Concerns of Heart Diseases and Mediations to Encourage Healthful Actions for Their Deterrence

Full text

International Journal of Bioinformatics and Biomedical Engineering
Vol. 1, No. 2, 2015, pp. 70-76
http://www.aiscience.org/journal/ijbbe
* Corresponding author
E-mail address: drmsarwar64@yahoo.com (M. Sarwar)
Concerns of Heart Diseases and Mediations to
Encourage Healthful Actions for Their Deterrence
Muhammad Haroon Sarwar
1
, Abdul Razzaq Mughal
2
, Safia Mughal
3
,
Muhammad Sarwar
4, *
1
Faculty of Medicine and Allied Medical Sciences, Isra University, Hyderabad, Sindh, Pakistan
2
Faisalabad Institute of Cardiology,
Faisalabad, Punjab, Pakistan
3
Hameeda Medicare, Ghulam Muhammadabad, Faisalabad, Punjab, Pakistan
4
Pakistan Atomic Energy Commission, Nuclear Institute for Agriculture and Biology, Faisalabad, Punjab, Pakistan
Abstract
The aim of this article is to describe some of heart diseases representing a range of situations that affect human heart. The term
heart disease is often used interchangeably with the term cardiovascular disease, which generally refers to conditions that
involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. There are many
different forms of heart disease and maladies under the heart disease umbrella including blood vessel diseases such as coronary
artery disease, heart rhythm problems (arrhythmias) and heart defects (congenital heart defects) with which a person sometime
is born. Other heart conditions, such as those that affect heart's muscle, valves or rhythm, also are considered various forms of
heart disease. Cardiovascular diseases are the leading cause of death and many of all global deaths are attributed to
cardiovascular diseases each year. Deaths caused by cardiovascular diseases are also higher in low and middle-income
countries because a large number of global deaths are caused by cardiovascular diseases occurring in those countries. The most
common cause of heart disease is narrowing or blockage of the coronary arteries and the blood vessels that supply blood to the
heart itself. It is estimated that during the coming decades, over many millions people will die from cardiovascular diseases.
There is therefore an increased emphasis on preventing atherosclerosis by modifying risk factors, for example by healthy
eating, getting regular exercise and avoidance of smoking or using tobacco of any kind. Early diagnosis and managing of other
health problems including high blood pressure, high cholesterol and diabetes that can raise risk of heart disease and heart
failure are needed at priority.
Keywords
Human Heart, Heart Disease, Cardiovascular Disease, Heart Attack, Heart Failure
Received: June 19, 2015 / Accepted: June 29, 2015 / Published online: July 13, 2015
@ 2015 The Authors. Published by American Institute of Science. This Open Access article is under the CC BY-NC license.
http://creativecommons.org/licenses/by-nc/4.0/
1. Introduction
The heart disease (also called cardiovascular disease) is a
class of diseases that involve the heart, the blood vessels
(arteries, capillaries and veins) or both (Maton et al., 1993).
The cardiovascular disease refers to any disease that affects
the cardiovascular system, principally cardiac disease,
vascular diseases of the brain and kidney, and peripheral
arterial disease (Bridget, 2010). The causes of cardiovascular
disease are diverse, but atherosclerosis and hypertension are
the most common. In addition, with aging a number of
physiological and morphological changes come that alter
cardiovascular function and lead to increased risk of
cardiovascular disease, even in healthy asymptomatic
individuals (Dantas et al., 2012). Smoking or using tobacco
of any kind is one of the most significant risk factors for
developing heart disease. Chemicals in tobacco can damage

International Journal of Bioinformatics and Biomedical Engineering Vol. 1, No. 2, 2015, pp. 70-76 71
the heart and blood vessels, leading to narrowing of the
arteries (atherosclerosis) ultimately leading to a heart attack.
Women who smoke and take birth control pills are at greater
risk of having a heart attack or stroke than those who do not
do because both smoking and taking birth control pills
increase the risk of blood clots (Sarwar et al., 2013; Sarwar
et al., 2015).
