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Prevention of heartattacks and othercardiovascular diseasesA guide for managers, employees andcompany health professionals
Health2013
The global oil and gas industry association for environmental and social issues
5th Floor, 209215 Blackfriars Road, London SE1 8NL, United KingdomTelephone: +44 (0)20 7633 2388 Facsimile: +44 (0)20 7633 2389E-mail: info@ipieca.org Internet: www.ipieca.org
OGP/IPIECA 2013 All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted inany form or by any means, electronic, mechanical, photocopying, recording or otherwise,without the prior consent of IPIECA.
International Association of Oil & Gas Producers
London office 5th Floor, 209215 Blackfriars Road, London SE1 8NL, United KingdomTelephone: +44 (0)20 7633 0272 Facsimile: +44 (0)20 7633 2350E-mail: reception@ogp.org.uk Internet: www.ogp.org.uk
Brussels officeBoulevard du Souverain 165, 4th Floor, B-1160 Brussels, BelgiumTelephone: +32 (0)2 566 9150 Facsimile: +32 (0)2 566 9159E-mail: reception@ogp.org.uk Internet: www.ogp.org.uk
OGP Report Number 491
Prevention of heartattacks and othercardiovascular diseasesA guide for managers, employees and
company health professionals
All photographs reproduced courtesy of Shutterstock.com, except pages 8, 26, 27 and 30 which arecourtesy of iStockphoto.com, and page 12 which is courtesy of Bibiphoto/Shutterstock.com.
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PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Contents
Executive summary 1
Introduction 3
What is a heart attack? 3
Symptoms of a heart attack 4
The brain and strokes 5
Hypertension (abnormally high blood pressure) 7
What is blood pressure? 7
Normal blood pressure 7
Interpreting the BP readings 8
When to treat hypertension 8
Non-medical treatment 9
Medical treatment 9
Smoking 10
Smoking and cardiovascular disease 10
Smoking and respiratory disease 11
Smoking and cancer 11
Other adverse health effects 11
Smoking in the workplace 11
Metabolic disorders 13
Cholesterol and triglycerides 13
Elevated blood sugar levels 14
What can the oil and gas industry do? 16
Physical inactivity 17
Health impacts of physical inactivity 17
How much physical activity do we need? 18
Risks and benefits of physical activity 18
Obesity 19
Psychosocial origins of the epidemic 19
Obesity and the oil and gas workforce 20
What can the oil and gas industry do? 20
Nutrition and diet 21
Nutrition and cardiovascular disease 21practical behavioural changes
What can the oil and gas industry do? 22
Alcohol 23
Lack of sleep 24
Sleep disorders 24
How sleep affects you heart 24
Practical behavioural changes 24
What can the oil and gas industry do? 25
Stress 26
What is stress? 26
How stress affects the heart 27
Warning signs of stress 27
Employees role in stress reduction 27
What can the oil and gas industry do? 28
The ageing workforce and cardiovascular risk 29
Characteristics of the older workforce 29
What oil and gas companies can do to 30address the risk of cardiovascular disease
Why should companies address the issue? 30
What can companies do? 30
Conclusion 31
References 32
Glossary 36
Appendices
Appendix 1Workplace health promotion 38(or cardiovascular prevention) checklist
Appendix 2H-Factor Programme 40(Sample of an information leaflet on prevention programmes aimed at employees within eni-Saipem)
Appendix 3Healthy workplaces: a model 43for actionFor employers, workers, policy-makers and practitioners (a World Health Organization guide)
Overview
Heart attacks and strokes related tocardiovascular disease (CVD) are the main causesof death among people working in the oil andgas industry today. This reflects a trend in thewider global population: worldwide, 13 millionpeople died of heart attacks and strokes in 2011,and CVD-related deaths per head of populationare increasing.
Although primarily non-occupational, and oftena consequence of lifestyle choices, cardiovasculardiseases represent a significant challenge to thecurrent and future operational and financialperformance of the oil and gas industry.
Designed primarily for company medicalprofessionals and line managers, this documentprovides basic guidance on the main types ofCVDs and their causes and symptoms.
The report also looks at some implications ofcardiovascular diseases for the oil and gasindustry, and offers strategies and improvementsthat can be implemented to help reduce thenumber of CVD-related deaths in future.
A reference section indicates additional sourcesof information relating to CVD. The appendicesinclude three useful tools that can help toreduce the incidence of workforce CVDs byraising awareness of their risks, causes,symptoms and outcomes, and also to promotehealthier lifestyles, both at work and at home.
