IT’S known as the silent killer - perhaps one reason why, whenever any of us dwell on our own mortality, we don’t give it too much consideration. Cancer can prove painful and protracted. Alzheimers is debilitating, degenerative and demeaning. So too is Parkinson’s Disease. As for vital organ failure — no thanks. All prove fatal in the end and all provide ample reason to be fearful of the grim reaper. But a heart attack? That’s something we can do in our sleep.

And yet the fact is, heart disease is the Western world’s - and Bermuda’s - biggest killer, amongst both men and women - the reaper’s richest annual harvest. Heart disease — specifically, coronary artery disease, a condition that blocks blood vessels and can lead to a heart attack — now affects one in two Bermudians.

A recent survey of US women indicated that most expected to die from some form of cancer. It’s a typical response. What the respondents didn’t realise is that, odds are, the majority will succumb to heart disease. It’s a highly prolific disease with a surprisingly low profile. And like so many diseases, it’s preventable — or at the very least, delayable by a decade or two. No wonder so many health professionals are frustrated by the general public’s almost casual acceptance of this illness as a comfortable fallback into the grave.

Which is why the Bermuda Hospitals Board spends one month a year promoting awareness of the killer. Ignorance is just as much an enemy as clogged arteries, a low understanding of your risks just as significant as a high blood pressure reading.

The theme of this year’s campaign, launched in conjunction with the Bermuda Heart Foundation, is ‘Know Your Numbers’, and it aims to highlight the importance of understanding the risk factors for cardiac disease. These key indicators include blood pressure, blood sugar, cholesterol levels and waist circumference.

Research has shown that by controlling these risk factors, the chances of developing this debilitating and sometimes fatal condition can be reduced.

King Edward VII Memorial Hospital staff are offering free screenings throughout the month. Members of the public can learn about their numbers next Wednesday from 12 p.m. to 2 p.m. in the KEMH lobby and find out more about how to prevent cardiac disease.

“Although we highlight information in February, we need to take good care of ourselves throughout the year,” said Cardiac Care Nurse Specialist Myrian Balitain-Dill.

“The intent of our campaign is to motivate people to be proactive in their healthcare. It really is a simple choice. Do I want to have my heart disease now, at 45, or do I want to have it when I’m 95?”

According to Nurse Balitain-Dill, it’s a choice we all have to face, and can all make. The killer may be silent, but it’s surprising how a few numbers can resonate.

BLOOD PRESSURE: “This tells us how hard your heart is working when it’s squeezing and when it’s relaxed,” said Nurse Balitain-Dill.

“The higher those numbers are, the harder your heart has to work. People can walk around with blood pressures of 190/90 and not know it - that’s why we call it the silent killer - because at some point your heart says ‘I’ve had it’ or you have a stroke, which is similar to a heart attack only it happens in your brain.”

BLOOD SUGAR> “Diabetes is huge on this island and we want people to know what their sugar levels are, even people not in the diabetic range,” said Nurse Balitain-Dill.

“You need to consider sugar as a poison. Your body reacts to it like an irritant. It increases inflammation and tells us that your metabolism is skewed somehow and there are a lot of metabolites sitting around your blood vessels. If they’re sitting there they’re going to be deposited. That’s why people with diabetes need to have their blood sugars within a controlled range. If you don’t know you need to get it tested. You don’t even have to be fully diabetic but if your body is not metabolising sugar in the way it should and that increases your cardio-vascular risk, your risk of a heart attack.”

CHOLESTEROL: “Cholesterol is a special molecule that transports fats but when you get tested we’re not looking at a single number but a cholesterol profile made up of good and bad cholesterol,” said Nurse Balitain-Dill.

“Total cholesterol for an average individual with no risk should be less than 200 milligrams per dilution. Bad cholesterol should be less than 160, but if you have heart disease it should be less than 100, preferably less than 70. The bad cholesterol is the one we’re interested in because it’s the one that deposits in your arteries.B>WAIST CIRCUMFERENCE: “This is becoming more important now because we’re finding that the fatty deposits around your middle are a good predictor of your cardio-vascular risk because that’s a different kind of fat that is more metabolically active then the fat that gets deposited in your hips,” said Nurse Balitain-Dill.

“Increasing weight particularly the fat percentage, does put you at risk but what we’re finding is that your waist is a better predictor for cardiovascular risk. For men we want it less than 40 inches and for women less than 35 inches. You can actually be not overweight and yet start growing this belly, which means you’re at an increased risk of cardio-vascular disease.”