The cardiovascular disease is the leading cause of deaths
worldwide, though cardiovascular mortality rates have
declined in many high-income countries (Bridget, 2010). At
the same time, cardiovascular disease and deaths have
increased at a fast rate in low and middle-income countries
(Finegold et al., 2012). Although cardiovascular disease
usually affects older adults, the antecedents of cardiovascular
disease, notably atherosclerosis, begin in early life, making
primary prevention efforts necessary from childhood (McGill
et al., 2008). Obesity and diabetes mellitus are often linked to
cardiovascular disease, as are a history of chronic kidney
disease and hypercholesterolaemia. In fact, cardiovascular
disease is the most life-threatening of the diabetic
complications and diabetics are two to four folds more likely
to die of cardiovascular related causes than no diabetics
(Vanhecke et al., 2006; Highlander and Shaw, 2010).
2. Different Heart Diseases
The heart disease or cardiac disease is the number one killer
even in a few advance countries of the world and it is also a
major cause of disability. The most common cause of heart
disease is narrowing or blockage of the coronary arteries and
the blood vessels that supply blood to the heart itself. This is
called coronary artery disease and happens slowly over the
passage of time. It is the major reason when peoples have
heart attacks. Other kinds of heart problems may happen to
the valves in the heart or the heart may not pump well and
cause heart failure that means the heart cannot pump blood
well to the rest of the body. Some peoples are born with heart
diseases problem (Jousilahti and Tuomilehto, 1999).
Coronary artery disease also called coronary arteriosclerosis
is the most common type of heart disease. It is the leading
cause of death in both men and women. It happens when the
arteries that supply blood to heart muscle become hardened
and narrowed. This is due to the build-up of cholesterol and
other material called plaque on their inner walls. This build-
up is called atherosclerosis. As it grows, less blood can flow
through the arteries. As a result, the heart muscle cannot get
the blood or oxygen it needs. This can lead to chest pain
(angina) or a heart attack. Angina results from reduced blood
supply to the heart that is caused by the narrowing or
blockage of the blood vessels that supply to the heart. Most
heart attacks happen when a blood clot suddenly cuts off the
heart's blood supply, causing permanent heart damage. Over
time, coronary artery disease can also weaken the heart
muscle and contributes to heart failure and arrhythmias.
Arrhythmias are changes in the normal beating rhythm of the
heart (Norhammar et al., 2004).
In atherosclerosis the walls of arteries become thick and stiff
because of the build-up of fatty deposits. The fatty deposits
are called plaques and when this happens, the flow of blood
is restricted. Atherosclerosis can happen throughout the body,
if it is in the arteries of the heart it is known as coronary
artery disease, and in the legs is known as peripheral arterial
disease. Population-based studies show that atherosclerosis
that is the major precursor of cardiovascular disease, begins
in childhood. The pathobiological determinants of
atherosclerosis in youth study demonstrated that intimal
lesions appear in all the aortas and more than half of the right
coronary arteries of youths aged about 7-9 years (Bertazzo et
al., 2013). This is extremely important considering that 1 in 3
peoples will die from complications attributable to
atherosclerosis. In order to treat this problem, education and
awareness that cardiovascular disease poses the greatest
threat, and measures to prevent or reverse this disease must
be taken.
Each year, over a million of peoples in the world have a heart
attack also called myocardial infarction and about half of
them die. Many peoples have permanent heart damage or die
because they do not get help immediately. It is important to
know about the symptoms of a heart attack and these
symptoms include chest pain or discomfort (feel like pressure
or squeezing), shortness of breath, discomfort in the upper
body parts such as arms, shoulder, neck and back, nausea,
vomiting, dizziness, light headedness and sweating. These
symptoms can sometimes be different in women they may
experience having difficulty in breathing, be very tired and
have pain in shoulder, jaw or upper back pain. Heart diseases
that affect women more than men include coronary
microvascular disease that is a problem that affects the
heart's tiny arteries, and broken heart syndrome which is the
extreme emotional stress leading to severe but often short-
term heart muscle failure. The older a woman gets, the more
likely she is to get heart disease. But women of all ages can
be concerned about heart disease. All women can take steps
to prevent it by practicing healthy lifestyle habits. Most heart
attacks happen when a clot in the coronary artery blocks the
supply of blood and oxygen to the heart. Often this leads to
an irregular heartbeat called an arrhythmia that causes a
severe decrease in the pumping function of the heart. If a
blockage that is not treated within a few hours may cause the
affected heart muscle to die (Jackson et al., 1999).
