The Insider | Albert Fenech

Sitting at his desk at Mater Dei Hospital, Professor Albert Fenech calmly assesses a number of ECG results.

"Peace of mind," he says, is "the best overall recipe for a healthy heart. Then people won't need to smoke that much, or overindulge in food. People will feel peaceful enough to enjoy mother nature at its best."

Which leads me to ask the professor: what is the main cause of heart disease these days?

"There are many factors that may affect the heart badly. However, one cannot single out a cause. When we've heard the same thing over and over again about how bad smoking is, and to look after our weight, day in day out, through health campaigns and so on, it doesn't have an impact on us any longer.

"What has emerged in recent years though, is that a major risk factor of heart disease which had been ignored in the past, is stress."

Mortality rate

Asked if people were experiencing heart problems at a younger age, Fenech says that "we always have had such cases".

"Fortunately, the overall incidence of mortality from heart disease is
diminishing and has been for the past 10 to 15 years, that's part of the reason why people are living longer. We have stretched our longevity."

And are men still more prone to
suffer from heart disease than women? "Yes, except that once women reach menopause, the incidence overtakes that of men. Menopause has indicated a shift in risk for women," Fenech says.

Fat blockers

"One has to be careful to use such impressive words as fat blockers.

"There exists medication that reduces the absorption of fat into the body but I think people are being advised to stick to the traditional methods of natural medicine - such as bran and porridge - because a lot of over-the-counter medications available have undesirable side-effects, mainly flatulence or constipation.

Insulin and heart disease

Does insulin increase chances of mortality in patients, I ask Fenech? His reply is: definitely not. "Insulin has helped make a big difference to diabetics, both in terms of complications they suffer and how normal a life they can live.

"It has been one of the major breakthroughs in diabetes, since diabetics had a very short life expectancy. And this is highly relevant to us Maltese since we have a high incidence of diabetes."

Fenech insists that insulin has made a big difference to diabetics and that prior to the discovery of insulin, "diabetics had a very short life expectancy".

Aspirin use

I questioned past reports in the
media on the pros and cons of aspirin use, and despite the reports, if aspirin was still considered "a great help" in avoiding strokes/heart attacks.

Fenech said that he was glad that I had asked him this question because according to him "the media has on the whole rendered patients a great disservice.

"Aspirin has been known for years that in a small proportion of individuals, it can cause gastric bleeding, which in the vast majority of cases is low grade. This can also eventually lead to anemia. But that is promptly reversed once the aspirin is stopped.

"There is absolutely no doubt that, scientifically,  patients who are either diabetic or suffer from heart disease would benefit greatly from the use of aspirin.

"The problem arose when everyone was being prescribed aspirin irrespective of the patient's history or profile, and clearly was of no benefit to a fair proportion of patients. But when you get newspapers
publishing reports stating that aspirin is dangerous, people seem to believe the papers more than their specialists' advice and as a result stop taking aspirin. And that's when problems start to arise."

Main rules/trends

Fenech emphasises on the main rules one should adhere to avoid heart
attacks: "first of all, quit smoking," adding that "sadly, it seems that teenage girls are smoking more, while smoking among adults at least has decreased.

"We also must get out of the habit of home-car-work-car-home, and
focus on enjoying life. The worst thing of course is to walk around with all that stress packed up inside us, taking it places where it doesn't belong, such as home, or during our time off."

But what mainly stresses the heart?

"Although stress is the major factor, stress is good for us. The problem is when it becomes a chronic condition, that it starts affecting our lives negatively."

Cardiac arrest in athletes

Hearing about a healthy person
suffering a cardiac arrest still comes as a shock to us. How do we understand this, in perspective, especially in light of recent cases of 'fit' athletes dying at a relatively early age.

Fenech says that one can be healthy but unfit, and one can be fit but unhealthy.

"Fitness certainly increases your chances of keeping healthy. There are many who are fit but still smoke - or are fit physically but still lead a lifestyle that damages them.

