THE STAR, TUESDAY 29 SEPTEMBER 2020
HEALTHY HEART
Fatal pair of cardiorenal syndrome
IN the 19th century, English
physician Dr Robert Bright
described heart disease in patients
with renal failure. This is probably
the earliest notation made in
medical history to express the
relation between both organs. As
the name suggests, cardiorenal
syndrome involves two essential
organs – “cardio” refers to the
heart, while “renal” refers to
the kidneys.
According to Prof Dr Azreen
Syazril Adnan, consultant physician
and nephrologist at MSU Medical
Centre, “Cardiorenal syndrome is a
clinical presentation that describes
the clinical manifestation involving
the two affected organs. Patients
affected by this syndrome usually
present with both heart- and
kidney-related complications. They
manifest with swollen legs,
difficulty in breathing, chest
discomfort and progressive urine
volume reduction.”
Cardiorenal syndrome is
classified based on the disease’s
onset and the organs that initiate
the clinical presentation’s cascade.
Organised into five different
categories, each represents
different outcomes and severity
of the disease.
Cardiorenal syndrome I
This clinical syndrome presents
in a sudden onset manner, usually
preceded with a sudden failing of
the heart resulting in low blood
perfusion to the kidneys. Typically,
the low blood pressure leads to a
reduction in urine output.
Biochemical changes in the blood
soon occurs, and in extreme
situations, deterioration of
consciousness sets in. This is
Putting out the fire of inflammation
INFLAMMATION happens to
everyone regardless of age, often
without you realising it. However, if
your body has excess inflammation,
it will send signals to notify you that
something is amiss in your system.
Some of the common signs include
body pain, constant fatigue,
insomnia, anxiety, gastrointestinal
complications, weight gain and
frequent infections.
Inflammation comes from the
Latin word for “to set on fire”. Like
fire, inflammation can serve or
harm us.
It is an essential part of the body’s
immune response to injuries and
infective foreign substances such as
bacteria and viruses. Acute
inflammation occurs as the body’s
natural healing process. This is a
good inflammation which the body
employs to defend itself against
foreign invaders that could
otherwise cause harm. The
symptoms subside once the body
has healed.
On the flip side, inflammation
can be bad if it persists. This
condition – known as chronic
inflammation – puts the body into
an emergency state for a prolonged
period. It can spread throughout
Prof Dr Azreen Syazril Adnan.
mainly due to an elevated
biomarker known as urea.
Urea is a biomarker that
generally presents in the human
body following a protein
breakdown, and is discharged from
the body via urine. A doctor’s
immediate management would be
to restore blood pressure and
improve blood perfusion to the
kidneys. However, this condition is
potentially reversible depending
on the duration of the kidney
injuries and how soon the kidneys
restore blood perfusion.
Cardiorenal syndrome II
This condition occurs due to a
long-standing heart problem –
often in elderly folk with a low
heart function for years, thus
compromising the blood perfusion
to the kidneys for a certain period
of time. The compromised blood
perfusion to the kidneys results in
irreversible damage.
the body and wreak havoc, leading
to a myriad of serious health
conditions. It is believed to be the
root for a myriad of health
conditions from allergies,
depression, autism, asthma,
arthritis and eczema, to some
life-threatening diseases such as
diabetes, heart attack, stroke and
even cancer.
Supplementing
with turmeric
Do not let inflammation rage
inside your body and silently take a
toll on your health! You can reduce
inflammation by making positive
lifestyle and dietary changes.
More than just a culinary spice,
turmeric possesses remarkable
health-promoting properties, thanks
to its well-known anti-inflammatory
and antioxidant properties. This
golden spice provides a safe,
natural approach to help calm
inflammatory responses in a host
of chronic diseases, ranging from
arthritis to Alzheimer’s disease,
diabetes, cardiovascular diseases
and even cancer.
Curcuminoids are known to
The outcome of this
condition is variable and mostly
results in chronic renal
impairment, due mainly to the
nature of the chronicity of both
the affected organs.
Cardiorenal syndrome III
This is a reversed version of
cardiorenal syndrome I that
occurs firstly due to the sudden
deterioration of kidney function,
resulting in impairment of the
heart’s function. The kidney
function’s sudden failure creates
a low urine output, leading to
suppress inflammation by
inhibiting NF-kB, a transcription
factor which triggers a cascade of
undesirable inflammatory
responses in the body. As a potent
antioxidant, curcuminoids
effectively protect the cells from
lipid peroxidation and oxidative
stress caused by free radicals.