The heart has four valves, normally; these valves open to let
blood flow through or out of heart and then shut to keep it

72 Muhammad Haroon Sarwar et al.: Concerns of Heart Diseases and Mediations to Encourage Healthful Actions for Their Deterrence
from flowing backward. But, sometimes they do not work
properly and a person could have regurgitation when blood
leaks back through the valve in the wrong direction, a
condition in which one of the valves of the heart, the mitral
valve, does not work properly. It is one of the most common
heart valve conditions and sometimes it causes regurgitation
and stenosis when the valve does not open enough and
blocks blood flow. The valve problems can be present at birth
or caused by infections, heart attacks or heart disease or
damage. The main sign of heart valve disease is an unusual
heartbeat sound called a heart murmur. The physician can
hear a heart murmur with a stethoscope, but many peoples
have heart murmurs without having a problem, and heart
tests can show if a person have a heart valve disease. Some
valve problems are minor and do not need treatment, while
others might require medicine, medical procedures, or
surgery to repair or replace the valve (Kvan et al., 2007).
Normally, if a person gets hurt, his body forms a blood clot
to stop the bleeding. Some peoples get too many clots or
their blood clots abnormally. Many conditions can cause the
blood to clot too much or prevent blood clots from dissolving
properly. The risk factors for excessive blood clotting include
certain genetic disorders, atherosclerosis diabetes, atrial
fibrillation, overweight, obesity, metabolic syndrome, some
medicines and smoking. Blood clots can form in or travel to
the blood vessels in the brain, heart, kidneys, lungs and limbs.
A clot in the veins deep in the limbs is called deep vein
thrombosis and it usually affects the deep veins of the legs. If
a blood clot in a deep vein breaks off and travels through the
bloodstream to the lungs and blocks blood flow, the
condition is called pulmonary embolism. Other
complications of blood clots include stroke, heart attack,
kidney problems and kidney failure, and pregnancy related
problems. The treatments for blood clots include blood
thinners and other medicines (Spence, 2006).
An arrhythmia also called irregular heartbeat is a problem
with the rate or rhythm of heartbeat. It means that the heart
beats too quickly, too slowly or with an irregular pattern.
When the heart beats faster than normal, it is called
tachycardia. But, when the heart beats too slowly, it is called
bradycardia. The most common type of arrhythmia is atrial
fibrillation, which causes an irregular and fast heartbeat.
Many factors can affect heart's rhythm, such as having a
heart attack, smoking, congenital heart defects and stress.
Some substances or medicines may also cause arrhythmias.
The symptoms of arrhythmias include fast or slow heartbeat,
skipping beats, light headedness or dizziness, chest pain,
shortness of breath and sweating. A physician can run tests to
find out if a person has an arrhythmia. Treatment to restore a
normal heart rhythm may include medicines, an implantable
cardioverter-defibrillator or pacemaker or sometimes surgery
(Inaba et al., 2012).
High blood pressure (hypertension) is the excessive force of
blood pumping through the blood vessels. The risk of heart
disease can be reduced by taking steps to control factors that
put at greater risk including control of blood pressure and
lowering of cholesterol. Blood pressure is the force of blood
pushing against the walls of arteries. Each time the heart
beats, it pumps blood into the arteries. The blood pressure is
highest when the heart beats, pumping the blood, this is
called systolic pressure. When the heart is at rest, between
beats, the blood pressure falls, this is called diastolic pressure.
The blood pressure reading uses these two numbers. Usually
the systolic number comes before or above the diastolic
number. A reading of 119/ 79 or lower is normal blood
pressure, 140/ 90 or higher is high blood pressure, and
between 120 and 139 for the top number or between 80 and
89 for the bottom number is called prehypertension.
Prehypertension means someone may ends up with high
blood pressure, unless takes steps to prevent it. High blood
pressure usually has no symptoms, but it can cause serious
problems such as stroke, heart failure, heart attack and
kidney failure. The high blood pressure can be controlled
through healthy lifestyle habits and taking medicines, if
needed (Moyer, 2012 a).
A stroke also called brain attack is a medical emergency and
strokes happen when blood flow to the brain stops. A stroke
occurs when a blood vessel in the brain or neck is blocked or
bursts and the consequences of a stroke can include problems
with speech or vision, and weakness or paralysis, and within
minutes, brain cells begin to die. There are two kinds of
stroke, the more common kind, called ischemic stroke, is
caused by a blood clot that blocks or plugs a blood vessel in
the brain. The other kind, called hemorrhagic stroke, is
caused by a blood vessel that breaks and bleeds into the brain.
