Caylen Lorick, 17044172
( Question b)

Lunga Simba, 16199813 
(Question d)

Anani Mboyi, 16203365 
(Question e)

According to the Heart and Stroke Foundation South Africa, 225 South Africans are killed by heart diseases every day.¹ The intervention that we have chosen is the Heart Mark programme. The Heart Mark logo can be seen on various food products.

Heart Mark has partnered with food manufacturers to make foods healthier. The Heart Mark is found on foods lower in salt, lower in sugar, lower in saturated fats, and higher in fibre.¹ To reduce the risk of having cardiovascular complications one should decrease the amount of sodium and cholesterol in their diet.²

The endorsement program is an effort to decrease the number of deaths in South Africa from preventable heart disease and stroke.

For example – Flora Pro.Active aims to resolve and/or reduce the occurrence of cardiovascular disease(CVD) specifically coronary heart disease(CHD) due to elevated levels of cholesterol subsequently reducing the number of cases of atherosclerosis/arteriosclerosis.³

How big is the health concern in South Africa and/or globally?

CVDs are the primary cause of global death: more people die yearly from CVDs than from any other cause.⁴

Approximately 17.7 million people died from CVDs in 2015, constituting 31% of all deaths globally. Of these deaths, an estimated 6.7 million was due to stroke and 7.4 million due to CHD.⁴

Above 75% of CVD deaths occur in low- and middle-income countries.⁴

Out of the 17 million premature deaths (below the age of 70) due to noncommunicable diseases in 2015, 82% are in low- and middle-income countries, and 37% are caused by CVDs.⁴

There are various causation factors that are related to coronary heart disease.

Predisposing factors that play a role: 

●        Age – The risk of developing heart disease increases with age.  Men and women over the ages of 45 and 55 respectively, are at an increased risk of such a disease.⁵

●        Gender – This disease affects more men than women. The time when women are at a risk is after menopause, when their bodies secretes less oestrogen, this causes their LDL cholesterol to rise and the HDL cholesterol to drop. These changes in cholesterol makes women more susceptible around these times.⁵

●        Family history – People who are at an increased risk are those whose immediate family members are diagnosed before the age of 55. The risk increases if male members (brother or father) were diagnosed. ⁵

Reinforcing factors that play a role include:

●        Cigarette smoking – Smoking decrease HDL cholesterol levels which in turn elevates the chances of developing atherosclerosis, blood clots and damages blood vessels.⁵

●        High blood pressure – Everyone in three people is said to have high blood pressure. Blood pressure above normal limits increases the chance of developing coronary heart disease. ⁵ 

●        Abnormal levels of blood lipids – If one has a high number of triglycerides (above 150 mg/dL) in their blood, their coronary arteries narrow. Previously, high levels of triglycerides were only considered a problem if the levels of HDL cholesterol were low, however, modern research revealed that this is no longer the case. High triglycerides still pose a big risk regardless of the level of HDL in one’s blood. Therefore, it is advised that individuals over the age of twenty should have a lipid profile test every five years to increase awareness of this rising health hazard. ⁵

●        Obesity – More than 50% of adults in the USA are obese. Obesity is directly related to coronary heart disease. ⁵

There is an increasing number of ongoing investigations with regards to the development of cardiac disease and most of these studies attribute to the disturbances in the balances of triglycerides, cholesterol and lipoproteins metabolism. Cardiovascular disease is one of the top causes of mortality nationwide, therefore many lifestyle, dietary and pharmacological interventions have been put in place as an attempt to combat and help maintain lipid and lipoprotein homeostasis. There are safe, cost effective interventions that help individuals manage their lipoprotein and lipid level. Some of these include the development of foods containing functionally active ingredients which are beneficial to the reduction of cholesterol. The studies done on these products support their claims to ultimately reduce the risk of cardiovascular diseases.⁷

We have selected an intervention to help curb these distressing factors that have become more and more common.  

●        In 1999, the Flora pro-active margarine was launched, with the claims to absorb cholesterol in the body by engaging the active ingredient plant sterols and incorporates omega 3 fatty acids and stanols enriched foods. This product has other health benefits as well such as vitamins b6 and b12 and is high on polyunsaturated fats.⁶

I can advise people to stop consuming butter which is made from animal fat and substitute this with margarine, e.g. flora, which contains less saturated fats and more unsaturated fats.

I can also try to convince my friends to exercise regularly. Experts recommend 30 minutes of moderate exercise a day.³ 

As medical students we can use this as a form of prophylaxis and practise for our future career as this will allow us to engage with people.

Most CVDs can be prevented by resolving behavioural risk factors such as smoking, poor diet and obesity, physical inactivity and excessive use of alcohol using population-wide programmes.⁴

People with CVD or who are at high cardiovascular risk (due to the presence of one or more risk factors such as hypertension, diabetes, hyperlipidaemia or already established disease) need early detection and management using counselling and medicines, as appropriate.⁴

A recent Hopkins study found that normal weight doctors are more prone to advise their patients about obesity, body mass index and weight loss than those who are themselves overweight.⁸ 

This study proves that doctors should lead healthy life styles not only to increase their quality of life but to be a good example for their patients. I would promote healthy living by encouraging my patients to have nutritious diets and exercise regularly.

2. Ibrahim H, Manohar P. Systemic Arterial Hypertension and Antihypertensive Drugs. In: Elmoselhi A. eds. Cardiology: An Integrated Approach New York, NY: McGraw-Hill; [cited 2018 22 April]. Available from Access Medicine: http://accessmedicine.mhmedical.com.uplib.idm.oclc.org/content.aspx?bookid=2224&sectionid=171661773

3. Flora Pro.Active [Internet]. Lowering your cholesterol with Flora pro.active [cited 2018 April 22] available from: http://www.floraproactiv.co.za/proactiv/lowering-your-cholesterol-with-flora-proactiv/default.aspx

4.  World Health Organization [Internet]. [cited: 2018 April 22] Available from: : http://www.who.int/end-childhood-obesity/facts/en/

5. Coronary heart disease. Hopkins Heart.2008; 1-14

6. Flora And Bannerol Case Study: Obtaining Customer Loyalty In Cholesterol-Lowering Products [internet]. London: Marketline, a progree digital media business; 2007. Available from: http://www.marketlineinfo.com  

7. Novel Functional Foods and the Metabolism of Plasma Lipids and Lipoproteins: Special Emphasis on Cholesterol. CHOLESTEROL. 2010 Jan 01

8. Russel C. Doctors, Practice What You Preach. The Atlanta. 2012 June 12.