Page 22 - Pakistan Link - March 26, 2021

P22 – PAKISTAN LINK – MARCH 26, 2021 COMMENTARY
n By Dr Syed Amir New Tools in Combating Heart Disease cumulated about their dispensation and safety.
Bethesda, MD Recently, based on empirical evidence, doctors

have theorized that their beneficial effects prob-
fter a leisurely round of golf on a balmy ably extend beyond what might be explained

Saturday afternoon in September 1955, simply by their ability to lower blood cholesterol.

APresident Eisenhower, the 34th presi- The most important reason for such speculations

dent of the United States, suffered a near fatal is the intriguing observation that not all heart
heart attack. Initially, his chest attacks can be explained by high cholesterol lev-
pain was attributed to stom- els. In nearly half the patients suffering a cardiac

ach upset and he was advised event, cholesterol levels are normal or below nor-
to take milk of magnesia, the mal. It has been suspected that inflammation of

standard treatment for gastric coronary arteries, through an as yet little under-
problems at the time. Even stood mechanism, is implicated in heart attacks.
when the symptoms persisted, The body responds to inflammation by releasing

his personal physician failed a protein, called high-sensitivity C-reactive pro-
to diagnose it as a heart attack since many of tein, or CRP, which can be readily measured in

the sophisticated tests, now routinely used in blood. And, fortuitously, statins are as effective
cardiology clinics, were not available then. The in reducing inflammation, as they are in reducing

president’s ailment was finally diagnosed with cholesterol levels.

the help of electrocardiography; the technique Sometime back, the results of a powerful
was just coming into use and was considered clinical study involving some 18,000 volunteers,
state-of-the-art technology. middle age or elderly men and women recruited

Having diagnosed the disease, there was lit- in 26 different countries, provided strong support

tle the physicians could do to avert the recurrence for the notion that inflammation plays a crucial
of the episode or help the president’s recovery. role in heart disease. Furthermore, the benefits

The science of cardiology a little more half a cen- of statin administration, at least in part, can be

tury ago was at a relatively primitive stage when attributed to its ability to reduce inflammation
measured by today’s standards. As was custom- in the arteries. All participants in the study had
ary, the best physicians who attended the presi- normal cholesterol, but elevated levels of CRP,
dent recommended complete bed rest and ad- the biomarker of inflammation. They were given

ministered injection of a blood thinner, heparin. a daily dose of statin, and were closely followed
Luckily, President Eisenhower recovered largely over a period of two years. At the end of this pe-

on his own, got reelected and served out a second President Eisenhower and medical personnel meet the press after his heart attack riod, it was noted that they had suffered half the
presidential term. Meanwhile, he continued to expected rate of heart attacks or strokes and had

experience periods of chest pains. He had been a diaries that he continued to experience excruci- heart disease. This decline has been attributed to 20 percent fewer deaths. The research was carried

heavy smoker all his life and continued with the ating chest pains years after he relinquished the a better understanding and control of major risk out by a team of cardiologists at several institu-

habit as no one at the time appreciated the strong reins of power and was leading a retired life in factors, such as high cholesterol, diabetes, high tions and the results were reported in the New
link between smoking and heart disease. Even the Islamabad. Apparently, his doctors had few ef- blood pressure and obesity. England Journal of Medicine, one of the world’s
role of high cholesterol, saturated fats and lack of fective tools available to treat or control his heart Cholesterol, especially low-density cho- most prestigious journals (November 2008).
exercise was not understood at the time. disease. lesterol, has received much attention in the past The authors estimate that the expanded

Life-saving surgical procedures such as by- In May 1971, he came to the United States decades because of its ability to form fatty de- use of statins in people who have elevated levels
pass surgery and angioplasty were still decades and underwent a bypass surgery procedure at posits inside the arterial walls. According to con- of CRP but normal cholesterol could potentially
away. At the end of his second term, President Cleveland Clinic, renowned for offering the most ventional wisdom, heart attacks are precipitated avert heart attacks and strokes in 25,000 people in

Eisenhower retired to his country farm near advanced treatment for heart disease. The heart when a segment of the cholesterol-laden plaque America alone. However, while the findings have

Washington, and eventually experienced a fatal muscle, however, had been so severely impaired becomes unstable and breaks away, causing blood been universally hailed as ground-breaking, they
heart attack in 1969. by that time that the former president was not clots that block the supply of blood to the heart. have also provoked a lively debate among medi-
Heart disease among the rich and famous helped by the procedure and he died on April 20, A range of drugs has been developed and widely cal researchers. Should people who are healthy
has not been uncommon. In his diaries, pub- 1974, almost six years after his first heart attack. prescribed to patients with high cholesterol lev- in every respect be tested for CRP and put on a

lished posthumously, President Ayub Khan has Treatment for heart disease has achieved els that cannot be reduced by diet and exercise. life-long regimen of powerful drugs whose po-

described the heart attack he suffered in 1968 as major advances since the days when Presidents Among these medicines, the most effective and tential side eff ects in the long run are unknown?

