Heart Disease Second Leading Cause of Death in Taiwan  

Despite the wide availability of fitness facilities, most Taiwanese still do not exercise on a regular basis. Photo: Matthew Fulco

Lack of exercise and poor diet are among the main reasons for the prevalence.

Last year my family and I moved into an apartment building with a small gym. There are treadmills, an elliptical trainer, an exercise bike, and dumbbell sets – enough equipment for a full workout.

It’s almost like having a private gym in my home. Even at peak times for gym use like early evening, I rarely have to share the space. In an 11-story building with multiple apartments on each floor, there are just a handful of people who use the fitness center.

As it turns out, my experience is not unique. A 2015 survey by the Health Promotion Administration (HPA) under the Ministry of Health and Welfare found that 76% of Taiwanese don’t get enough exercise. The World Health Organization (WHO) recommends at least 150 minutes a week of moderate physical exercise or 75 minutes of vigorous physical activity.

Physical inactivity is a top risk factor for heart disease, the No. 2 cause of mortality in Taiwan after cancer. In 2016 nearly 21,000 people died of cardiovascular disease in Taiwan, according to government data. The heart disease mortality rate rose 0.37% that year.

Heart attacks are responsible for most deaths caused by heart disease. The primary risk factors for a heart attack are elevated blood pressure (hypertension), blood lipids (lipidemia), and blood sugar (hyperglycemia), as well as high cholesterol.

A heart attack occurs when the flow of blood to a heart muscle is obstructed, depriving the heart of oxygen and nutrients. Plaque, a buildup of fat, cholesterol, and other substances, causes the blockage.

Despite awareness that physical activity is important for a healthy heart, “most Taiwanese don’t exercise,” says Lin Jiunn-Lee, president of the Taiwan Society of Cardiology and a cardiologist at National Taiwan University Hospital. “It’s a cultural problem. Physical activity isn’t a big part of our education system so most people never develop good exercise habits when they’re young.”

Lack of physical activity raises the risk of high blood pressure and diabetes, conditions which can ultimately lead to cardiovascular disease (CAD), Lin notes. Regular exercise reduces heart disease risk by controlling cholesterol and blood pressure, regulating blood sugar, and helping people stay at a healthy weight.

Some cardiologists say that regular exercise boosts the number of smaller blood vessels that connect various coronary arteries. If an obstruction occurs in one of the major coronary arteries, those blood vessels can serve as an alternate route for blood supply to the part of the heart muscle most susceptible to a heart attack.

The contemporary diet could be another factor contributing to the prevalence of cardiovascular disease here, says Kevin Chueh, MSD’s regional director of medical affairs for Asia-Pacific and China. Home-cooked Taiwanese food, which tends to use small amounts of oil and include plenty of greens, is not the problem. Rather it’s the “frequency of eating out” by Taiwanese, he says. “They seldom cook for themselves.”

Fried foods, which are popular in Taiwan as snacks, often contain trans fats that raise the amount of bad cholesterol in the blood, increasing the risk of heart disease. Photo: Matthew Fulco

Indeed, the prevalence of low-cost mom and pop eateries means that it’s often more economical to eat out – or bring back take-out – in Taiwan than to cook. The affordability and convenience of restaurant food are attractive given people’s limited time and incomes.

But Taiwanese restaurant food is often unhealthy, especially dishes served at banquets. Banquet dishes are almost entirely meat and starch-based, with just a smattering of vegetables. Ahead of the recent Chinese New Year holiday, the Taipei Department of Health urged residents to forego feasting on meat and seafood, suggesting that they instead eat vegetables, fruits, and other foods rich in fiber.

Controlling heart disease

The first line of defense against heart disease is to alter unhealthy lifestyle habits, Lin says. It would be a good idea to start early on – in childhood. That won’t be easy though. More than five years ago, the Child Welfare League Foundation said that weak physical education programs at schools reduce children’s motivation to exercise.

There hasn’t been a marked improvement since. In a May 2017 article published in PLOS One, a peer-reviewed scientific journal, Taiwanese researchers wrote: “The Taiwanese public has been encouraged to increase their participation in recreational sports for decades; however the results to date have not been outstanding.”

Hopefully, better public education about the health benefits of exercise will change people’s attitudes. The researchers point out that Taiwanese who do moderate-intensity exercises like fast walking for 15 minutes a day or 92 minutes a week live three years longer and have a 14% lower mortality rate than their sedentary counterparts.

Meanwhile, there are treatment options for Taiwanese adults with cardiovascular ailments, such as medication to control blood pressure. New medications are in the pipeline as well. MSD’s Chueh notes that ertugliflozin, a new drug developed by MSD and Pfizer to treat diabetes, has been approved by the U.S. Food and Drug Administration. It is a sodium glucose cotransporter 2 (SGLT2) inhibitor that promotes the expulsion of excess blood sugar from the body through urine. By lowering a person’s blood sugar, the drug can help to reduce the risk of heart attack and stroke.

MSD previously developed a drug called anacetrapib to reduce the risk of serious cardiovascular disease. Anacetrapib works by inhibiting the cholesterol ester transfer protein (CETP) and boosting levels of “good” cholesterol (HED) in the blood. MSD ultimately abandoned anacetrapib after its modest performance in a clinical trial of 30,000 patients. Those patients had a 9% reduced risk of a major coronary event compared to those who did not take anacetrapib.

Medical device makers also see opportunities to control heart disease. In a February report, the Virginia-based Electrochemical Society notes that a research team from National Tsing Hua University and National Cheng Kung University has developed a portable sensor device able to measure C-reactive protein (CRP) in the blood. Elevated CRP levels indicate inflammation that may be linked to coronary disease.

Alerting users to high CPR levels “could be potentially life-saving,” the Electrochemical Society says. The benefits would be greatest for people experiencing “silent” heart attacks, coronary failure that occurs without typical symptoms like intense chest pain, sudden pain in the arm, shortness of breath, and dizziness. Silent heart attacks account for 45% of all coronary failure, according to Harvard Medical School.

Since the Taiwanese researchers’ device measures “specific cardiac markers in the blood” in real time, it can alert users that they are having a silent heart attack even if they have no obvious symptoms. Medical personnel who arrive on the scene can also use the device to accurately diagnose patients.

It is uncertain when the device will be available commercially. Wang Yu-lin, a professor at National Tsing Hua University and a member of the research team, told the Electrochemical Society that he and his colleagues “are collaborating with hospitals and industries, and trying to make this device become a real product.”

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