Newsday
BAVINA SOOKDEO
Every year, thousands of families in Trinidad and Tobago are affected by sudden strokes, heart attacks and amputations – events often linked to one hidden culprit: vascular disease. According to Prof Vijay Naraynsingh, distinguished surgeon and researcher who works at Medical Associates Hospital, St Joseph, this condition quietly threatens lives across TT, but with awareness and prevention, many cases can be avoided. He spoke to the Newsday as the world observes Vascular Disease Awareness Month.
Naraynsingh explained that vascular really means vessels. “We’re talking about blood vessels or lymphatic vessels – arteries, veins and lymphatics. Lymphatics are the ones that carry fluid, but really arterial and venous are the two more common conditions. All the arteries and the veins will be part of our vascular speciality.”
With a career spanning over 45 years, the doctor, likens the vascular system to a household piping network: “The heart pumps blood like water into your house. If there’s a blockage in a pipe, it affects where it’s going. A blockage to the brain can cause a stroke, to the heart – a heart attack, to the kidneys – kidney failure and to the legs – gangrene and amputation.”
When it comes to veins, varicose veins are the most common issue. However, as Naraynsingh pointed out, it’s the arteries that are far more dangerous. He noted that in TT, the leading cause of death is heart disease, followed closely by strokes – both of which are vascular conditions. “In the system of pipes, the pipes go bad with age. They can go bad with other things too (like smoking and with cholesterol issues) but by and large, the pipes degenerate with age,” he said.
And while these age-related changes are expected, lifestyle factors are accelerating the problem, making vascular disease an increasingly urgent concern. Naraynsingh warned that cases of vascular disease are on the rise, also driven by increasing rates of diabetes, obesity and hypertension – and worryingly, it is now appearing more often in younger people as well.
According to the surgeon, vascular disease is rarely confined to one area. “When you have vascular disease, it’s a multi-system disorder. You cannot have one pipe rusting and assume the rest are fine. If someone has heart disease, chances are they also have issues in their brain, kidneys, or limbs. It’s a generalised disease that just manifests in a particular organ at that time.”
Naraynsingh further explained that when a patient goes to him with a stroke, he does not treat the stroke in isolation. After addressing the immediate issue, he also investigates for heart disease, kidney disease, lower limb disease and signs of generalised vascular disease, with the aim of controlling the condition across the entire system.
Emphasising that prevention is the best defence, Naraynsingh advised, “The easiest thing is to do your regular checks – blood pressure, sugar, lipids. When we see abnormalities even before symptoms appear, we can start preventative measures like losing weight, exercising (which everyone should be doing), stopping smoking and using medication if necessary.”
Screening, he added, is especially critical for those at higher risk. “If you are diabetic, you need fairly extensive checks – your heart, eyes, kidneys, carotids and lower limbs.”
As for treatment, it varies depending on how the disease presents. “If the problem is diabetes or hypertension, we aim for tight control,” Naraynsingh explained. “If there’s vessel narrowing, we can use blood thinners like aspirin or Plavix, or medication to lower cholesterol.”
Surgical options have also evolved. Naraynsingh explained that surgery for vascular disease varies depending on severity and location. In the heart, the most common procedure is bypass surgery, but milder cases may only require angioplasty and stenting. In angioplasty, a wire is inserted into the narrowed vessel, and a balloon is inflated to widen it. If the vessel collapses again, a stent – “like a collapsible wire fence” – is placed to keep it open. Bypass surgery, on the other hand, leaves the blocked vessel in place but creates a new pathway, like laying a fresh pipe alongside a blocked one and joining it above and below the obstruction. For patients with strokes or reduced blood flow to the brain, surgeons often operate on the carotid artery in the neck, removing the plaque in a procedure called endarterectomy. For lower limb disease, both bypass surgery and angioplasty with stenting are common. Ultimately, he stressed, the technique depends on the extent, location, and number of blockages, since ‘a pipe doesn’t rust in just one spot – it rusts in many.’ There is no one-size-fits-all treatment; it must be tailored to each patient’s pattern of disease.
One of the greatest barriers, Naraynsingh believes, is the lack of timely access to advanced care. “People don’t understand the value of what I call ‘snatch and run,’” he explained. If someone has chest pain, families often wait on an ambulance – which can take half an hour, an hour, or even longer – when in reality, no hospital in Trinidad is more than 20 to 30 minutes away. “While you’re waiting on the ambulance, the patient could die” he stressed. The most important thing is getting them to the hospital quickly. The bigger issue, he added, is what happens after arrival. In the entire public system, there is only one Cath lab (a hospital procedure room with specialised imaging equipment used to diagnose and treat heart conditions), located at Mount Hope and it is not a 24-hour service.
“Ideally, we should have at least two or three major hospitals equipped with trained personnel available 24/7 to handle emergencies the moment a patient arrives, because every minute lost means the heart muscle is dying.” The same urgency applies to strokes, where patients must receive treatment within four hours before brain tissue is irreversibly damaged. “Time is brain,” he stressed. “If you arrive too late, even if the clot is removed, the brain cells are already dead.” He noted that private Cath labs exist, but they remain prohibitively expensive for many patients.
His message during Vascular Disease Awareness Month is to “Get screened and do your regular checks. For diabetics especially, be vigilant and do extensive checks. We have not decreased our amputation rate in Trinidad and Tobago yet, and we need to work aggressively on that but it requires a multi-tiered approach.”
At both a personal and national level, the fight against vascular disease comes down to prevention, awareness and timely care. “We really need to increase public awareness of how urgent the matter is. When somebody gets a heart attack or a stroke, you get them to an institution fast. Time is brain, time is heart,” the doctor warned.