A mini-strokes or transient ischemic attacks occur when the
blood supply to the brain is briefly interrupted. Symptoms of
stroke are sudden numbness or weakness of the face, arm or
leg (especially on one side of the body), sudden confusion,
trouble speaking or understanding speech, sudden trouble
seeing in one or both eyes, sudden trouble walking, dizziness,
loss of balance or coordination, and sudden severe headache
with no known cause. If a person has any of these symptoms,
he must get to a hospital quickly to begin treatment. Acute
stroke therapies try to stop a stroke while it is happening by
quickly dissolving the blood clot or by stopping the bleeding.
Post-stroke rehabilitation helps the individuals to overcome
disabilities that result from stroke damage. Drug therapy with
blood thinners is the most common treatment for stroke
(Micha and Mozaffarian, 2010).
Heart failure also called cardiac failure or congestive heart
failure is a condition in which the heart cannot pump enough

International Journal of Bioinformatics and Biomedical Engineering Vol. 1, No. 2, 2015, pp. 70-76 73
blood to meet the body's needs. Heart failure does not mean
that heart has stopped or is about to stop working. It means
that heart is not able to pump blood in the way it should do
and it can affect one or both sides of the heart. The
weakening of the heart's pumping ability causes blood and
fluid to back up into the lungs, the build-up of fluid in the
feet, ankles and legs called edema, and tiredness and
shortness of breath. The common causes of heart failure are
coronary artery disease, high blood pressure and diabetes. It
is more common in peoples who are 65 years old or older,
who are overweight, and peoples who have a heart attack.
The men have a higher rate of heart failure than women. The
physician can diagnose heart failure by doing a physical
examination and heart tests. Treatment includes treating the
underlying cause of heart failure, medicines and heart
transplantation if other treatments fail (Norhammar et al.,
2004; Highlander and Shaw, 2010).
A heart attack (myocardial infarction) occurs when the
heart’s supply of blood is stopped. A heart attack may not be
fatal, especially if patients receive medical attention and
treatment to deal with the blockage soon after having heart
attack, but patients are likely to be left with a damaged heart
post heart attack. A heart attack manifests as severe central
chest pain, which may also radiate to the left arm, shoulder
or jaw, while severe shortness of breath, sweating and feeling
faint are common additional symptoms. Sudden death occurs
when there is an abrupt loss of the heart's ability to pump
blood. This may be because of heart attack or serious
abnormality of the heart’s rhythm (Jousilahti and Tuomilehto,
1999).
The healthy kidneys clean blood by removing excess fluid,
minerals and wastes. They also make hormones that keep
bones strong and blood healthy. But if the kidneys are
damaged, they do not work properly and harmful wastes can
build up in body. The blood pressure may rise and body may
retain excess fluid and not make enough red blood cells. This
is called kidney failure also called end-stage renal disease or
renal failure. If kidneys fail, patients need treatment to
replace the work they normally do. The treatment options are
dialysis or a kidney transplant and each treatment has
benefits and drawbacks. There is no matter which treatment a
physician chooses, patients will need to make some changes
in their life, including how to eat and plan the activities. But,
with the help of healthcare providers, family and friends,
most peoples with kidney failure can lead full and active
lives (McGill et al., 2008; Bridget, 2010).
Cholesterol is a waxy, fat-like substance that occurs naturally
in all parts of the body and the body needs some cholesterol
to work properly. The cholesterol at all is not bad, in fact, it
is actually essential to the proper functioning of our body.
Cholesterol in the right amounts helps our cells to grow and
function properly. But, if a person has too much cholesterol
in blood, it can combine with other substances in the blood
and sticks to the walls of arteries. This is called plaque and
plaque can narrow arteries or even block them. The high
levels of cholesterol in the blood can increase the risk of
heart disease. The cholesterol levels tend to rise as a person
gets older. There are usually no signs or symptoms that a
person has high blood cholesterol, but it can be detected with
a blood test. A person is likely to have high cholesterol if
members of his family have it, are overweight or eat a lot of
fatty foods. A person can lower his cholesterol by exercising
more, eating more fruits and vegetables, and also may need
to take medicine to lower cholesterol (Jackson et al., 1999;
Kvan et al., 2007).
