In accordance with the theme of this year’s World Heart Day (September 29), heart-healthy environments, Director General Shu-Ti Chiou of the Health Promotion Administration has made a special appeal to the people to exercise the four “heart” rules, “healthful eating,” “regular exercise,” “not smoking,” and “regular checkups and controlling high blood pressure, high blood sugar, and high cholesterol,” to create environments beneficial to heart health and to reduce the risk of cardiovascular disease. 


The World Heart Federation has indicated that heart disease, stroke, and other cardiovascular diseases are the number-one killers in the world. These diseases result in approximately 17.3 million deaths globally each year, 30% of all deaths around the world. This is more than the number of deaths from cancer, AIDS, and malaria. If control measures are not taken, the number of deaths from cardiovascular disease around the world will increase to 23 million per year by 2030. Heart disease is the number-two killer of Taiwanese citizens. According to statistics from the Ministry of Health and Welfare, in 2013, heart disease took 17,694 lives in Taiwan. An average of 2 people died from heart disease every hour. 

Director General Chiou stated that one of the primary causes of deaths from heart disease is acute myocardial infarction. An analysis of National Health Insurance hospitalization data from the past 5 years (2009 to 2013) has indicated that the standardized incidence rate of acute myocardial infarction among Taiwanese people has remained unchanged (from 58.7 per 100,000 people to 57.0 per 100,000 people). Further analysis based on sex and age group indicates that although the rate has decreased among women, it has tended to increase among men. In addition, the incidence of myocardial infarction among men is more than two times greater than it is among women. In regard to age, the incidence of acute myocardial infarction among men over the age of 70 has tended to decrease annually. However, the incidence among those between the ages of 40 and 49 has increased from 76.4 per 100,000 people in 2009 to 99.2 per 100,000 people in 2013, an increase of 30% (Table 1 shows the analysis of the incidence of acute myocardial infarction in Taiwan). The Health Promotion Administration has warned middle-aged men that regardless of whether they work hard in their businesses or take care of their families, they must be healthy to be without worry. The primary risk factors of heart disease are high blood pressure, high blood sugar, high cholesterol, smoking, obesity, and lack of exercise (Appendix 1). According to the results of the 2007 Tracking Survey of High Blood Pressure, High Blood Sugar, and High Cholesterol in Taiwan, the probability of heart disease within 5 years of people with high blood pressure, high blood sugar, or high cholesterol is 1.9 times, 1.5 times, and 1.8 times greater than that of people without these conditions. The probability of heart disease within 5 years of overweight (BMI higher than 24) people is 1.4 times greater than that of people with BMI less than 24. The probability of heart disease within 5 years of people with excessive waistlines (more than 90 cm among men and more than 80 cm among women) is 1.5 times greater than that of people with normal waistlines. In addition, the risk of heart disease in the future among people who smoke or are exposed to secondhand smoke is also higher than that of the general population. Fortunately, these risk factors can all be controlled through a healthy lifestyle. As long as people grasp the four “heart” rules below, they can possess a good heart that will keep them energetic for a long time. 



- Healthful Eating: The household forms a common food atmosphere. Parents and children share food at the same table. Good habits with three regular meals and fewer snacks should be developed. Boiled water should replace sugary drinks. Diets should include more vegetables, brown rice, and whole grain cereals and should avoid oil, salt, and sugar. Foods high in saturated fat should be reduced. The consumption of excessive amounts of processed or refined foods should be avoided. During cooking, steaming, boiling, and blanching should replace frying. 


- Regular Exercise: Maintain 30 minutes of moderate physical activity 5 times a week. Examples include stretching exercises, housework, playing with children, dancing, jogging, and cycling. These can all make your heart healthier. Parents can also encourage children to do more housework or to go outside and play. Children should never spend a long time staring at television screens, computers, or cellphones. It is never too late for exercise. You can start with 15 minutes of exercise every day and then gradually lengthen this time. Moving and sweating more certainly have numerous benefits for one’s health. 


- Not Smoking: Both direct smoking and passively inhaling secondhand smoke increase the risk of heart disease. Smokers are encouraged to take the initiative to quit immediately. The benefits of quitting for the heart can be seen immediately. A year after quitting, the risk of coronary heart disease can decrease by 50%. Five years after quitting, the risk of stroke is virtually the same as that of people who never smoked. The Health Promotion Administration now provides second-generation smoking cessation services. Smoking cessation medication is also covered by the National Health Insurance. The highest cost is only NT$200, making quitting no longer a difficult task. If people have any questions regarding smoking cessation, they can call a free smoking cessation advice line established by the Health Promotion Administration at 0800-636363 or contact county and city health bureaus to receive smoking cessation counseling services. People have only to make the determination to quit smoking, reject smoking, and prevent the exposure of their friends and family to the hazards of secondhand smoke. This is the beginning to regaining one’s health. 


- Regular Checkups and Controlling High Blood Pressure, High Blood Sugar, and High Cholesterol: Proper use should be made of the free adult preventive health services provided once every 3 years for people between the ages of 40 and 64 and once a year for people aged 65 and older by the Health Promotion Administration. Services include checkups of a number of major risk factors for heart disease, including BMI, waist circumference, blood pressure, blood sugar, and cholesterol. The “Treasured Heart Code” scale (Appendix 2) can be used for a self-check of heart health. In addition, in regard to the topic of weight loss, a healthy weight management advice line can be called at 0800-367-100 (the numbers 367 are homophones for losing weight in Taiwanese, and the numbers 367-100 mean exercising to lose weight). Every day from 9:00 AM to 9:00 PM, dietitians and exercise professionals provide free telephone counseling services in Mandarin and Taiwanese to teach the public healthy ways of life with “smart eating, happy exercise, and daily weighing.” People are welcome to make more use of this service.