Raising understanding and awareness ofheart attacks and strokes, and the maincauses of cardiovascular disease.
The main body of this report provides an
introduction to heart attacks and strokes,
including their symptoms and potential industry
responses. It also offers a guide to the most
common causes of cardiovascular disease while
suggesting optionsboth non-medical and
medicalfor reducing the risks.
The main causes of CVD include: hypertension (abnormally high blood
pressure); smoking and the use of smokeless tobacco; metabolic disorders; physical inactivity; obesity; nutrition and diet; alcohol; sleep disorders; stress; and ageing.
Oil and gas industry responses to the riskof cardiovascular disease
Global trends suggest that the oil and gas
industrys future workforce may be more
susceptible to lifestyle choices that can increase
the incidence of CVD. For this reason it is
essential for companies to put in place risk-
based health promotion programmes that are
capable of addressing this lifestyle problem.
Without such efforts, the future repercussions
are likely to have a negative impact on the
industrys business.
This report urges the industry to implement
initiatives to promote workforce well-being and
to sustain them over the long term. It is essential
to understand that the risk of CVD is a global
problem that is likely to worsen both worldwide
and in the oil and gas sector. Data on the issue
should be collected over time and used to
coordinate mitigation efforts and provide
feedback to management.
Specific and general recommendations to
address CVD are contained throughout the
report. It suggests that effective company
leadership has a key role in promoting workforce
well-being and reducing CVD risk factors.
Among actions recommended by the report are
the implementation of health assessments and
screening; awareness, education and training;
promotion of risk factor reduction, such as
1
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Executive summary
smoking prevention and reduction, healthier
diets, increased physical activity, stress
prevention and reduction, and fatigue
management.
One suggestion in this regard is that the industry
should consider involving the families of its
workers in the reduction of CVD risk through the
provision of initiatives, such as family fitness
days, promoting healthy diets and lifestyles.
Conclusion
Awareness and prevention of cardiovascular
diseases, although a non-occupational problem,
can have a positive impact on business. For this
reason it is imperative that the industry develops
and sustains health management programmes
that address this issue.
The work location is often the first place where
cardiovascular risk factors are identified and
where steps can be implemented to provide
treatment or prevention. However, it must be
clearly understood that the onus of prevention
and treatment rests with individual employees
and not the company or industry.
The oil and gas industry is unique because work
often takes place at remote locations where
medical care may be limited and that are long
distances from specialist treatment centres. For
this reason, regular health assessments can help
identify and reduce risk factors, and define
individual action plans to promote healthy
lifestyles, improve the quality of life and reduce
medical bills. Healthy individuals have a greater
chance of living longer.
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superior vena cava
right coronary artery
left coronary artery
aorta
pulmonary artery
inferior vena cavaleft ventricle
right ventricle
Cardiovascular diseases (CVDs), i.e. heart attacks
and strokes, are the main causes of death within
the oil and gas industry.
Within the general population, it is estimated
that more than 13 million deaths occur
worldwide as a result of ischaemic heart disease,
stroke or other form of cerebrovascular disease;
this is more than 10 times the number of yearly
deaths caused by road vehicle accidents.
Heart attacks and strokes, considered as non-
occupational illnesses, are mainly due to the
coexistence of numerous cardiovascular risk
factors due to lifestyle issues which, along with
ageing, increase the death toll.
The more cardiovascular risk factors one
accumulates over the years, the greater the risk
of having a heart attack or stroke at an early age
with increased potential severity. The major
cardiovascular risk factors include: high blood pressure; tobacco use; high levels of cholesterol in the blood; high levels of sugar in the blood; physical inactivity; overweight or obesity; poor nutrition (an unhealthy diet); and alcohol use;
and to a lesser degree: lack of sleep; and poor stress management.
Other cardiovascular diseases (peripheral arterial
diseasealso known as peripheral vascular
disease; rheumatic heart disease; congenital
heart disease; deep vein thrombosis; and
pulmonary embolism), although potentially
severe, are responsible for far fewer deaths per
year in the world.
The work location is often the first place where
cardiac risk factors are identified and where steps
can be taken to provide treatment or remedy.
However, it must be clearly understood that the
onus of prevention and treatment rests on the
individual and not on the company or industry.
This basic guidance document is designed for
doctors, medical professionals, employees and
line managers, and outlines a number of
strategies and improvements that the oil and gas
industry can implement to reduce the number of
CVD-related deaths in the years to come.