As the gold standard for
turmeric extracts, Curcumin C3
Complex is the foremost clinically
studied natural anti-inflammatory
and antioxidant with a multitude
of health benefits. Standardised to
95% curcuminoids, it contains not
only curcumin, but all three
curcuminoids – curcumin,
demethoxycurcumin (DMC) and
bisdemethoxycurcumin (BDMC).
These three major curcuminoids
are in naturally occurring free
form, which confers greater bio-
efficacy compared to its conjug-
ates. It is far more readily
absorbed and available for
use by the body for enhanced
health benefits.
DMC and BDMC have a
profound effect on the activity of
curcumin. The combination of
these three curcuminoids proves
more efficient in protecting
volume in excess. This volume
overload state affects the heart
pumping function which later
segues into heart failure.
The immediate restoration of
kidney function will sustain the
overburdened heart and improve
the condition back to normal. The
patient’s outcome depends solely on
how soon the potential insult to the
kidney is identified and eliminated.
Cardiorenal syndrome IV
The long-standing kidney
impairment results in various
complications, including
abnormalities of the blood vessels.
In normal conditions, the kidney
functions to stabilise biochemical
constituents in the blood. Calcium,
phosphate and potassium are a few
of the minerals absorbed from our
diets, and are maintained within a
specific range to allow for normal
physiological body functions by
our healthy kidneys. Unfortunately,
in kidney impairment, many of
these minerals come in excessive
amounts that potentially interfere
with normal body functions – blood
vessel health included. For instance,
the deposition of calcium and
phosphate products in the arteries
easily occurs in long-standing renal
impairment patients.
The coronary arteries of long-
standing kidney failure patients
that supply blood to the heart are
not spared either. The narrowing
of these coronary arteries due to
the calcium-phosphate deposition
later leads to fatal heart disease
development. This is the most
common type of cardiorenal
syndrome, representing 45%
to 50% of all types of
cardiorenal syndrome.
Turmeric provides a safe, natural approach to calm inflammatory
responses in a host of chronic diseases.
against oxidative stress compared
to taking curcumin on its own.
Moreover, the presence of DMC
and BDMC stabilises the curcumin.
With BDMC, Curcumin C3 Complex
is more soluble, making it more
absorbable in the gastrointestin-
al tract.
The addition of BioPerine – a
black pepper extract containing
no less than 95% piperine –
significantly enhances the
absorption of curcumin by up to
2,000%. With this natural
bioenhancer, Curcumin C3
Cardiorenal syndrome V
Unlike other cardiorenal
syndromes, the kidney and heart
failures occurring in this clinical
condition are associated with
other organ failures. Cardiorenal
syndrome V is a systemic failure
of the human bodily system,
leading to a loss of the heart and
kidney functions.
It is often caused by systemic
infection or disseminated infection
in the blood which may be from
bacterial or viral infections. The
fatality rate is higher in this type
of cardiorenal syndrome.
Patients with a risk of developing
kidney impairment and heart
disease are potentially also at risk
of this ‘fatal pair’.
Diabetic and hypertensive
patients are routinely affected, so
they require close monitoring of
their blood parameters and general
well-being. Achieving the
recommended targets of blood
pressure and sugar levels are
among the methods used to avoid
these syndromes.
Usually, the focus will be on
recognising the clinical syndrome
and deciding the potential insult
leading to organ failure. A
systematic diagnostic approach is
crucial, and immediate corrective
measures require close monitoring
of the patient’s response to the
instituted treatment.
Certain drugs like diuretics are
then commonly prescribed, mainly
to reduce the excess volume.
Diuretics are drugs that promote
urination and, in the majority of
cardiorenal syndromes, would
relieve these patients’ clinical signs
and symptoms.
Complex is able to reach, enter
and remain within their target
cells for longer periods of time
for optimal health support.
An assurance of safety, both
Curcumin C3 Complex and
BioPerine have been granted
GRAS (Generally Recognised as
Safe) status by the US Food and
Drug Administration.
n This informational article is
brought to you by VitaHealth.
For more information, call
1800 183 288.
6 Healthy Heart THE STAR, TUESDAY 29 SEPTEMBER 2020

Natural way to maintain

a healthy cholesterol level
IN recent years, the incidences of
non-communicable diseases
(NCDs) such as heart disease have
been on the rise in Malaysia,
according to the 2019 National
Health and Morbidity Survey by
unhealthy lifestyles.