The key to keeping these numbers down is common sense, according to Nurse Balitain-Dill. Eating a low-fat, fruit-and-vegetable rich diet and taking regular exercise should keep arteries clog-free for years.

“But we have people coming through the door and you’re scratching your head thinking ‘how did they get coronary heart disease?’ Nurse Balitain-Dill said.

“In fact right now we have someone in right now who’s 30 years old, doesn’t smoke, doesn’t drink, eats properly, the textbook body type - and they have heart disease. But if these numbers are checked and controlled, they will better guarantee that you will not suffer from a cardio-vascular event.”

While there are many forms of heart disease, including damage to the muscle itself, the most predominant type of disease is coronary heart disease. It’s also the most preventable one.

“If you eat your fruits and vegetables, if you keep your stress levels low, if you don’t smoke, if you don’t drink lots of alcohol, you’re less likely to suffer heart disease,” Said Nurse Balitain-Dill.

“There’s no guarantee but you’re better guaranteed.

“With regard to high blood pressure your heart is eventually going to say ‘alright, I’ve had it’. Many of our heart failure patients’ hearts have become so big and boggy because of longstanding high blood pressure that was not treated.

“When your heart has to work so hard it has to stretch and after a while it doesn’t squeeze well - it just gives a squirt instead of a big old squeeze to get blood up to wherever it needs to go.

“So no, you cannot live a long and healthy life with high blood pressure and high cholesterol because at some point it will get you. Your body has a way of adapting but eventually it will say ‘I’ve had it’. You can only put up with so much and then you’re done.

“But if you get your risk factors sorted out now that can make the difference between having a heart attack at 40 or getting it at 60. That’s the choice. Because we’re all living longer and we have all this technology everybody will be living longer and probably dying of heart disease. But at what point will it happen? I want to get my heart disease when I’m 95 rather than 45 - that’s the choice that we now have and it’s an easy choice.”

And of course the first step in making that choice is to be tested to find out what your numbers are.

“The first thing you have to do to bring these numbers down is to get to know them - so you have to get screened,” said Nurse Balitain-Dill.

“And ‘fine’ is not a number. It’s no good saying ‘well my doctor said my blood pressure was fine’. It two numbers. We want people to be empowered and the only way to do that is to get them to know their numbers.

“The problem is that people who think they are well aren’t ready to make that move. It’s the people who have been cut open because they’ve had a catheter snaked up their chest.

“They’re the ones who are saying, ‘okay, I’m ready now because I know what this is all about’. The people who haven’t gone through that don’t know that and we’re trying to save them.

“We’re trying to get the message out there but it’s almost as if we have to wait until they’ve had their heart attack before we can say ‘see, are you ready to listen?”Secondly, you need to know what the recommendations are and then work with your physicians and nurses to get those numbers down.

“We didn’t talk about walking but 10,000 steps a day is the number that we want people to walk. That’s five miles, but nobody walks anymore. Our lifestyles are killing us.”

And it’s not just killing men. Women are just as likely to die from the disease, which kills more of us every year than any other illness.

“In 2000 about 256 people died of heart-related diseases in Bermuda and it’s basically a one-to-one ration,” said Nurse Balitain-Dill.

“Heart disease isn’t something that women really consider at all. There was a poll in the States and less than 30 per cent of women said they thought they would die from heart disease. If we ourselves don’t realise that heart disease is our number one killer, we’re not going to be paying attention.

“The only issue is that women normally present later in life and slightly differently.

“Because women’s symptoms are more vague, nobody pays attention. It’s a case of ‘there’ there dear, you’re going to be okay’ and the next thing you know is she’s having a heart attack. And because the diagnosis isn’t carried out until later, the prognosis is worse, a woman is more likely to die.

“For a woman who has to have by-pass, the prognosis is worse, even though the surgery is the same as for a man.

“Even though the techniques and technology are better now, we are seeing improvements in men’s mortality but not so much in women.

“But really there’s no secret to heart health, our only problem is that all these gadgets have got in the way and we no longer move and for 99 cents I can supersize your fries. We have to move more and eat sensibly.

“In the 19th century our biggest cause of death was famine - in the 21st century it is abundance. Because of technology everybody is living longer and they’re living with their diseases longer. That’s the problem. I have a job for life.”