Dr. Md. Mizanur Rahman

We usually start thinking about our heart only after experiencing chest pain, shortness of breath, or sudden loss of consciousness. Yet the risk of heart disease often develops much earlier, silently and gradually. High blood pressure, diabetes, high cholesterol, tobacco use, unhealthy dietary habits, and physical inactivity can affect the body over many years. A person may have no symptoms at all. Therefore, feeling healthy does not necessarily mean that there is no risk. Preventing heart disease requires three things: awareness, regular health check-ups, and accessible healthcare services.

According to the World Health Organization, cardiovascular diseases caused approximately 19.8 million deaths worldwide in 2022. Tobacco use, excessive salt intake, unhealthy diets, physical inactivity, air pollution, and conditions such as high blood pressure and diabetes contribute to these diseases. Heart disease is also a major public health challenge in Bangladesh. In the 2018 national STEPS survey, 10 percent of respondents aged 18–69 reported that they had experienced a heart attack, heart disease-related chest pain, or stroke at some point in their lives. This was based on information provided by survey participants and should not be interpreted as the current prevalence of heart disease in the country. However, it highlights the need to strengthen the identification of cardiovascular risks and improve access to appropriate treatment.

Prevention begins with understanding one`s own risk factors. Adults should have their blood pressure checked regularly. Blood sugar and cholesterol should be tested as advised by a physician, and any family history of heart disease should be communicated to the doctor. Depending on age, weight, smoking habits, previous illnesses, and family history, a physician can determine how frequently an individual needs health checks. A single normal test result is not a lifetime guarantee of good health, just as having risk factors does not mean that heart disease is inevitable. Identifying risks early creates an opportunity to take timely action.

Many people underestimate high blood pressure because it may not cause any noticeable problems. However, high blood pressure often exists without symptoms and, when left uncontrolled for a long period, can damage the heart and blood vessels. The same applies to diabetes and high cholesterol. When these conditions are diagnosed, it is not safe to assume that changing one`s diet alone will be sufficient or that medication is unnecessary. Decisions about starting, stopping, or changing the dosage of medication should always be made in consultation with a physician.

Tobacco use is one of the major risk factors for heart disease. In addition to smoking, smokeless tobacco products such as jarda and gul are also harmful. Quitting tobacco can be difficult, so simply telling someone to "use more willpower" is not an adequate solution. Support from family and the workplace, counseling services, and medical assistance when necessary can all play an important role. It is equally important to protect oneself and family members from exposure to secondhand smoke.

Reducing salt intake, limiting excessive oil, unhealthy fats and highly processed foods, and increasing the consumption of vegetables, fruits, pulses and fibre-rich foods can support heart health. Instead of unrealistic advice such as completely eliminating salt from the diet, sustainable changes, such as reducing added salt during cooking and at the dining table, are more practical. People should also develop the habit of reading food labels on packaged products, although producers and regulatory authorities have a responsibility to ensure that such information is presented clearly and in an understandable manner. If healthy food is expensive or difficult to obtain, simply blaming individuals is not enough. The availability of affordable and nutritious food must also be improved.

Regular walking and physical activity are beneficial, but everyone`s physical capacity is different. Physical activity should be increased gradually, taking age, physical condition, and chronic illnesses into consideration. Those who spend most of the day sitting at work can take regular breaks and walk for a few minutes. However, if someone experiences unusual chest pain or shortness of breath during exercise, they should not force themselves to continue. They should stop and seek medical advice. Adequate sleep, managing mental stress, and reducing prolonged sitting are also important components of overall health.

Chest pressure or pain, shortness of breath, cold sweats, nausea, dizziness, or pain spreading to the arm, shoulder, jaw, or back may be signs of a heart attack. Symptoms are not the same for everyone. In particular, women, older people, and individuals with diabetes may sometimes experience symptoms that differ from the commonly recognized signs. If a heart attack is suspected, it can be dangerous to assume that the pain is caused by "gas," wait for it to go away, rely on home remedies, or follow advice from social media. Emergency medical care should be sought immediately. In the case of a heart attack, delays in treatment can increase damage to the heart.

Discussions about preventing heart disease often focus mainly on individual diet and exercise. Personal habits are certainly important, but maintaining a healthy lifestyle is not equally easy for everyone. Long working hours, traffic congestion, unsafe environments for walking, the cost of healthy food, and the easy availability of inexpensive processed foods all influence people`s choices. Therefore, heart health is not simply a matter of individual willpower. It is also a matter of the social environment and public policy.

Bangladesh has already taken policy initiatives in this area. The multisectoral action plan for the prevention and control of noncommunicable diseases for the 2018–2025 period emphasized the roles of different sectors in addressing risk factors such as tobacco use, unhealthy diets, physical inactivity, and air pollution alongside healthcare services. Bangladesh has also worked on the WHO Package of Essential Noncommunicable Disease Interventions (WHO-PEN) approach and treatment protocols for identifying and managing hypertension and diabetes at the primary healthcare level. In 2025, a joint declaration involving 35 ministries expressed a commitment to inter-ministerial cooperation in addressing noncommunicable diseases. These initiatives represent policy-level progress. The immediate priority now should be their consistent implementation and transparent reporting of results.

The government`s responsibility is to expand access to regular blood pressure, diabetes, and cardiovascular risk assessments at upazila health complexes and primary healthcare facilities; ensure trained personnel, necessary diagnostic facilities, and essential medicines; and establish an effective referral system for transferring seriously ill patients to higher-level healthcare facilities without unnecessary delay. Affordable healthcare is also essential so that the cost of treatment does not push families into financial hardship. At the same time, effective enforcement of tobacco-control laws, initiatives to reduce excessive salt and harmful fats in food, safe footpaths and spaces for walking, and the dissemination of reliable health information through schools, workplaces, and the mass media are necessary. Regularly publishing progress and relevant data would allow citizens to understand how effectively policy commitments are translating into real improvements in people`s lives.

There is no single solution to preventing heart disease. People need to understand their own risk factors, develop healthier habits, and seek medical attention quickly when warning signs appear. The healthcare system must be capable of detecting disease early and providing continuous and affordable treatment. At the same time, the government must create policies and environments in which staying healthy is not a privilege available only to a small number of people who are sufficiently aware or financially capable. Awareness and a healthy lifestyle are essential for preventing heart disease. Making a healthy lifestyle possible for all requires the collective efforts of individuals, society, government, healthcare professionals, and all other relevant stakeholders.

About the Author:
Dr. Md. Mizanur Rahman
(Physician and Columnist)
Residential Medical Officer,
United Healthcare Service Limited, Dhaka.
Phone: 01929468687
Email: msmizan512@gmail.com