3. Prevention and Management
of Heart Diseases
The causes, prevention, and treatment of all forms of
cardiovascular disease remain active fields of biomedical
research, with hundreds of scientific studies being published
on a weekly basis. Cardiovascular disease is treatable with
initial treatment primarily focused on diet and way of life
interventions. Many forms of heart diseases can be prevented
or treated with healthy means of choice and control existing
health problems like high blood pressure and diabetes. Some
of currently practiced measures to prevent cardiovascular
disease include a low fat and high-fiber diet including whole
grains, fruits and vegetables intake, tobacco cessation and
avoidance of second-hand smoke, avoidance of alcohol
consumption as the alcohol intake increases the risk of
cardiovascular disease, lowering of blood pressure if it is
elevated, decrease in body fat if overweight or obese, reduce
in sugar consumptions, decrease of psychosocial stress, and
increase in daily activity to 30 minutes of vigorous exercise
per day at least five times per week (Wang et al., 2004;
Klatsky, 2009). For adults with a known diagnosis of
hypertension, diabetes, hyperlipidemia, or cardiovascular
disease, routine counseling to advise them to improve their
diet and increase their physical activity have been found to
significantly alter behavior, and thus are recommended. The
dental care in those with periodontitis, affects the risk of
cardiovascular disease and exercise in those who are at high
risk of heart disease has been well studied (Dickinson et al.,
2006; Moyer, 2012 b).
3.1. Diets
A diet high in fruits and vegetables decreases the risks of
cardiovascular disease and death. Evidence suggests that the
diet including proportionally high consumption of olive oil,
legumes, unrefined cereals, fruits, and vegetables, may

74 Muhammad Haroon Sarwar et al.: Concerns of Heart Diseases and Mediations to Encourage Healthful Actions for Their Deterrence
improve cardiovascular outcomes. There is also evidence that
this diet may be more effective than a low-fat diet in bringing
about long-term changes to cardiovascular risk factors (e.g.,
lower cholesterol level and blood pressure). The diet
containing high portion of nuts, fish, fruits and vegetables,
and low in sweets, red meat and fat has been shown to reduce
blood pressure, lower total and low density lipoprotein
cholesterol, and improves metabolic syndrome; but the long
term benefits outside the context of a clinical trial have been
questioned. A high fiber diet appears to lower the risk and
total fat intake does not appear to be an important risk factor.
A diet high in trans fatty acids; however, does appear to
increase rates of cardiovascular disease. Worldwide, dietary
guidelines recommend a reduction in saturated fat intake.
However, there are some questions around the effect of
saturated fat on cardiovascular disease in the medical
literature (Sacks et al., 2001; Azadbakht et al., 2005; Walker
and Reamy, 2009; Stamler, 2010; Bhupathiraju and Tucker,
2011; Sarwar et al., 2014).
Some medical reviews do not find evidence of harm from
saturated fats, while other reviews found suggestive evidence
of a small benefit from replacing dietary saturated fat by
unsaturated fat. A meta analysis concludes that substitution
with omega 6 linoleic acid (a type of unsaturated fat) may
increase cardiovascular risk. Replacement of saturated fats
with carbohydrates does not change or may increase risk,
however benefits from replacement with polyunsaturated fat
appear the greatest (Siri-Tarino et al., 2010; Paterna et al.,
2008; Bochud et al., 2012). Another review of dietary salt
concludes that there is strong evidence that high dietary salt
intake increases blood pressure and worsens hypertension,
and that it increases the number of cardiovascular disease
events; the latter happen both through the increased blood
pressure and quite likely, through other mechanisms.
Moderate evidence has found that high salt intake increases
cardiovascular mortality; and some evidence found for an
increase in overall mortality, strokes and left ventricular
hypertrophy (Bhupathiraju and Tucker, 2011; Bochud et al.,
2012; Sarwar et al., 2013).
3.2. Supplements
While a healthy diet is beneficial, in general the effect of
antioxidant supplementation (vitamin E, vitamin C, etc.), or
vitamins has not been shown to protect against
cardiovascular disease and in some cases may possibly result
in harm. Mineral supplements have also not been found to be
useful. Niacin, a type of vitamin B3, may be an exception
with a modest decreases in the risk of cardiovascular events
in those whose are at high risk. Magnesium supplementation
lowers high blood pressure in a dose dependent manner.
