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DUBAI: When Wali Khan, a Dubai-based investment banker, visited his doctor seeking stress-relieving medication to cope with a difficult period in his fast-paced life, little did he know he was a few beats away from a full-blown heart attack.

At 40, Khan was mindful of his family’s long history of heart disease and believed he lived a healthier lifestyle than his father, who had suffered his first heart attack at 47. After a routine visit to the hospital for sudden shortness of breath — assumed to be anxiety-related — he discovered he was otherwise asymptomatic.

“(Despite this) my doctor, aware of my family history, insisted on a coronary angiogram,” the Pakistani-Brit told Arab News. The test revealed two blockages that required immediate stenting — a procedure in which a small, expandable tube is inserted into narrowed coronary arteries to keep them open and restore blood flow, preventing a heart attack.

The diagnosis changed his life.

Since undergoing the procedure in 2014, he has quit smoking, made exercise and sleep a priority, and walks an hour most evenings.

“Walking worked better than any medication for stress,” said the father of two, adding that he still visits his cardiologist every three months and continues to take prescribed medication.

“I was trying to find alternative ways of managing stress, but on the way, I discovered that I was living the lifestyle I was supposed to be living,” Khan told Arab News.

Khan, now 52, has since had two more stents — in 2015 and 2022 — but acknowledges that a persistent doctor and immediate access to private healthcare saved his life.

“If I had been in a slower healthcare system, I might have been sent home with a stress diagnosis. It would have been a very different outcome,” he said.

Many people around the world, however, are not as fortunate.

According to the World Health Organization, cardiovascular disease remains the leading cause of death globally, claiming far more lives each year than wars.

An estimated 19.8 million people died from CVDs in 2022, making up roughly 32 percent of global deaths, with 85 percent caused by heart attack and stroke.

Over three-quarters of these deaths occur in low and middle-income countries.

In the Middle East, Egypt recorded the highest number of cardiovascular deaths in 2021 with 275,665 — accounting for nearly 40 percent of all fatalities in the country — followed by Turkiye (205,740), Iran (169,582), Iraq (87,555), and Yemen (59,153).

Despite this staggering scale, action remains low.

On Sept. 29, the World Heart Federation marks the 25th anniversary of World Heart Day with a campaign to raise people’s awareness of healthy living, while urging governments worldwide to take action by improving access to treatment for high blood pressure and reducing heart health inequalities.

Currently, only 16 the 193 member states of the WHO have developed national strategies or action plans dedicated to heart health, most in Europe and the western Pacific, according to a WHF report.

Dr. Taskeen Khan, a member of the WHF advocacy committee (and no relation to Wali Khan), said the Arab world is facing a rapid epidemiological transition driven by urbanization, changing diets high in salt, sugar, and unhealthy fats, as well as sedentary lifestyles. This creates a high burden of risk factors like hypertension, diabetes, and obesity, which are the primary drivers of CVD.

While individual responsibility plays a role in maintaining health, she said the high death toll also reflects broader policy shortcomings.

“Health systems in the region struggle with treatment access and the data needed to ensure patients are being diagnosed, treated and controlled effectively,” Khan, former technical officer for CVD management portfolio at WHO, told Arab News.

She noted that social determinants, including income, education, and marketing of unhealthy products, also create an environment in which these risk factors thrive.

The disparity between Arab countries is driven by the pace of economic development and subsequent policy response.

“Some countries have been leaders in enacting taxes on sugar-sweetened beverages and tobacco, or mandatory limits on salt and trans fats in food. Others lag behind.” 

She pointed to successful examples the region can build on: salt-reduction initiatives in Jordan and Egypt; higher tobacco taxes across parts of the GCC; and growing adoption of WHO’s Hearts package to standardize hypertension treatment.

Conflict and instability can also reverse years of progress. Khan said that war and displacement cost patients access to CVD medicines and regular checkups, especially as the focus shifts to emergency response and infectious diseases.

“The result is a silent crisis within a crisis: People survive a conflict only to succumb to a preventable heart disease because the system to manage their condition no longer exists,” she said.

Another worrying trend is the rise of CVD risk in younger people. Childhood and adolescent obesity, pre-diabetes, early hypertension, and high rates of smoking and vaping are fueled by aggressive marketing of unhealthy products and digital lifestyles that reduce physical activity.

For all these factors, Khan said that an effective strategy must be multi-faceted: implementing strong policies to create healthier environments, strengthening primary healthcare systems, and advocating for broader cross-sectoral actions that address the root causes.

WHO guidance underscores those priorities. As part of scaling up action, WHO launched the Global Hearts Initiative to standardize primary-care approaches to hypertension and CVD risk, especially in low and middle-income settings.

The World Heart Federation reported that 80 percent of CVD deaths are preventable. If the world increased effective treatment of high blood pressure from one in five today to one in two, it could prevent 130 million premature deaths.

“Avoidance requires proactive, evidence-based policymaking. It is not inevitable,” Khan said. “Countries can leapfrog by implementing the WHO ‘best buys’ — cost-effective steps like salt reduction and tobacco control — before the burden becomes unmanageable.”

She said that without supportive national policies, clinical interventions have limited reach.

These could include taxes on tobacco, sugar and unhealthy foods; mandatory reformulation to cut salt, sugar and trans fats; clear front-of-pack warning labels; and comprehensive bans on smoking in public places.

Policy matters, but individuals still have agency, she added.

This year’s WHF campaign invites people to undertake some activity for at least 25 minutes daily for 25 days in September, share survivor stories, and sign a global petition urging governments to expand access to lifesaving treatment.

The federation highlights that 30 minutes of daily movement could help tackle up to 80 percent of cases — even as one in three adults, and eight in 10 young people, are not active enough.

“Get your blood pressure and blood sugar checked regularly. Reduce salt intake by cooking more at home and avoiding processed foods. Aim for at least 30 minutes of moderate activity, as simple as a brisk walk, most days. Don’t smoke, and if you do, seek help to quit. And take your medication as prescribed,” Khan said.

Meanwhile, Wali Khan said that lifestyle changes, particularly adopting effective stress management techniques, can be a game-changer.

“Originally, when you are diagnosed with advanced heart disease at 40, it is depressing. You wonder if you will see 60 or 70,” he said. “But once you start making changes — exercising, walking, sleeping better, being surrounded by a positive and healthy community — you feel better.”

He urged people, particularly those with a family history of cardiovascular issues, to undergo regular checkups before symptoms appear.

“If I could go back in time, I would have adopted a healthier diet in line with WHO guidelines much earlier, and not stressed over the little things in life.”