a big win against CHD. The chemicals in cigarettes cause inflammation of the blood vessels, which hastes the narrowing of the blood vessels.
Presenting with severe disease
Of course, some patients can come in with a severe state of CHD. In these cases, lifestyle changes won’t cut it. Doctors will prescribe medications such as aspirin for blood thinning and preventing blood clots, statins, and other medications to lower cholesterol, and beta-blockers or other medications to control high blood pressure.
Other treatments for CHD include balloon angioplasty or stent placement, procedures where blood vessels are widened with a tiny balloon or expanded with a metal mesh coil to open the arteries and restore blood flow. Coronary artery bypass surgery or CABG is another CHD medical intervention where blocked coronary arteries are substituted with a healthy blood vessel from another part of the body.
Although these medications and surgeries are available, they can only alleviate the symptoms. In other words, they can’t cure CHD. According to Dr. Raul Lapitan, a cardiologist from Makati Medical Center, “when you have a clogged artery, the blockage will forever be there. There’s no truth to claims that drinking a particular drug or health supplement can melt plaque or cholesterol. Medicines can only prevent or lessen the chances of the cholesterol from completely blocking the artery.
Where to find help
While lifestyle changes are mostly manageable, costs for medications and surgeries can rack up quickly. CABG procedures in private hospitals can cost up to 1-2 million pesos, with the average price being Php 700,000 to 1,000,000. Thankfully, PhilHealth, private insurance companies, and public hospitals can help lower the costs.
Under PhilHealth, patients are entitled to the following case rates:
- Ischemic heart disease without myocardial infarction: Php 12,000
- Ischemic heart disease with myocardial infarction: Php 18,900
- Postprocedural disorders due to mechanical complications from coronary artery bypass: Php 10,300
- Chronic heart disease without complications: Php 4,000
Since hypertension and dyslipidemia are common comorbidities in patients with CHD, case rate benefits for these diseases can also apply. Hypertensive emergencies can reimburse Php 9,000, while diseases with high cholesterol can reimburse 6,600 Php.
PhilHealth also offers a Z-Benefits package for patients who need a CABG procedure. This package covers Php 550,000 and can be availed at the following hospitals:
- Philippine Heart Center
- Vicente Sotto Memorial Medical Center
- De La Salle University Medical Center
- Southern Philippines Medical Center.
The details and requirements for availing of this service can be found in Section IIIA here. The price for a CABG procedure at the Philippine Heart Center can be viewed here. UP-PGH also has a non-profit organization that helps indigent patients who require urgent cardiovascular procedures and interventions. Their contact details are on their Facebook page.
When it comes to medications, opting for generic drugs is an easy way to cut costs. Patients with CHD may require several medications to control various comorbidities, which means more prescribed drugs. It’s a common misconception that branded drugs are better and more effective than generics, but this was proven false. Additionally, DOH established a Hypertension and Diabetes Club, which helps to provide free access to hypertension and diabetes medicines.
There are various support groups for CHD patients, with CHD including Heart Health Foundation of the Philippines and Heart Disease Support Group Philippines. Heart Health Foundation also provides cardiac healthcare assistance for patients that can meet their criteria.
Numbers to know
It’s also important to be educated on the main comorbidities of CHD, including diabetes, hypertension (high blood pressure), and hyperlipidemia (high cholesterol). The Philippine Heart Center urges the public to Know Your Numbers:
- Blood pressure must be less than 120/80
- Blood cholesterol must score less than 200
- Blood glucose should be less than 7% for the A1C test, and less than 180 mg/dL for the after-meal blood glucose test
- BMI should be 18.5-24.9
Remember to with make healthier lifestyle choices to prevent coronary heart disease. An active lifestyle, better food choices, and avoidance of alcohol and nicotine can go a long way in improving your health.
Sources:
Beckerman J. (2021). Heart Disease: Types, Causes, and Symptoms. Retrieved from https://www.webmd.com/heart-disease/heart-disease-types-causes-symptoms
Bhargava H. (2020). Coronary Artery Disease. WedMD. Retrieved from https://www.webmd.com/heart-disease/guide/heart-disease-coronary-artery-disease
Centers for Disease Control and Prevention. (2019). Coronary Artery Disease. Retrieved from https://www.cdc.gov/heartdisease/coronary_ad.htm
De La Salle University Medical Center. DLSUMC Offers The Z Benefit Package For Coronary Artery Bypass Graft (CABG) Of PhilHealth. Retrieved from https://www.dlshsi.edu.ph/dlsumc/dlsumc-offers-z-benefit-package-coronary-artery-bypass-graft-cabg-philhealth
Department of Health. (2012). Implementing Guidelines On The Institutionalization Of Philippine Package Of Essential NCD Interventions (PHIL PEN) On The Integrated Management Of Hypertension And Diabetes For Primary Health Care Facilities. Retrieved from https://extranet.who.int/ncdccs/Data/PHL_D1_PHIL%20PEN.pdf
Department of Health. Leading Causes of Mortality. Retrieved from https://doh.gov.ph/Statistics/Leading-Causes-of-Mortality
Junio L. (2018). Heart disease still leading cause of death in PH. Philippine News Agency. Retrieved from https://www.pna.gov.ph/articles/1026785
Mayoclinic. Coronary artery disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613
Pahati-Sarne M. (2020). Coronary Artery Disease. Business Mirror. Retrieved from https://businessmirror.com.ph/2020/02/06/coronary-artery-disease/
PhilHealth. (2015). Z Package Cares for the Heart. Retrieved from https://www.philhealth.gov.ph/news/2015/zpackage_cares.html
Philippine Statistics Authority. (2000). Leading Causes of Death, Philippines: 2000. Retrieved from: https://psa.gov.ph/sites/default/files/SR%20097%20Leading%20Causes%20of%20Death%2C%20Phil.%202000.pdf
Philippine Statistics Authority. (2021). Causes of Deaths in the Philippines (Preliminary): January to December 2020. Retrieved from https://psa.gov.ph/content/causes-deaths-philippines-preliminary-january-december-2020-0
Photo: Johns Hopkins Medicine. Anatomy and Function of the Coronary Arteries. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-and-function-of-the-coronary-arteries
Photo: Mayoclinic. Coronary artery disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613
PSA: Heart diseases, cancer among leading cause of death in Philippines in 2020. (2021). ABS-CBN News. Retrieved from https://news.abs-cbn.com/spotlight/07/06/21/heart-diseases-cancer-leading-cause-of-death-2020-psa
Yee, J. (2020).Heart disease in PH worst in Southeast Asia - WHO. Philippine Daily Inquirer. Retrieved from https://newsinfo.inquirer.net/1371108/heart-disease-in-ph-worst-in-sea
