Global Health Advisor, Clinical Governance at International SOS Dr Chris van Straten/HANDOUTA person can go through an ordinary workday without feeling unwell while high blood pressure, raised blood sugar or high cholesterol quietly increases the strain on the heart and blood vessels.
For Dr Chris van Straten, Global Health Advisor, Clinical Governance at International SOS, that is why cardiovascular health should not only become a concern when a person develops chest pain or collapses.
"From a young age, go get your blood pressure test, go get your sugar test, go get your cholesterol test," van Straten said.
As the world observes World Heart Day on September 29, the World Heart Federation is using its 2026 campaign, "Don't Miss a Beat", to highlight cardiovascular disease and symptoms that can go unnoticed.
The federation says World Heart Day is observed globally every September 29, bringing together its members and partners to raise awareness of cardiovascular disease.
Cardiovascular diseases are the leading cause of death globally, according to the World Health Organisation. An estimated 19.8 million people died from cardiovascular diseases in 2022, accounting for about 32 per cent of all deaths globally, with 85 per cent of those deaths attributed to heart attack and stroke. More than three quarters of cardiovascular deaths occur in low- and middle-income countries.
In Kenya, World Heart Federation data show that 32,082 people died from cardiovascular disease in 2024. The country's age-standardised cardiovascular mortality rate was 127 per 100,000 people.
Separately, data from the Institute for Health Metrics and Evaluation, published through Our World in Data, show cardiovascular diseases, including heart attacks, strokes and other conditions, accounted for 11 per cent of deaths in Kenya in 2023, equivalent to about 31,400 deaths.
Van Straten said changing lifestyle patterns in parts of Africa are contributing to growing cardiovascular risks.
"In many African countries is now increasing numbers of cardiovascular disease because of many of these lifestyle changes that have come," he said.
High blood pressure can remain hidden
Hypertension is one of the risks that can go unnoticed because many people do not experience symptoms.
The World Health Organisation estimates that 1.4 billion adults aged 30 to 79 had hypertension in 2024, with about 600 million, or 44 per cent, unaware that they had the condition. Only about 23 per cent had their blood pressure under control.
Van Straten said a person can have high blood pressure for years without knowing it, while the condition continues to put pressure on the heart and arteries.
"You can have high blood pressure for a couple of years and not know that in the background it's putting a lot of strain on your arteries, putting a lot of strain on your heart and causing damage, but you're not feeling anything," he said.
World Heart Federation data put hypertension prevalence in Kenya in 2019 at 34.7 per cent among women and 31.4 per cent among men.
Van Straten said workplaces can provide an opportunity for people to discover the condition early.
He described programmes in which workers could privately have their blood pressure checked by a nurse or another trained person at the workplace, followed by education and support where readings were high.
He said some programmes he had worked on also combined screening with healthier food, opportunities for exercise during the working day and support for workers who were already receiving treatment.
Van Straten said some of the programmes were associated with lower hypertension rates over an 18-month period, followed by fewer hypertension-related emergencies, heart attacks and strokes.
He said the results were not automatic and depended on the company, its culture and individual behaviour.
Sitting for long hours and the cardiovascular system
Van Straten said prolonged sitting is another issue for workers who spend most of their day at a desk or computer.
"The heart, your arteries, the big vessels, they were really built to move every day," he said.
He explained that regular movement helps muscles and blood vessels function, while prolonged inactivity reduces energy expenditure and can contribute to weight gain, raised blood sugar, cholesterol and inflammation.
"If we just sit the whole day, a couple of things happen," van Straten said.
The World Health Organisation identifies physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol as major behavioural risk factors for cardiovascular disease. Their effects can include raised blood pressure, raised blood glucose, raised blood lipids and overweight or obesity.
Van Straten said workers should break up long periods of sitting with movement.
"Every hour, like after this call, the first thing I'm going to do is get up and move," he said, describing how he tries to incorporate short walks and stretching into days filled with meetings.
He also recommended more vigorous exercise several times a week.
"At least three or four times a week, you want to get your heart rate up," van Straten said.
Everyday habits can raise cardiovascular risk
Van Straten also spoke about smoking as one of the lifestyle factors that can increase cardiovascular risk. He linked the issue to his own experience, recalling that he smoked when he was younger before he fully understood what it could do to his health.
"I used to smoke when I was younger. I thought it was cool. I didn't really understand the damage I was doing," he said.
He said his understanding changed as he became more aware of the effects of smoking on the body, particularly its impact on the lungs, arteries and heart.
"I realised this is actually quite dumb, and I stopped smoking," van Straten said.
He recommended reducing highly processed foods, salty foods and sugary products while eating more fruits and vegetables.
World Heart Federation data show tobacco smoking prevalence in Kenya was 10.7 per cent in 2019.
