Heart disease has become the number one killer in Pakistan over the last two decades. Cardiologists in many urban centres are alarmed by the increasing number of young people, those as young as 30 or 40, who have heart attacks. While many factors contribute to the rising incidence of cardiovascular disease in this country, obesity is among the most critical and fastest-growing.
There is no question that obesity is a factor. The question is how well it contributes to the increased incidence of cardiovascular disease throughout the country.
The Growing Burden of Obesity in Pakistan
Since the last 10 years, there has been a continuous increase in the number of Canadian adults and children who are considered person of higher weight. The rate of urbanisation, change in lifestyle (less exercise), processed foods and sugar, and long hours of work have dramatically altered the way we live our lives. Fast food has taken over much of the role formerly filled by traditional home-cooked meals.
Obesity is not just an appearance issue; it is a condition of the body in which the excess body fat interferes with the normal metabolic processes of the body. Obesity can also result in increased blood pressure, a greater risk of elevated blood cholesterol levels, and can cause insulin resistance. Each one of these increases an individual’s level of risk for a heart attack, and when three of them are combined, the level of risk is further increased.
How Obesity Leads to Heart Attacks
A heart attack occurs when blood flow to part of the heart muscle is blocked, usually due to a clot forming in narrowed coronary arteries.
Obesity accelerates this process in several ways:
1. High Blood Pressure
Excess weight forces the heart to pump harder to circulate blood. Over time, this strains the arteries and damages their lining.
2. High Cholesterol
Obesity is often associated with increased LDL cholesterol and triglycerides, which contribute to plaque buildup in arteries.
3. Type 2 Diabetes
Pakistan has one of the highest diabetes rates globally. Obesity is a major driver of insulin resistance. Diabetes further damages blood vessels and significantly increases heart attack risk.
4. Chronic Inflammation
Excess body fat promotes low-grade inflammation in the body, which contributes to arterial damage and clot formation.
When these risk factors cluster together, the likelihood of a cardiac event rises sharply.
Why Heart Attacks Are Happening at Younger Ages
Doctors in cities like Karachi, Lahore, and Islamabad increasingly report younger patients presenting with acute coronary syndromes. Several patterns stand out:
- Early weight gain beginning in adolescence
- Limited physical activity
- Smoking combined with obesity
- High stress levels
- Poor routine health screening
When obesity begins early in life, arteries are exposed to risk factors for longer periods. This accelerates atherosclerosis, making heart attacks possible at a much younger age than seen in previous generations.
The Role of Obesity?
It’s a well-known fact that obesity is a significant risk factor for various diseases; however, it is not the only factor contributing to disease.
Below are some other major contributors:
- Genetic factors (family history and genetic composition)
- Smoking
- Stress and lack of sleep
- Environmental pollutants
- Untreated high blood pressure
Though obesity is often the main connection between multiple risk factors. For instance, obesity increases the risk for developing diabetes and hypertension and both of these have independent, high predictive values for heart attack.
What Are the Challenges to Our Public Health Systems?
One of the largest barriers to addressing these issues in Pakistan is a lack of public education. People don’t consider being a person of higher weight a medical issue until they develop health problems. Preventive assessment of cholesterol, blood glucose, and blood pressure is rarely part of a typical health care plan.
Most people receive their health care from medical professionals in an emergency or when they are already sick instead of through a preventive health care system. Without population-level approaches to address obesity, the incidence of heart attacks will not decrease.
What Needs to Be Done?
Individuals need to take responsibility for decreasing their obesity by making healthy food choices, exercising regularly, and having routine medical check-ups.
Policymakers can also help residents decrease their rates of obesity by:
- Educating the public about healthy versus unhealthy food choices
- Regulating the marketing of unhealthy food products
- Promoting physical education within elementary and middle schools
- Providing community-based screening for cardiovascular risk factors
Any amount of weight loss can significantly decrease blood pressure, improve cholesterol levels, and reduce the risk of developing diabetes.
