Asia's War With Heart Disease — page 3

For those who can afford it, treatment options are expanding, not just in China but worldwide. If drugs are given early enough and in large-enough doses, heart disease might even be nipped in the bud. A landmark study released in March by pharmaceutical company Bristol-Myers Squibb suggests that using drugs called statins to reduce cholesterol well below currently recommended levels could substantially reduce the risk of a heart attack. Likewise, at an Asian-Pacific Society of Cardiology conference in January, doctors repeatedly emphasized the importance of prescribing drugs, such as ACE inhibitors and ARBs, to control high blood pressure, which seems to strike many Asians to an unusual degree and which is directly linked to the region's high rate of stroke.

Some of the most promising research of this kind is being done in Asia. Scientists at the University of Hong Kong (HKU), for example, are currently working on a potentially groundbreaking treatment for heart patients who can't be helped by conventional drugs and who are too ill for surgery. Led by Dr. Tse Hung-fat, the HKU team is using stem cells harvested from a patient's own bone marrow to help restore diseased heart tissue. Clogged or damaged vessels that supply the heart with blood can't repair themselves, which is why bypass surgery is usually the best chance for many patients. But the HKU researchers have found that when the stem cells are injected into the heart muscle via a catheter, patients can develop new blood vessels to replace those that have been blocked or damaged by heart disease.

These are still early days, but some of the results have been remarkable. Before he was enrolled in HKU's stem-cell study, septuagenarian stroke victim Ho Kwong had to take 20 pills a week for his heart disease and couldn't walk more than a few steps without tiring. After undergoing stem-cell therapy, he says, "I'm able to continue my life as it was before. I can go outside with my friends, and I can sing karaoke." The cure isn't complete, because the therapy can't yet regenerate heart muscle, says Tse, but the treatment "means a lot for these kinds of patients. It's important for them in terms of quality of life."

Still, the vast majority of Asians don't have access to such cutting-edge medicine. Closer to the norm is Kaneez Fatima, a frail 45-year-old woman whose defective heart valve has meant repeated visits to the run-down rooms of Nishtar Hospital in Multan, Pakistan. Doctors there say that if Fatima doesn't receive a replacement valve soon, she will die. Her husband, Haji Mohammad Akram, who works in a local textile mill and makes $600 a year, has already sold their house to pay for his wife's medical bills. Three times he's traveled the 400 kilometers to Lahore to try to arrange an operation for his wife at a government hospital, at a cost of one month's salary for each trip, but the waiting list is too long and the red tape has proven exasperating. The procedure would cost $7,000 at a private hospital, which Akram says he can't afford: "There is no money."

That lament is familiar in hospital wards throughout Asia. With health-care resources so scarce, some experts argue that countries like India and China should focus on the persistent threat of infectious diseases, such as tuberculosis, before combating heart disease. But doctors like the World Heart Federation's Poole-Wilson say the high cost of treating people after they become CVD victims and the "double burden" of continued infectious disease is no reason to ignore the problem—it only makes it more important to focus resources on education and prevention.

Many Asians simply don't realize how dangerous heart disease can be for them. "They may be aware in a very piecemeal fashion," says Dr. Sania Nishtar, founder of Pakistan's pioneering medical NGO Heartfile, "but the concerted awareness level, the point that can make a difference, is extremely low." Gill of the International Obesity Task Force tells the story of a driver he hired during a visit to India, who said his health-care strategy was to save his money now so that he could afford the best bypass surgeon around when he had his inevitable heart attack. "I don't think it ever struck him that he could do something about it or change what could happen," Gill says.

That's the kind of skewed thinking that Nishtar is determined to change. An expert in preventative cardiology, Nishtar founded Heartfile in 1998 to promote CVD prevention among Pakistan's most vulnerable populations. In remote villages like Basti Jhandhawala near Lodhran in southern Punjab, Nishtar and her team of doctors spread basic information about cardiovascular disease to locals who quite literally wouldn't know a heart attack if it hit them.

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