Like every morning, Joaquim Figueroles left the house to go get the newspaper and read it in peace. But on that day in 2022, this 69-year-old retired teacher couldn't dedicate time to his favorite ritual. “I noticed a pain in my chest and I was drowning a little,” he recalls. For this reason, he went to his Primary Care Center in La Bisbal d’ Empordà (Girona) and, after a normal electrocardiogram, returned to his house with a future appointment for the cardiologist.
However, a while later he felt much worse again and went straight to the hospital. “When I was halfway there the pain became unbearable. “I thought it wasn't coming,” he recalls with serene emotion. The diagnosis they gave him was definitive: two clots were detected in two coronary arteries. Since that day, Joaquim joins the extensive list of people affected by diseases of the circulatory system, whose prevalence reached, in 2019, 9.8% of the population in Spain, as published by the Ministry of Health.
Cardiovascular diseases are a particularly silent chronic disease. And until we reach a heart attack, our body can experience a silent process and, for many patients, they do not present significant symptoms. This is what can happen with atherosclerotic cardiovascular disease (ASCVD). Atheromatous plaque can constantly accumulate in our arteries, which causes the wall of the coronary artery to thicken and, consequently, blood flow to be obstructed.
“This can grow without us knowing anything. The problem is when the plaque ruptures or erodes unexpectedly and is complicated by thrombosis. Then the artery can suddenly become clogged and cause anything from sudden death to an acute myocardial infarction,” explains Dr. Xavier García-Moll, clinical head of cardiology at the Hospital de Sant Pau. ASCVD is the leading cause of heart attacks and strokes, and causes 85% of deaths related to cardiovascular diseases worldwide, according to the World Health Organization (WHO).
In fact, more than 50% of Spaniards have two or more cardiovascular risk factors. Until before having the heart attack, Joaquim had not been aware that he was suffering from any cardiovascular ailment, nor that his life was in danger. He had had a previous episode of pain in his chest and arm, but, since he had been painting, he attributed those discomforts to his physical work. “After having had the heart attack I did relate them to him,” Joaquim admits, regretfully.
For Dr. García-Moll, whenever we talk about the causes of cardiovascular diseases, we must refer to the so-called risk factors, many of them modifiable unlike age or sex. The main ones are high blood pressure, diet, hypercholesterolemia, obesity, tobacco consumption and diabetes mellitus. “We are increasingly sedentary: we eat more than we used to and we move less,” the doctor points out. The main warning to the population is that leading an unhealthy lifestyle can lead to cardiovascular pathology. By eliminating risk factors that can be changed and properly controlling those that cannot be changed, your chances of developing heart disease can be reduced.
Since he was little, Joaquín had had lung problems, but that did not stop him from playing soccer or riding a bicycle when he was young. Now older, he walked a lot. He only drank a couple of beers a week, although he does admit that he started smoking when he was a child. “At the age of thirteen or fourteen I was already smoking like a carter, although I couldn't swallow the smoke and I gave it up after the military,” he admits. In fact, his habits or his diet never made her think that he could be affected by a heart attack.
On the other hand, the last year before that event, Joaquim had very high LDL-C values, known as bad cholesterol. Control of LDL-C levels is essential to prevent the formation of atheromatous plaques and reduce the risk of future cardiovascular events. For this reason, his family doctor recommended that he stop eating foods that could be harmful to him.
“They advised me to be strict with my diet and eliminate everything that could raise my cholesterol level,” says Joaquim. “Once I had a heart attack, the cardiologist told me that my cholesterol should always be at very low levels,” he says. In fact, people who have had a heart attack should have an LDL cholesterol level less than 55 mg/dl, according to the recommendation of clinical practice guidelines.
The medical message is strong: cardiovascular diseases can be prevented if we follow some medical recommendations and incorporate them into our daily lives. “There are studies that show reductions in mortality simply if we move and walk more,” says the cardiologist at Hospital de Sant Pau. Other measures available to everyone are “modifying your diet, which is not that difficult and does not mean going hungry. And if we must have a treatment, follow it. No matter how good it is, if I don't take it, it won't have any effect on me," the doctor warns.
In preventing a heart attack, both to avoid having it for the first time and to avoid repeating it, it is essential to apply all the dietary measures prescribed by the doctor. “It's the easiest thing to say, but also the hardest thing to do,” the doctor acknowledges. The key is to combine treatment and some basic advice such as limiting or prohibiting salt consumption if you have hypertension, eating fewer calories and doing more physical activity. "Whoever manages to modify his lifestyle will be very adherent to the treatment, that is, he will take it and have a better prognosis," says the cardiologist.
After the heart attack, Joaquim signed up for a three-month cardiac rehabilitation service, in which several days a week he did scheduled exercises, received nutritional advice and talks on how to eat correctly. “This was very good for me to recover,” he admits. Today, Joaquim leads a life that is as active and calm as possible, and follows a diet and treatment according to his condition. He used to put salt in his food, but now he doesn't do it anymore, and he hardly eats red meat. He has also given up sausages and sweets. In addition, he walks forty-five minutes a day, goes up and down stairs, and knows how to deal with worries.
For this retiree from Bisbal d’Empordà, stress and little sleep could also have taken their toll. “I am a restless person who suffers. Sometimes you have the intuition that things can happen in the family and you anticipate events that later do not happen,” he confesses. “Over the years you learn to distance yourself from what you can't fix,” he adds calmly. He now goes to sleep thinking that the next day everything will be different, while still being aware that he must do everything in his power for the sake of his health.
A patient who has suffered a recent heart attack should know “that what they have had has been serious and potentially fatal,” says the cardiologist. “There are many people who think that they enter the hospital, everyone runs and in 24, 48 or 72 hours they are home again. But the heart attack could have taken them away,” he warns. What's more, having gone through it does not free them from suffering another similar episode in the future, but in this type of case the risk is even greater. Hence, taking measures to anticipate any scenario is vital.
“For someone to come to us, cardiologists, is a failure of prevention,” explains Dr. García-Moll. To prevent this from happening, primary care is key. “In general, health systems are too dedicated to disease and should be dedicated to health, that is, to promoting health instead of treating disease,” comments the specialist.
“When you go to the hospital, you receive first-class treatment. But you need an overview and only your family doctor can give you that. “It is a pillar of healthcare,” says Joaquim, who has had no trouble assuming that his condition as a patient is for life. After what he has experienced, he has realized, even more so, that the most important things are the little things in everyday life, along with family and friends. “To people who have suffered a cardiovascular incident, I would tell them not to be afraid,” he says, optimistically, although the shine in his eyes gives him away. His formula is as simple as it is effective: “we can avoid it by not making the same mistakes.”