What is a heart attack?
A heart attack (also called a myocardial
infarction, coronary thrombosis or coronary
occlusion) is a condition caused by the complete
blockage of one or more of the coronary arteries
or its branches, i.e. the blood vessels that supply
blood and oxygen to the heart muscle.
This condition commonly occurs in men over 40
years old and to a lesser degree in women over
50 years of age after the menopause. Heart
attacks can also occur in men in their 20s and
30s with a family history of premature coronary
artery disease.
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PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Introduction
Above: the heart is a
muscle that pumps
blood to the organs
of the body. Located
in the thorax,
between the two
lungs, the heart
beats approximately
70 times a minute or
more than 100,000
times per day, every
day throughout life!
In one day the heart
will have pumped
more than 30,000
litres of blood. The
heart rate increases
during exercise, fear
and excitement.
Figure 1 The human heart
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With the worldwide increase in female
consumption of tobacco, women are rapidly
catching up with men in terms of heart attack
frequency and age of occurrence.
Ageing and the cardiovascular risk factors can
lead to a narrowing and hardening of the
arteries in the body. This is called arteriosclerosis.
In the coronary arteries, which irrigate the heart,
this results in reduced blood flow to the cardiac
muscle. If a build-up of fatty deposits
(atherosclerosis), a blood clot or spasm totally
clogs or constricts one of the previously
narrowed arteries the result is a heart attack. If
the blood flow is not restored quickly, the heart
muscle becomes damaged from lack of oxygen
and begins to die. This is an emergency.
Symptoms of a heart attack
The typical symptom of a heart attack is chest pain,which: is most often severe, persistent, and described
as tightness, squeezing or a crushing
sensation usually located in the centre of the
chest behind the breastbone or sternum; it
may mimic heartburn in some cases;
spreads to the neck, back, jaw, shoulders or
arms (particularly the left arm and hand); lasts for more than 15 minutes, sometimes
coming and going; occurs at rest or during activity; is often accompanied by palpitations,
fainting, cold sweats, nausea or vomiting,
shortness of breath, and a feeling of fear,
anxiety, imminent death or impending doom;
and may be accompanied by signs of shock or
loss of consciousness.
Figure 2 Causes of a heart attack
Women are less likely to survive heart attacksthan men!
Women are just as vulnerable to heart attacks asmen, and represent nearly half of the heart attackdeaths worldwide. To put this in perspective,women have a much greater chance of dying of aheart attack than of dying from breast cancer.Because the menopause is a cardiovascular riskfactor, women tend to experience heart attacksabout 10 years later than men.
Heart disease has often been mistakenlyconsidered to be a mans disease. And becauseheart attack symptoms in women are often verydifferent to those experienced by men, womenare less likely to realize, or even to believe, thatthey are having a heart attack. It is common forwomen to fail to recognize the symptoms of aheart attack and, as a consequence, women aremore likely to delay emergency treatment.
The most common heart attack symptom forwomen, as in men, is pain or discomfort in thechest. However, more than 40% of women reporthaving no chest pain or discomfort prior to, orduring, their heart attack. This absence of chestpain can result in lost time and incorrect diagnosison the part of the receiving medical professional.
Major symptoms in women during a heart attackoften include one or more of the followingthese may also be responsible for additional losttime and incorrect diagnosis:
unusual fatigue sleep disturbance
sleep disturbance shortness of breath;
indigestion anxiety
cold sweats dizziness
1. Atherosclerosisthe artery is cloggedwith fatty substances, e.g. cholesterol
2. Blood clotprone to developing inarteries affected by atherosclerosis
3. Spasma temporary constrictionin the artery wall
1
23
Above: a heart attack
occurs when the
blood vessels that
supply the heart
become blocked. This
can result from a
narrowing of the
arteries due to fatty
deposits, which in
turn can encourage
the formation of
blood clotsthe
most common cause
of a heat attack. A
less common cause is
a spasm, i.e. a
sudden, temporary
tightening of the
muscles in the walls
of artery.
A suspected heart attack is a medical
emergency requiring urgent attention.
Treatment is most effective when administered
within the first hour (the golden hour) after
the onset of symptoms. The faster a person
having a heart attack is transferred to
emergency facilities where the clogged arteries
can be unclogged, the greater his or her
chances of surviving.
Unfortunately, almost one-third of all heart
attacks are silent and go completely
unrecognized. They do not produce symptoms
of chest pain, and the victim may be treated for
a non-cardiological problem. For example, chest
discomfort may be confused with indigestion or
anxiety. In such cases, patients have a greater
risk of dying than those who experience the
typical severe chest pain of a heart attack.