"Now it's much more difficult to have that kind of problem, as a few years ago, athletes didn't undergo regular health checks, and people who died playing football in their 20s had a problem with their heart which today, thanks to an echocardiogram (ultrasound), can easily be diagnosed, drastically reducing the risk.

"I think it's very important that everyone tries entering the habit of doing routine check-ups, checking for conditions that don't normally make you feel unwell.

"It's common for people to visit their doctor only when they feel unwell. But if you have high blood pressure for instance, or diabetes - which are two of the main problems in our society - you aren't going to feel unwell. You are only going to find them out if you go to a GP and have your blood pressure monitored and sugar and cholesterol levels checked.

"If one does these checks every so often, he or she can determine his health situation and feel at ease. Only if one finds that he has a problem
after undergoing such checks, that he or she should start having them done more often.

"Also, it's a frame of mind thing, that when somebody is aware he's got something, this is when the problem gets bigger.

"The big issue is: just because you feel well, it doesn't mean there's nothing wrong with you. So if you want to make sure that you're in the clear, you must undergo these tests.

"Just like when you go to a dentist. We should go to a dentist regularly to prevent tooth decay. And prevention is always far better than cure - and less costly.

"It would also take a massive load off our national health service and would allow us to treat people who really need treatment."

Prevention

At what age should one start undergoing heart checks?

"People should start in their mid-20s, even for the sake of getting a sugar level, ECG, and cholesterol baseline.

"This can act as a good point of reference for specialists wishing to look up some form of history.

Brisk walking

Fenech says that walking is just as good as jogging. "Walking is safer though. At least, it doesn't traumatise your joints. You get as much benefit from brisk walking as you do jogging."

And what about yoga, can it help prevent heart ailments?

"Absolutely," Fenech says. "It helps the mind, body and soul."

How do you differentiate between pain caused by a heart attack and that caused due to gastric trouble?

"It's not possible for an individual with no medical training to execute a conclusion. So if you have a pain, before you decide its due to old age, indigestion, being unfit, one should consult a doctor. By that, I don't mean everybody should come to Casualty because that would be the wrong thing to do.

"Just simply consult your GP, and only if the GP is concerned, than you are referred to Casualty."

Hereditary conditions/emotional problems

Marriages within close relatives can lead to heart problems for the child. Is this true?

"Marriages with close relatives can lead to all sorts of problems for a child, not only with the heart but the whole system."

When asked whether the consumption of tea and coffee could add to the risk factor, Fenech said that when taken in moderation it's fine - but if consumed excessively, it may lead to problems, like palpitations.

Fenech also pinpoints emotional problems as being a major factor of heart problems.

In fact, according to Fenech, there's a condition - which was only recognised over the past 15 years - called the Broken Heart Syndrome. This occurs especially when a person goes through an acute emotional and stressful situation.

Sedentary lifestyle

 "A sedentary lifestyle is not ideal, but if it moves at a happy rhythm, it can at least mitigate some of the negative effects," Fenech says.

On organic food consumption, Fenech thinks that it can be good for us in theory but in practice not so much, following doubts cast in the past on some of GM's products.

Statins

A top cardiologist recently argued we should dial back on statins due to diabetes risk.

"I think that if you look at the benefits that statins have had on diabetics, one has to take that into consideration on assessing the risks.

"Nowadays, if one is diagnosed as diabetic, he or she would likely be given statins and aspirin as well as anti-diabetic medication."

First aid

Fenech offers up some direct advice when it comes to emergency and
first aid.

"Go straight to hospital, as quick as possible, don't bother phoning a doctor, just get down to getting to a hospital though."

Is vigorous coughing good on sensing symptoms of a heart attack?

"This is an unsubstantiated theory that has unfortunately gained ground on the internet. There is little scientific evidence to support this theory, other than the fact that when somebody's heart stops you get them to cough, but you don't know when your heart stops until you faint."

Smoking

In the hope of some consolation, as a smoker, I ask Fenech if smoking really is as bad as it's propped up to be.

Fenech says: "Well, if you smoke for pleasure it's one thing, but if you smoke out of addiction, it's a
another."