He also said treatment should not be abandoned in favour of lifestyle changes alone where a person has been diagnosed with a condition requiring medical care.
Prolonged stress and the heart
Van Straten said stress itself is not necessarily harmful because the body's normal response to an immediate threat is designed to help a person react.
When the threat passes, he said, the body should return towards its normal state. The concern arises when stress becomes prolonged and does not allow the body to recover.
"If you're constantly stressed, you can have high blood pressure, you can have high sugar, you can have high cortisol and adrenaline," he said.
Van Straten recalled working long shifts in emergency departments earlier in his career, where he dealt with heart attacks, gunshot wounds and road crashes.
He said he noticed changes in his own blood pressure and blood sugar during periods of sustained stress and began paying greater attention to managing stress.
He said he now uses meditation, deep breathing, exercise and conversations with friends or a professional when he feels particularly stressed or anxious.
Family history can mean earlier checks
Cardiovascular risk can also have a genetic component. Van Straten said his mother had hypertension and that he developed high blood pressure in his 30s.
"I inherited that from my mum, but because of that, I started testing," he said.
He said he began treatment at about 35 and continues to monitor his blood pressure, blood sugar and cholesterol.
WHO lists family history as a non-modifiable risk factor for hypertension. Age and certain existing conditions, including diabetes and kidney disease, are also recognised risk factors.
Van Straten said people with a family history of hypertension, diabetes or heart disease should consider screening earlier rather than waiting until they are older.
He said there is no single age at which everyone must begin cardiovascular screening because individual risk differs.
"Start your blood pressure when you're young," he said, particularly where there is a family history.
For people with a strong family history, he said blood pressure and blood sugar can be checked from a younger age, while cholesterol screening can be considered earlier depending on the person's risk.
Van Straten said people should not assume that feeling well means they have no cardiovascular risk, particularly because hypertension can remain silent.
"You're not always going to have symptoms," he said.
He said the same applies to diabetes because although some people with high blood sugar may develop symptoms such as increased thirst and frequent urination, others may not recognise a problem early.
Another misconception, according to van Straten, is that having a family history means cardiovascular disease is inevitable.
He said his own experience shows why early monitoring and treatment can make a difference.
What to do during a heart emergency
Van Straten said workplaces should prepare for cardiovascular emergencies before they occur.
If a colleague suddenly develops severe chest pain, shortness of breath, sweating or collapses, the person should not be left alone while someone activates the emergency response plan and seeks medical help.
He said workplaces should have a trained first-aid responder, accessible emergency equipment, an automated external defibrillator where available, emergency contacts and a clear referral hospital.
For suspected stroke, he said staff should look for signs such as confusion, difficulty speaking, facial weakness or weakness of one arm and should record when the symptoms started before seeking emergency care.
The World Health Organisation lists sudden weakness or numbness of the face, arm or leg, particularly on one side, confusion or difficulty speaking, vision problems, dizziness and loss of balance among possible stroke symptoms. It advises people experiencing such symptoms to seek medical care immediately.
For a suspected heart attack, WHO lists chest pain or discomfort, pain in the arms, shoulder, jaw or back, shortness of breath, nausea, light-headedness, cold sweating and paleness among possible symptoms.
Van Straten said staff should not wait for symptoms to disappear, leave the person alone or delay emergency care while trying to establish the exact cause.
He also said an emergency protocol should not simply remain on paper.
"It is not enough just to write the protocol," he said. "You need to drill it."
He said drills can reveal how long it takes to identify the emergency, locate equipment, contact an ambulance and transfer a patient to the appropriate facility.
Prevention starts before the emergency
Van Straten said employers and employees both have roles in reducing cardiovascular risk.
Employers can provide opportunities for health checks, make healthier food available, allow workers time to exercise and support employees who need treatment.
Employees, he said, must also take responsibility for monitoring their health and following treatment.
He said the approach can benefit both workers and employers because preventing serious illness can help workers remain healthy and productive while reducing the disruption that occurs when skilled employees develop severe health problems.
Van Straten said his experience working across different countries had increasingly shifted his attention towards prevention.
He said even relatively small interventions, such as health education, workplace screening, exercise opportunities and follow-up support, can help identify people who need treatment before they develop an emergency.
For van Straten, the prevention message starts with knowing the numbers.
"Go get your blood pressure test, go get your sugar test, go get your cholesterol test," he said.
He said people should also remain physically active, eat healthier food, avoid smoking, get adequate sleep, manage prolonged stress and seek treatment when health checks show a problem.
For workplaces, he said preparation should extend beyond health education to having practical systems for recognising and responding to cardiovascular emergencies.
"The dream is that we prevent it so that the emergency is the last resort," van Straten said.