Any chest pain which lasts for more than 15
minutes must be considered a heart attack, and
the victim should be transported to a medical
facility as a matter of urgency.
The brain and strokes
What is a stroke?
A stroke is the clogging or bleeding of an artery
in the brain provoking the partial or total
destruction of one or more of the specialized
nerve centres. This medical emergency can result
in neurological damage (e.g. partial or total
paralysis of a limb or an entire side of the body
(hemiplegia), speech impairment (aphasia), vision
or memory loss, etc., coma, disability and death.
Irreversible damage appears when the brain tissue
is deprived of oxygen for more than three hours.
Ischaemic strokes, i.e. those caused by a blood
clot which cuts off the flow of blood to the brain
(also called brain attack or acute ischaemic
cerebrovascular syndrome) are responsible for
more than 80% of all strokes observed. Less
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PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
The brain is a highly
developed computer
made up of billions of
nerve cells or neurons
with various specialized
nerve centres that
coordinate and
regulate everything in
the bodyfrom the
memory, reasoning
and emotions to the
heart beat, breathing
and body temperature
as well as the mobility
and sensitivity of the
body. Blood is carried
to the brain by the
carotid and vertebral
arteries which branch
out into a complex
arterial network within
the brain.
Figure 3 The human brain
common are haemorrhagic strokes which occur
when a weakened blood vessel ruptures, causing
bleeding into the brain.
Strokes affect men more often than women.
Ageing (most strokes appear over 65 years of age
but they can appear at any age) and the same
cardiovascular risk factors that produce a heart
attack are responsible for ischaemic strokes.
Symptoms of a stroke
Early recognition and treatment of a stroke is
essential in order to reduce the severity and
increase the chances of total recuperation.
The US National Stroke Association has identified
the Act FAST rule for rapid recognition of a
stroke:
F for Face: Ask the person to smile. Does oneside of the face droop?
A for Arms: Ask the person to raise both arms.Does one arm drift downward?
S for Speech: Ask the person to repeat a simplephrase. Is their speech slurred or strange?
T for Time: If any of the above signs appearcontact the local emergency service immediately.
Cardiovascular risk factors
The major cardiovascular risk factors are
summarized in the Introduction on page 1.
Whilst steps can be taken to reduce the risk of
CVD from these factors, there are several other
cardiovascular risk factors which cannot be
changed. These include:
Age: the older one gets the greater the risk.More than half of all heart attacks and
ischaemic strokes take place after the age
of 65. Gender: men are more likely to develop
cardiovascular problems than premenopausal
women (however, once past the menopause,
a womans risk is similar to that of a man). Heredity: if there is a history of heart attacks
in a family, particularly under the age of 55,
the likelihood of having a heart attack
increases.
The good news is that it is possible to reduce
the effects of the majority of cardiovascular risk
factors by modifying certain poor lifestyle
habits. However, it is important to realize that
all of the cardiovascular risk factors are
intertwined, for example: smoking increases
blood pressure; stress and smoking increase
levels of bad cholesterol; and lack of sleep
increases obesity and blood pressure.
The following sections review each of the
cardiovascular risk factors and identify what the
individual and company can do to reduce the
risks.
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Figure 4 Causes of a stroke
Smoking, alcohol,
obesity and stress,
among other factors,
are important
contributors to heart
attacks and strokes.
blood clot
cerebral artery
Above: an ischaemic
stroke occurs when a
blood clot lodges in
an artery causing a
blockage, which in
turn cuts off the flow
of blood to the brain.
Less common are
haemorrhagic
strokes (not shown on
the diagram) which
occur when a blood
vessel ruptures,
causing bleeding
into the brain.
Hypertension is a major and highly prevalent
aetiological factor in the development of
cardiovascular disease as well as heart and
renal failure. It is estimated that around 1,000
million people worldwide suffer from
hypertension; this number will continue to rise
over the coming years due to increased life
expectancy and the other cardiovascular risk
factors reviewed in this document.
Hypertension alone is estimated to cause 4.5%
of the disease burden globally, which is more
than that caused by tobacco or alcohol.
What is blood pressure?
Blood pressure is the pressure exerted by the
blood on the walls of the arteries. It is described
using two numbers, such as 120/80. The top
number is the systolic pressure, which
corresponds to the pressure in the arteries when
the heart contracts. The bottom number is the
diastolic pressure, which corresponds to the
blood pressure in the arteries when the heart
rests between heartbeats.