A slight modification in our
daily diet with the inclusion of
high fibre foods such as oat bran
– which contains the cholesterol-
lowering substance called “oat
results in a reduction of one’s low-
density lipoprotein cholesterol (bad
cholesterol) level.
Two-in-one health benefits
bran powder. Bioactive oat beta-
glucan is high in molecular weight
and has been scientifically shown
to produce good viscosity effects in
the gut for optimal cholesterol-
lowering results, according to the
in the EFSA Journal.
l Lower in calories, higher in
total fibre and lactose-free
l Contains no added sugar,
artificial additives or preservatives

the Ministry of Health Malaysia.
NCDs are diet-related chronic
diseases and the dominant risk
factors are a high blood
cholesterol level, diabetes,
hypertension and obesity. The
aforementioned survey noted that
eight million Malaysians have a
high cholesterol level, 3.9 million
Malaysians have diabetes, 6.4
million Malaysians are afflicted
with hypertension and 3.7 million
Malaysians are obese.
It is estimated that the
prevalence of these NCD risk
factors will continue to increase
and is indeed a worrying trend
for the country because many
people seem to be oblivious to the
truth and continue to indulge in
beta-glucan” – is one of the most
natural ways of managing a high
blood cholesterol level.
Oat beta-glucan is a soluble
form of dietary fibre that produces
a cholesterol-lowering effect due
to its high viscosity. It dissolves
inside the digestive tract where it
forms a thick gel in the small
intestine. This viscous ‘net’ traps
cholesterol and cholesterol-related
particles (bile acids) and prevents
them from being absorbed into
the bloodstream. They are then
passed, harmlessly, out of the
body. When the liver subsequently
has to produce more bile acids –
which are needed by the body for
fat absorption – it uses cholesterol
in the bloodstream to do so. This
The Biogrow Oat BG22 oat bran
powder presents two-in-one health
benefits in a much smaller and
easy-to-consume serving size. Some
of the advantages of Biogrow Oat
BG22 include:
l Provides 3g of bioactive oat
beta-glucan with just two scoops/
sachets (approximately 18g) of oat
Scientific Opinion on the
substantiation of health claims
related to beta-glucans from oats
and barley and maintenance of
normal blood LDL-cholesterol
concentrations, increase in satiety
leading to a reduction in energy
intake, reduction of post-prandial
glycaemic responses and “digestive
function” pursuant to Article 13(1)
of Regulation (EC) No 1924/2006
Taking Biogrow Oat BG22 is a
natural way to obtain the highly
bioactive oat beta-glucan from our
daily diet. Remember, a healthy
cholesterol level is the key to
achieving a heart-healthy lifestyle.
This article is brought to you by
Legosan (Malaysia) Sdn Bhd.
n For more information, call
03-7956 2220 (Mondays to Fridays,
9am to 5pm) or email info@
biogrow.com.my

Approved health claims:

The health claims for oat beta-
glucan that are approved by the
European Food Safety Authority
and the Ministry of Health
Malaysia are as follows:
l 3g of oat beta-glucan daily
aids in lowering cholesterol
l Oat soluble fibre (beta-
glucan) helps to decrease the rise
of blood glucose, provided that it
is not consumed together with
other food
l Consumption of beta-glucan
from oats contributes to a
reduction of the glucose rise after
a meal
THE STAR, TUESDAY 29 SEPTEMBER 2020 7
8 Healthy Heart
How to become
a heart donor
YEAR by year, the number of people who
are in need of heart transplants is
increasing. Because of heart disease, a
heart transplant becomes the last option as
there are no other treatment available for
the condition.
However, there is a need for more heart
donors in Malaysia as the demand for heart
transplants way surpasses supply. Heart
transplants are thus important, but do you
know how it is done and what makes a
person eligible to be a heart donor?
Anybody can donate their heart – except
those who are suffering from infectious
diseases such as hepatitis B and C, HIV and
syphilis. If you are below 18 years old, you
need your parents’ or guardians’ permission
to become a heart donor.
You can become an organ donor by filling
out an organ donor registration form
available at all government hospitals,
district health departments and district
health centres.
After you have registered as an organ
donor, you will receive a donor’s card to
keep on your person. You must also tell
your family members of your wish to
become an organ donor, so that your family
members can make the necessary
arrangements upon your death.
A heart donation can only occur once a
person is declared as being brain dead.
Brain death is when there is no circulation
of blood and oxygen to the brain, thus
ending all functions that support life such as
breathing. However, other organs like the
heart, kidneys and liver can still function
when the breathing machine is left on.
