Cayman is already in the grip of a cardiovascular-disease crisis – and a specialist doctor has said that urgent moves had to be made to gather proper statistics so healthcare professionals could tackle the problem head-on.
Cardiologist Dr. Krzysztof Kukula said heart disease, strokes and related conditions such as obesity, diabetes and high blood pressure were the biggest killers in the developed world.
He added that treatments had advanced in recent years, but more statistical information was needed to better target preventative measures.
Kukula, who works at Doctors Hospital, said, “Generally, we are much better at treating cardiovascular disease, but there is more of it, so the prevention is a major problem.”
He added, “Children are more likely to be overweight and, later, develop type 2 diabetes and cardiovascular disease.
“Because the burden of all the risk factors is increasing, the burden of cardiovascular disease is also increasing, despite the armaments we have to prevent it.
“This is the main reason that in a number of countries, for almost the first time in history, life expectancy may start to decrease.”
Kukula explained that the variety of health insurance types in Cayman, although they offered freedom of choice, meant a fragmented approach to health care and made amassing proper statistical data on disease difficult.
He said: “Generally, we don’t really know what’s going on in Cayman. We don’t have proper statistics on which to base interventions.
“We have an idea of the high burden of cardiovascular disease, but don’t really have precise data because there is no registry of cardiovascular disease prevalence in Cayman and no registry of treatments and outcomes.
“We know enough to realise the situation is bad, but we don’t know how bad it is.”
But he said, “Generally, it likely looks similar to the US, or perhaps a little worse than the US.”
Cardiac time bomb
Kukula added, “It’s not really a time bomb – that bomb has gone off already. We see plenty of people with stroke, heart attacks or heart failure.”
One solution could be to make it mandatory for GPs in the public and private sector to monitor patients for cardiovascular disease, including risk factors, and report findings to public health authorities, he said.
Although there were limitations, that could be the simplest solution and perhaps could be aided by the authorities to ease the financial burden on patients, he said, adding, “It’s about getting people to see a physician.”
He explained those visits “opened up the door” to follow-ups and would help doctors to tackle problems before they developed into disease.
Kukula was speaking after he delivered a talk at the Doctors Hospital and Integra Healthcare conference “Frontiers of Healthcare 2025: Building Resilient Healthcare Systems”, the second of its type, on 26 Sept. at Hotel Indigo, Grand Cayman.
He said it was “vital” to have accurate figures for heart attacks, diabetes, strokes and the prevalence of obesity to be able to deploy health care resources properly.
Kukula explained that treating cardiovascular problems once disease had taken hold was very expensive.
“It’s an old truth that prevention is much more effective and hugely cheaper than treatment.”
But he added, “We don’t know much about the prevalence of risk, the prevalence of risk factors and what to focus on, so we can’t be effective in our preventative measures.”
Kukula said, “And it’s not easy to acquire because of the multiple insurers, providers and different types of insurance.”
But he added, “That doesn’t mean we shouldn’t try to get some idea of where we are exactly. Just concluding we are not in a good place is not good enough.
“Once we know where we are, we devise some optimal prevention measures … but first we need some data.”
However, Kukula said, “Although we don’t have the data to support what I’m saying, Cayman almost certainly is a very comorbid place in terms of cardiovascular disease and its complications.
“That’s true for most westernised countries, but my guess is in Cayman that’s even more noticeable than in other places.”
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“…One solution could be to make it mandatory for GPs in the public and private sector to monitor patients for cardiovascular disease…” Really ???
I have to address two main issues with prevention and treatments of CVD.
To treat something, you have to properly diagnose it first. Right?
Issue #1. Microvascular disease is more common in women
Implicit and explicit biases in favor of men are STILL present in cardiology, affecting women’ diagnosis. Historically, and even today, women are underrepresented in cardiovascular clinical trials. For decades, research used men as the “gold standard,” leading to diagnostic and treatment guidelines based on male physiology.
Treatment protocols are STILL based on male-centric research.
Significant gender gaps in cardiovascular disease diagnosis and treatment exist due to a range of biological, clinical, and systemic biases. This disparity results in women being underdiagnosed, undertreated, and facing poorer outcomes, despite CVD being the leading cause of death for women globally.
Due to different or “atypical” symptoms, women’s heart disease is often misdiagnosed as anxiety or gastrointestinal issues, leading to delayed treatment. A lot of women are being told to just watch their cholesterol levels and see their doctor in a year.
While some women do have obstructive coronary heart disease, a significant proportion, especially those with heart attack symptoms, present with non-obstructive disease, particularly coronary microvascular disease (CMVD) which can be particularly challenging to diagnose and treat.
Women may experience symptoms of a heart attack (angina) even without blockages in the larger arteries, a condition sometimes referred to as ischemia with non-obstructive coronary arteries. Despite being non-obstructive, CMVD is a serious condition that carries a poor prognosis and can lead to significant adverse cardiac events.
Women are more likely to develop CMVD, where the small blood vessels are the problem. STANDARD heart tests and angiograms often DO NOT show the small-vessel issues, making it harder to diagnose.
Microvascular heart disease remains underdiagnosed because standard cardiac tests, like standard angiograms, cannot visualize the heart’s tiny blood vessels, leading to symptoms being misattributed or ignored. When the main, larger coronary arteries are clear of significant blockages, it gives a false impression that there’s no heart disease.
Diagnosing CMVD requires advanced, often invasive, testing that assesses blood flow through the heart’s smallest arteries. Even Health City Cayman, specializing in CVD, doesn’t have tools and equipment (and perhaps expertise) to diagnose CMVD (please correct me if I’m wrong but they do not specifically list diagnosis and treatment for microvascular heart disease and my inquiry about CMVD few years ago did confirm that)
Even when diagnosed, women are less likely to receive the most aggressive and guideline-directed treatments, such as certain medications or timely surgical interventions like stents.
Issue #2. Physical activity in Cayman.
Due to the high heat and humidity, people are less physically active in the Cayman Islands, especially during the summer and midday.
Grand Cayman can feel void of natural shade in many areas and the need for more pedestrian-friendly infrastructure like shade structures or tree-lined walkways.
The island’s infrastructure could be improved with more shade sails over streets or walkways to encourage pedestrian activity, especially in places like George Town.
Pedestrians face, besides scorching sun, unsafe conditions due to a combination of narrow, non-existent, or obstructed sidewalks, sharp road turns, heavy traffic, poor pedestrian crossing visibility, driver behavior leading to frequent near-misses and serious injuries.
How Singapore became obsessed by shade. https://www.bbc.com/future/article/20250922-how-singapore-became-obsessed-by-shade
Lastly: STRESS!!! is the #1 contributing factor to CVD.
Even slightly, but persistently increased heart rates encourages oxidative stress with endothelial dysfunction, via increased inflammatory messengers, leading to stimulation of arteriosclerosis of the blood vessels.
Oxidative stress triggers endothelial dysfunction by promoting the release of inflammatory messengers like cytokines and chemokines, which recruit immune cells to the vascular wall, causing further damage. This creates a vicious cycle where oxidative stress leads to endothelial activation, a proinflammatory state marked by reduced nitric oxide and increased production of reactive oxygen species leading to vascular disease.
Pay attention to this if you regularly and persistently experience even slightly increased heart rates. Cardiologist won’t tell you this.
As you can see, if you managed to read the entire comment, there is more to diagnostics and treatment of CVD than proper statistics.
People all need to start with simple walking. Go for walks.