Magnesium therapy is recommended for patients with
ventricular arrhythmia as well as for the treatment of other
cardiovascular diseases (Bruckert et al., 2010; Fortmann et
al., 2013; Lavigne and Karas, 2013).
3.3. Medications
Aspirin has been found to be of overall benefits in those
whose are at low risk of heart disease as the risk of serious
bleeding is equal to the benefit with respect to cardiovascular
problems. Statins are effective in preventing further
cardiovascular disease in peoples with a history of
cardiovascular disease. As the disease event rate is higher in
men than in women, the decrease in events is more easily
seen in men than women. In those whose are without
cardiovascular disease but risk factors, statins appear also
beneficial with a decrease in mortality and further heart
disease. A cardiac stent is used to treat narrowed coronary
arteries and stents can also be used to improve blood flow
immediately following a heart attack. A drug-eluting stent is
coated with medicine and the medication is released into the
blood vessel to help in preventing it from getting blocked up
again (Gutierrez et al., 2012; Berger et al., 2011).
4. The Impact of Local Diet on
Heart Disease Frequency
Worldwide, the major killer cardiovascular diseases are due
to unbalanced diets and physical inactivity. Risk of their
main forms, is reduced by eating less saturated (e.g., cheese,
animal products) and trans fats (often used in cakes, cookies
and fast food), and sufficient amounts of polyunsaturated fats,
fruits and vegetables, and less salt to reduce blood pressure,
as well as by physical activity and controlling weight. The
role of diet is crucial in the development and prevention of
cardiovascular disease. Normally, unsaturated fats,
polyunsaturated and monounsaturated are beneficial for heart
health, which are present in fish, nuts, seeds and vegetables.
Low fruits and vegetables intake accounts for about 20% of
cardiovascular disease worldwide because these contain
components that protect against heart disease and stroke.
Whole grain cereals are unrefined and do not have the bran
or germ removed, and these contain folic acid, B vitamins
and fiber, all of which are important protectors against heart
disease. In countries where fish consumption is high there is
a reduced risk of death from all causes as well as
cardiovascular mortality. Eating nuts regularly is associated
with decreased risk of coronary heart disease. There is
evidence that soy has a beneficial effect on blood lipid levels,
and eating 47 gm of soy protein a day leads to a 9% drop in
total cholesterol. High blood pressure (hypertension) is a
major risk factor for cardiovascular disease if a diet is high in
sodium. It has been estimated that a universal reduction in

International Journal of Bioinformatics and Biomedical Engineering Vol. 1, No. 2, 2015, pp. 70-76 75
dietary intake of sodium by about 1 gm of sodium a day,
about 3 gm of salt, would lead to a 50% reduction in the
number of peoples needing treatment for hypertension
(World Health Organisation, 2015).
5. Conclusion
Heart diseases may be a leading cause of death, but it does
not mean that peoples should have to accept it as a fate.
Although the peoples have a lack of the power to change
some risk factors such as family history, sex and age, yet
there are some key heart’s disease prevention steps that can
be taken. An early diagnosis and treatment of heart
abnormalities can prevent heart failure and heart attack. Most
of the heart problems can be avoided in the future by
adopting a healthy standard of living. Some other heart’s
disease prevention tips are doing no smoking if a person
smokes (because carbon monoxide in cigarette smoke
replaces some of the oxygen in blood); eating fruits,
vegetables, fish, lean meats and whole grains; choose of
foods that are low in saturated fat and avoiding trans fat;
limiting use of sodium and sugar; avoiding alcohol; getting
exercise for 30 minutes on most days of the week (daily
exercise can reduce risk of fatal heart disease); staying at a
healthy weight (lose weight if needed); choosing foods that
lower cholesterol; and getting regular health screenings.
Managing of other health problems including high blood
pressure, high cholesterol and diabetes that can raise risk of
heart disease and heart failure are needed. Early diagnosis
and regular screening of heart abnormalities can tell whether
a person needs to take an action for these conditions. Drug
therapy to lower blood pressure and reducing blockages in
the coronary arteries with anti-cholesterol drugs has been
shown to reduce heart failure rates.
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