If a person dies because the heart stops
beating, it is categorised as a normal death.
THE STAR, TUESDAY 29 SEPTEMBER 2020
Registered donors who have died in this
manner will not be eligible to donate their
hearts. According to statistics, only three in
1,000 people qualify for organ donation
upon death.
Once the registered donor has stopped
breathing, the heart can continue to beat
with the help of a ventilator. Doctors will
confirm the death of the registered donor
before they harvest the heart. The
transplant must occur within four to six
hours after the donor’s heart is recovered.
When it comes to heart transplant
recipients, there is a waiting list – but it
doesn’t work on a first-come, first-served
basis. Several factors are looked into when
a heart becomes available. The distance
from the donor hospital, medical urgency
and pediatric status are three factors that
are considered. Additionally, other key
factors in matching a donor’s heart with a
transplant candidate include blood volume
and blood type.
There is always a
possibility where a
recipient’s body
rejects the heart, but
the survival rate for
patients who have
undergone a
heart transplant
a year after
surgery is more
than 85%.
If you are not
yet an organ
donor, register
now. You could
be saving a life
by doing so.
THE STAR, TUESDAY 29 SEPTEMBER 2020
A healthy heart pumps about five
litres of blood per minute regularly
throughout the body to ensure a
human being stays alive. However,
when there is an abnormality in
the heart, problems can occur that
would lead to serious
complications and even death.
Cardiomyopathy, a disease of
the heart muscle, is one such
abnormality. Dr Shamruz Khan,
consultant cardiologist at Subang
Jaya Medical Centre, explains
cardiomyopathy is an umbrella
term for a wide spectrum of
disease entities affecting the
structure and function of the heart
muscle. “It is a common final
response of the heart muscle to
various genetic and environment
insults, making it harder for the
heart to pump blood,” he says.
Dr Khan mentions there are
many types of cardiomyopathy,
but it can generally be divided into
two groups – ischemic and non-
ischemic cardiomyopathy. Both
groups of cardiomyopathies can
ultimately lead to heart failure.
Ischemic cardiomyopathy refers
to cardiomyopathy caused by
significant obstructions and the
narrowing of the arteries that
supply the heart muscle itself, also
called the coronary arteries. Other
causes of cardiomyopathy that are
not due to disease in the coronary
arteries are categorised under non-
ischemic cardiomyopathy. Usually
asymptomatic in the early stage, it
tends to occur in younger people
and may be detected during
regular health screenings, which
can highlight abnormal blood tests
and electrocardiograms, for
example, among other findings.
Be on the lookout
Dr Khan notes patients with
cardiomyopathy can be relatively
asymptomatic, or they can present
with a wide variety of symptoms
which include:
l Heart failure symptoms –
reduced effort tolerance,
breathlessness on exertion, leg
swelling, abdominal swelling,
fatigue, coughing when lying flat
l Chest pain/pressure
l Rhythm-related issues – heart
palpitations or pounding/fluttering
heartbeats
l Feeling light-headed,
dizziness, fainting
l Stroke
l Cardiac arrest
l Sudden cardiac death
It can be quite difficult to be
certain if presenting symptoms
are a result of a benign cause or
because of cardiomyopathy, and
as such, Dr Khan urges everyone
to be vigilant. This is especially
crucial if you have a family
history of unexplained heart
failure or sudden death in family
Am I at risk?
Because patients with
cardiomyopathies can be
relatively asymptomatic, a
person’s first and last symptom
could be sudden cardiac death.
Hence, it is important for people
who are at a higher risk to go for
regular check-ups to reduce their
risk of complications or
probabilities of sudden death.
Some factors that could lead to a
higher probability of
cardiomyopathy are:
l Conditions affecting the heart
including a previous heart attack,
coronary artery disease or an
infection in the heart
l Obesity
l Long-term alcohol abuse
l Illicit drug use such as
cocaine, amphetamines and
anabolic steroids
Staying a step ahead
of cardiomyopathy
Dr Khan advises living a heart-healthy lifestyle and making good lifestyle choices such as eating a healthy diet,
getting regular exercise and sleep, and reducing stress.
Dr Khan says the
recuperation and
quality of life of
a person with
cardiomyopathy
highly depends on
the presentation of
symptoms, cause and
type of treatment.
members below the age of 50, or
if you are experiencing any of
these symptoms.
“There is no harm in checking if
you have any of these symptoms.
