Ischemic Heart Disease: A Public Health Concern in the South Pacific

Non-communicable diseases (NCDs) continue to plague the South Pacific, accounting for most of the mortality rates in the region [1]. Of the top NCDs responsible, cardiovascular diseases, in particular, ischemic heart disease, has been listed as one of the leading causes of death among Pacific Island Countries and Territories (PICTs) [1]. This has led to a growing concern that if this public health burden is not properly addressed, the negative impact might not only influence the health of individuals but also take an economic toll on each country [2].

Ischemic heart disease, also known as coronary heart disease or coronary artery disease, is a term given to heart problems that are caused by the narrowing of arteries that supply the heart’s muscles [1]. It is often caused by atherosclerosis, the build-up of plaque in blood vessels, but can also be due to a blood clot or vascular constriction (i.e. constriction of blood vessels) [1]. When blood and oxygen supply to the heart muscle tissues (myocardium) is completely blocked, it can result in the death of myocardial tissues, or heart muscle tissues. This is called a myocardial infarction (MI) or, more commonly, a heart attack [1].

In cases where narrowing of the arteries is less than 50%, symptoms are usually absent, however, symptoms do develop the more atherosclerosis progresses [1]. Exercise or heightened emotion may also cause symptoms due to the increased demand for oxygen [1].

Given that the early stages of ischemic heart disease is almost asymptomatic, it is important that at-risk patients screen themselves at health centers regularly. Dr. Vishal Gupta, speaking of patients at Papua New Guinea, said that oftentimes, patients presented themselves with “full-blown, multiple blocks”, with most of them needing heart by-pass surgery [2].

Siaki and Loescher also asserted that most Pacific Islanders incorrectly perceived their risk of cardiovascular disease [3]. Since perceived risk is an important factor in health behavior change theories, they suggested that more research and funding would help identify socioculturally appropriate interventions which would help promote accurate risk perceptions among the group [3]. This is really concerning since cardiovascular diseases, including ischemic heart disease, are among the leading causes of premature death in the South Pacific region [4].

In 2020, an article was published documenting the burden of disease in 204 countries and territories [2]. This article showed that in 2019, ischemic heart disease was one of the leading causes of death in several of the Pacific Island Countries and Territories. For instance, in Papua New Guinea, the Solomon Islands, and Nauru, it was ranked first overall for that year; in Fiji and Tonga, it ranked second [2].

Common risk factors of ischemic heart disease that were listed included: smoking, excessive alcohol consumption, fatty foods, and excessive carbonated soft drinks [5], [2]. All of such practices being very common in low- and middle-income countries such as in the South Pacific.

According to another article, the burden of non-communicable diseases in Fiji were so influential on the population, accounting for over 80% of deaths annually, that any small increase in the NCD mortality rate would have a significant increase in the economic burden of the country [6].

As stated above by Siaki and Loescher, one of the major challenges would be changing the perceptions of how Pacific Islanders viewed their risk of cardiovascular disease [3]. This can be undertaken by governments, NGOs, and individuals pushing for a preventative agenda, instead of just a curative approach when symptoms worsen [6].

Individuals can also help mitigate the problem by changing lifestyle behaviors such as a healthier diet, regular exercise, and avoiding harmful substances such as tobacco and alcohol [6]. In addition, the government could also encourage healthful practices by subsidizing healthy foods and drinks, while simultaneously heavily taxing harmful substances [6]. Businesses could also promote healthful activities as teambuilding exercises [6]. Overall, if such recommendations are carried out, they should not only help each individual but also positively influence the economy of the country.

References

[1] G. 2. D. a. I. Collaborators, "Global burden of 369 diseases and injuries in 204 countries," Global Health Metrics, vol. 396, no. 10258, pp. 1204-1222, 2020.

[2] S. S. Chand, B. Singh and S. Kumar, "The economic burden of non-communicable disease mortality in the South Pacific: Evidence from Fiji," PLoS ONE, vol. 15, no. 7, 2020.

[3] I. o. M. (. C. o. S. S. C. D. Criteria, "Ischemic Heart Disease," in Cardiovascular Disability: Updating the Social Security Listings., Washington DC, National Academies Press (US), 2010.

[4] G. A. Salmang, "Coronary Artery Disease On The Rise In PNG, Says Dr Gupta," Post Courier, 9 May 2019. [Online]. Available: https://postcourier.com.pg/coronary-artery-disease-rise-png-says-dr-gupta/. [Accessed 6 June 2021].

[5] L. A. Siaki and L. J. Loescher, "Pacific Islanders' perceived risk of cardiovascular disease and diabetes," Journal of transcultural nursing: official journal of the Transcultural Nursing Society, vol. 22, no. 2, pp. 191-200, 2011.

[6] "Coronary heart disease," NHS, 10 March 2020. [Online]. Available: https://www.nhs.uk/conditions/coronary-heart-disease/. [Accessed 6 June 2021].