he was preparing to attend a banquet given by Eisenhower and Ayub Khan suffered from it. To- popular belong to a class of drugs known as There is, however, no debate about the financial

King Husain of Jordan in Islamabad during his day, almost anyone who can afford the cost can statins, which are sold under a variety of com- implications of such a practice. The testing and

state visit. In the following days, his life hung in receive excellent cardiac care in most countries of mercial names. These have proven relatively safe treatment will cost huge amounts of money at a

precarious balance. He was attended, besides top the world. Knowledge about the causes, preven- and have been credited with saving millions of time when medical costs are already burgeoning

Pakistani cardiologists, by an eminent British tion and treatment of heart diseases has grown patients from the devastating effects of heart at- in this country. The investigators are optimis-
cardiologist, Professor Goodwin. Although Ayub spectacularly during the past decades. Conse- tacks and strokes. tic that more definitive answers to these vexing

Khan survived the heart attack, he never fully re- quently, there has been a sharp worldwide de- Statins have been in use for well over a questions will emerge in the future through the
covered or regained his health. He recorded in his cline in morbidity and deaths due to stroke and decade and much valuable information has ac- work of other scientists.
n By Ziqian Cecilia Dong Germany, and Austria, is developing. This

New York tool will enable utility companies and gov-

ernment officials to identify areas that are

cross the country, policymakers are most vulnerable to extreme weather events
scrambling to protect their com- and assess the effectiveness of potential in-

Amunities from the eff ects of climate frastructure improvements.
change. Various emerging technologies can
Massachusetts Governor Charlie Baker help communities get the most out of their
proposed real-estate tax increases to fund investments. For one, microgrids -- the tiny
dam and drainage system upgrades, which electric grids that can supply a single build-

would help residents cope with floods and ing or neighborhood with electricity, usually
storms. Meanwhile, a few months earlier, of- generated from renewable energy sources.

ficials from several Florida counties agreed These distributed power sources can oper-
to work together to minimize the damage ate independently and don’t rely on miles of
caused by rising sea levels. power lines.

Adaptation efforts like these are crucial. Spending money up-front to evaluate
Four in ten Americans live in coastal areas -- adaptation initiatives saves money in the
and this population will surge in the coming long run. Consider one project in St Paul,

years. Sustained flooding can cripple homes Minnesota. Storm water runoff caused fre-

and infrastructure like roads, bridges, sub- United States experienced its most expensive tense in the coming decades. Computer quent local flooding in the Capitol Region

ways, and wastewater treatment plants. hurricane season in history in 2017 -- storms modeling and visualization tools can help us Watershed District. Officials evaluated sev-

Policymakers have limited time and caused more than $300 billion in damages. identify the weakest links and plan strategi- eral plans and decided on a strategy that
resources. So, they should rely on the latest Flooding and other damage from Hurricane cally. utilized green infrastructure and special
computer modeling and other technologies techniques like rain gardens -- in which
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to identify and implement the most efficient Protecting Cities from Rising Water shrubs and plants capture rain water. Thanks

adaptation strategies. to these improvements, flooding decreased

Rising water levels have already wrought dramatically.
Consider work by researchers at Texas
Harvey alone forced 37,000 Texans into shel-
havoc across the country. From 2000 to Harvey alone forced 37,000 Texans into shel- Consider work by researchers at Texas Communities -- both in the United

2015, coastal “sunny day flooding,” or flood- ters in September 2017. A&M University. They conducted a simula- States and worldwide -- must prepare for se-
ing caused by high tides rather than storms, Our country is losing natural defenses tion of Southeast Florida that demonstrated vere storms and rising seas. New technology

more than doubled on the Southeast Atlantic against flooding. Between 2004 and 2009, how rising seas will damage the road net- can help them invest their resources wisely.
coast, according to the National Oceanic and 80,000 acres of US coastal wetlands -- which work. It found that installing water pumps And with the right infrastructure upgrades,

Atmospheric Association. And it increased soak up flood waters -- disappeared each now would save money in the long run. communities can minimize future damages
75 percent on the Northeast Atlantic coast. year. Mangrove forests -- which help block Or take IN-SOURCE, a 3D modeling and save lives. (Ziqian (Cecilia) Dong, PhD,
Climate change is making storms more sea waters -- are also declining thanks to hu- framework and visualization tool that my is an associate professor in the Department
destructive and frequent by heating up man activity. team at New York Institute of Technology, of Electrical and Computer Engineering at

ocean waters and increasing flooding. The Floods and storms will grow more in- along with partners in the United States, New York Institute of Technology)

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