The critical point here is not to
miss anything related to your
heart, which can be catastrophic.
l Certain chemotherapy drugs
and radiation therapy for cancer
l Family history of
cardiomyopathy, heart failure
and sudden cardiac arrest,
especially those of a younger age
(below 50)
l Long-term uncontrolled high
blood pressure
l Certain diseases such as
diabetes, an under- or overactive
thyroid gland or
hemochromatosis (a disorder
that causes the body to store
excess iron)
Of course, some of these symptoms
may be related to other factors
such as fitness-related issues,
certain medications, other organ
involvement or being on your feet
for too long, among others.
However, if it is indeed
cardiomyopathy, then you can at
least be treated earlier,” he says.
He states that as a general rule
of thumb, real symptoms related
to cardiomyopathy would get
progressively worse. One-off
symptoms would usually not
amount to anything serious on
further assessment.
Vigilance is key
Cardiomyopathy is a dangerous
condition as late diagnosis and
treatment can lead to various
issues such as valve problems,
blood clots resulting in stroke and
Long-term maintenance
In many instances, the causes
of cardiomyopathy are
idiopathic (unknown) or
genetically inherited. For others,
it is an acquired condition
relating to other pre-existing
health conditions such as
metabolic disease, long-term
diabetes, thyroid conditions,
heart rhythm-related issues,
viral, bacterial or fungal
infections, uncontrolled stress
or even previous infection with
Covid-19. Therefore, Subang
Jaya Medical Centre consultant
cardiologist Dr Shamruz Khan
explains doctors need to
diagnose the accurate cause for
each case before determining
the treatment.
Depending on the type of
cardiomyopathy and its cause,
treatment can be administered
via medication, surgery or
even heart failure, cardiac arrest
and sudden death.
Hence, it is crucial to be aware of
the condition and seek treatment
as soon as you are diagnosed with
it. While certain rare genetic-
related cardiomyopathies cannot
be prevented, Dr Khan says early
detection and treatment can
improve one’s lifespan and
symptoms. “We aim to improve the
long-term outcomes, reduce the
number of hospital admissions and
the possibility of sudden cardiac
arrest with treatment,” he says.
He observes that sometimes
when previously healthy people
die suddenly at home, it was most
probably the first presentation of a
heart condition – in other words,
the first symptom was death! In
this situation, it is important for
surviving first degree family
members to get a check-up,
devices. Dr Khan says the
recuperation and quality of life
of a person with
cardiomyopathy highly depends
on the presentation of
symptoms, cause and type of
treatment. All treatments have
side effects, so the decision to
employ a certain treatment
looks at how the benefits
outweigh the risks.
Dr Khan says, “Once you are
diagnosed, you will be on quite
a few different medications, so
frequent follow-ups should be
done to monitor your kidney
function, assess symptoms and
observe how the medication
affects your health.”
Hence, while you may live
your life as normal after getting
your cardiomyopathy stabilised,
there are some new practices
that you will need to add to your
Healthy Heart 9
Dr Shamruz Khan.
especially if the deceased was of a
young age.
Hence, he advises to:
l Be vigilant of your family
history, especially with regards to
unexplained sudden death or
heart failure
l Try to control traditional risk
factors of diabetes, hypertension
and dyslipidaemia
l Attend regular medical
assessments
l Always be aware of
symptoms – seek medical
attention as soon as possible if
they occur
Dr Khan also advises living a
heart-healthy lifestyle and
making good lifestyle choices
such as avoiding the use of
tobacco, alcohol or illegal drugs,
controlling high blood pressure,
high cholesterol and diabetes,
eating a healthy diet, getting
regular exercise and sleep, and
reducing stress.
All in all, if you suspect you are
experiencing symptoms which
may be related to your heart as
described previously, he urges
speaking to a cardiologist before
deciding on any further
assessment, investigation and
management. “Even if you are a
fit athlete, you can have genetic
abnormalities which can lead to
cardiomyopathy. It can affect
anyone, so it is better to be safe
than sorry,” he says.
n For more information, call
03-5639 1212.
lifestyle such as:
l Take your medications as
directed by your doctor
l Go for your regular check-
ups and blood results
monitoring
l Ongoing cardiac
assessments which may include
electrocardiograms,
echocardiograms, cardiac CT or
magnetic resonance imaging
l Regular device monitoring
if device-based therapy is used
l Quit smoking, eliminate or
minimise the amount of alcohol
you drink, manage stress and
get enough sleep
l Eat a healthy balanced diet,
maintain an ideal body weight
and get modest exercise after
further discussion with your
doctor about the most
appropriate programme of
physical activity