Heart disease is the No1 killer in adult men and women, according to the World Health Report published by the World Health Organisation.

Heart disease had long been the second-most common cause of death in Hong Kong. According to statistics provided by the Hong Kong Department of Health, more than 60,000 hospital admissions in 2000 were for heart disease. In 2002, 4,969 deaths were caused by heart disease, accounting for 14.5 per cent of all deaths in Hong Kong. Coronary heart disease was the most dominating component of heart disease deaths (67.6 per cent).

Coronary heart disease is caused by the cholesterol layers depositing on the inner walls of coronary arteries. This narrows the lumens of the arteries, diminishing the blood supply to cardiac muscle and causing a heart attack.

Tse Tak-fu is honorary clinical associate professor of the department of medicine at the University of Hong Kong, and a registered specialist in Cardiology of the Medical Council of Hong Kong. He is also president of the First Global Conference on Cardiovascular Clinical Trials and Pharmacotherapy 2004.

The conference will be held next month in Hong Kong and is jointly organised by the International Society of Cardiovascular Pharmacotherapy, the World Heart Federation and the Hong Kong College of Cardiology.

According to Dr Tse, coronary heart disease is becoming more common in Hong Kong because of the ageing population. Industrialisation is another factor. People are eating diets higher in fat, salt and cholesterol, living a highly stressed life and exercising less.

Many people believe heart disease is a male affliction. However, this is not exactly the case. Women do develop heart disease about 10 years later than men, but at around 60, they begin to catch up.

According to the report 'Women and Heart Disease' published in the Yale University School of Medicine Heart Book, before menopause the female hormone estrogen that regulates menstruation protects women against heart attacks. Estrogen increases high-density lipoprotein, a substance in the blood that gets rid of cholesterol and thus prevents blockages in the arteries.

But women are more likely to die when faced with heart attack. According to reports of studies published in the 2002 Heart and Stroke Statistical Update by the American Heart Association, 38 per cent of women and 25 per cent of men will die within one year after the first recognised attack; 35 per cent of women and 18 per cent of men survivors will have another heart attack within six years; 46 per cent of women and 22 per cent of men survivors will be disabled with heart failure.

Women are almost twice as likely as men to die after bypass surgery.

Fifty per cent of men and 63 per cent of women who died suddenly of coronary heart disease had no previous symptoms of the disease. In fact, men and women may develop different symptoms of a heart attack. While the classic symptom of crushing chest pain is experienced by most men, this symptom may be absent in some women.

Almost 15 per cent to 20 per cent of women having a heart attack complain specifically of pain high in the abdomen, shortness of breath and profuse sweating. Preceding or during an attack, women may also complain of chronic fatigue, indigestion, pain in the back or jaw, and heart palpitations.

To prevent heart disease, one should avoid smoking and alcohol abuse, do regular aerobic exercise, maintain a balanced diet and reduce stress. Dr Tse also suggested that men over 35 and women over 40 should go for an electrocardiogram and echocardiogram and have a regular yearly check-up.

Unchangeable risk factors

Increasing age

Gender

Heredity (including race)

Changeable risk factors

Smoking tobacco

High blood cholesterol

High blood pressure

Physical inactivity

Obesity

Diabetes mellitus

Stress

Too much alcohol

Source: American Heart Association