Lack of knowledge hinders heart patients from eating well

A survey of Mater Dei patients who had underwent an angioplasty and similar interventions due to heart disease, were failing to adhere to lifestyle changes such as kicking their smoking habit, eating better, and taking up exercise.

Cardiology-registered nurse Justin Lee Mifsud, who presented the conclusions of the ‘Patient Adherence to Cardio-protective lifestyle Interventions’ (PACI) study at London’s St Mary’s Hospital, described the findings of his survey as ‘disappointing’.

Of 193 patients he interviewed during 2012 and 2013 at Mater Dei Hospital, 31.6% of patients smoked cigarettes, while 30.6% were adhering to physical activities as per guidelines, 36.3% were consuming five fruits and vegetables per day, and 9.8% were consuming three portions of oily fish per week.

“Total cardio-protective lifestyle adherence rate to all goals resulted in only 52.5%,” Mifsud said. “A large proportion of Maltese patients with prevalent coronary heart disease do not achieve the lifestyle for secondary prevention… there is still considerable potential to improve the standards of preventive cardiology to reduce the risk of coronary heart disease events and mortality in Malta.”

In Malta, ischemic heart disease is the leading cause of death, account for 21% of total mortality, with 319 male deaths and 328 female deaths in 2010, showing a decrease of 47 male deaths and an increase of 19 female deaths over the previous year.

Maltese post-PPCI patients are more likely to avoid smoking rather than to engage in aerobic physical activities and consuming a healthy diet. PPCI – percutaneous coronary intervention – is commonly known as an angioplasty, a non-surgical procedure to treat narrowed heart arteries.

“The findings revealed that a number of patients fail to adhere to cardio-protective lifestyle measures. In fact, the total average rate of cardio-protective lifestyle adherence to all seven goals – not smoking, physical activities as per guidelines, consuming five fruits and vegetables per day, consuming three portions of oily fish per week, avoiding high salt, sugar, saturated and trans-fats – amounted to only 52.5%,” Mifsud said of his survey results.
He said the “undesirable results” were similarly reported in various other studies, and that while over 78% will stop smoking, only 30.6% take up exercise and only 51% consume a healthy diet.

Quitting – exercising – eating better

A large proportion of patients (68.9%) reported that they were smokers prior to their cardiac event for at least 37.5 smoking years.

Out of these, 31.6% stated that they still smoked following their cardiac intervention, with an average number of 13 cigarettes per day. Of those still smoking at interview, 90.5% (or 42) reported that they ‘really tried quitting’.

“The fact is, that in patients who have been smokers and experience an atherosclerotic cardiac event, quitting reduces the risk of a recurrent cardiac event by up to 50%, yet the present study revealed that up to 31.6% of the Maltese post-PPCI patients, are currently smoking with an average number of 13 cigarettes per day,” Mifsud said.

69.4% considered themselves to be physically active – but only 30.6% were actually exercising five times a week.

As for food, in all 29%, 32.6% and 25.9% were consuming foods high in salt content, saturated and trans fats, and sugar content – respectively. Moreover, 36.3% stated that they were getting the daily recommended intake of fruit and vegetables and 9.8 % the recommended weekly intake of oily fish.

“They are not following a healthy diet. The fact that 40.4% reported having an inability to understand food labels and 34% having inabilities to estimate portion sizes, makes it more likely that Maltese patients are consuming foods high in salt, fat and sugar, such as ‘ham, bacon, sausages, table salt, fatty meats, fatty cheeses, puff pastries, fried food, Soft drinks, cakes and biscuits’,” Mifsud, citing examples used at interview.

“If Maltese PPCI patients will not change their dietary habits, weight improvement is unlikely to happen,” Mifsud said, citing the low intake of oily fish.

Mifsud said Mediterranean diet food items were more costly, especially fish. However, although low income was the second most recognized barrier amongst the Maltese PPCI patients, there was no significant association with low adherence to oily fish, and fruit and vegetables.
“Other factors are putting Maltese PPCI patients in difficulty to adhere to a diet low in refined sugar, salt, saturated and trans saturated fats while increasing the daily consumption of fruit, vegetables and oily fish. Indeed it seems that the Maltese post-PPCI patients are not following the typical Mediterranean diet, despite Malta’s central location in the Mediterranean sea. This could be due to the globalization which has taken place along the years, conditioning the Maltese to abandon the traditional healthy Mediterranean diet,” Mifsud said.

Mifsud suggests that it is lack of knowledge on the dangers of high trans and saturate fats in foods, that post-PPCI Maltese patients suffer from. “Similarly, in the European Prospective Investigation into Cancer and Nutrition (EPIC), it was found that a high consumption of meat and fats and a low consumption of olive oil and fish were inversely correlated with educational level.”

Mifsud estimated that if Maltese PPCI patients had to fully adhere to smoking cessation, adequate physical activities and food habits, “a large number of recurrent cardiac events could be prevented, reducing tertiary healthcare costs. In return, more financial budget could be made available for preventive cardiology programmes.”