A stethoscope and inflatable cuff-like
manometer (sphygmomanometer) placed
around the arm are all that is required to
measure blood pressure. Blood pressure
readings should be taken on both arms and can
be expressed either in millimetres or centimetres
of mercury (Hg).
Having ones blood pressure checked is a simple,
painless medical activity that only takes a few
minutes, but which can save lives by preventing
a heart attack or stroke years later. If high blood
pressure is diagnosed and confirmed, treatment
is required.
Blood pressure should be measured with a
properly calibrated instrument which has an
adequately-sized cuff (i.e. the width of the cuff
should be 40% of the circumference of the limb
testedcuffs that are too small or too large will
produce erroneous results). The test should be
carried out with the patient in a seated or lying
position, after a minimum five-minute rest and
with the arm to be measured resting level with
the heart. It is also advisable for the
measurement to be taken two or three times, for
example at the beginning, during and at the end
of the consultation. It is possible for an
individual to carry out a self-measurement if
properly trained. This may benefit patients by
allowing them to monitor their blood pressure
response to antihypertensive medication,
thereby improving patient adherence to therapy.
Normal blood pressure
The accepted threshold for normal blood
pressure varies constantly over an individuals
lifetime, and even during each 24-hour cycle.
Normal blood pressure for an adult (age 18 and
above) is considered to be 120/80 mm Hg.
Variations of this value can be considered in
respect of an individuals age (e.g. the elderly),
sex and possible coexisting morbidities (e.g.
type 1 diabetes, coronary artery disease, chronic
kidney disease).
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PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Hypertension (abnormally high blood pressure)
Blood pressure
should be measured
with a properly-sized
and calibrated
instrument, with the
subject in a seated or
lying position, after a
five-minute rest and
with the arm resting
level with the heart.
It is natural for blood pressure to vary during the
day, from one day to the next, and in reaction to
stressful situations, depending on a variety of
factors. Repeated measurements of blood
pressure are therefore recommended before
establishing the diagnosis. One elevated blood
pressure reading does not mean that a person has
high blood pressure; however, such a reading
should be followed by additional measurements
over a period of several weeks. The physician may
wish to monitor an individuals blood pressure at
home via a 24-hour monitoring device. This
process is called ambulatory blood pressure
monitoring (ABPM) and records blood pressure
values during the wide range of situations and
activities that a person experiences throughout
the day, including during sleeping periods. The
averages of the 24-hour values that are used to
diagnose hypertension are a systolic
measurement above 129 mm Hg, or diastolic
measurement above 80 mm Hg.
Interpreting the BP readings
Normal blood pressure is considered to be
The goal of hypertensive therapy is the
reduction of cardiovascular and renal morbidity
and mortality by lowering the blood pressure.
An untreated hypertensive patient is at great
risk, not only of developing a disabling or lethal
CVD (e.g. left ventricular failure, myocardial
infarction, stroke) but also of renal failure and
retinal affections of the eyes. Effective medical
control of hypertension will prevent or forestall
all complications and prolong life in patients
with elevated numbers such as a diastolic blood
pressure greater than 90 mm Hg.
In clinical trials, antihypertensive therapy has
been associated with average reductions of
3540% in stroke incidences; 1525% in
incidences of myocardial infarction; and more
than 50% in incidences of heart failure.
Non-medical treatment
Non-medical treatment mainly addresses
lifestyle modifications and the management of
coexisting conditions (e.g. diabetes, cholesterol).
Lifestyle modifications may contribute to
preventing and reducing hypertension at all
stages of the condition; however, these
modifications are not always enough to
normalize BP even though they may reduce it
by up to 1015 mm Hg.
Lifestyle modifications that can reduce blood
pressure and prevent hypertension include: reducing weight in individuals who are
overweight or obese; implementing dietary measures to reduce salt
intake (to less than 5 g/day), and control
diabetes and blood lipids (fats); increasing physical activity; moderating alcohol consumption; and cessation of smoking.
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PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Non-medical
treatment, such as a
healthy diet to help
lose weight, reduce
salt intake and
control diabetes,
may contribute to
reducing blood
pressure by up to
1015 mm Hg.
Medical treatment
When an individual is not able to normalize
blood pressure through lifestyle modifications
alone, certain blood pressure-reducing
medication may be required. This will need to be
prescribed by a physician. The goal of such
medication is to bring the individuals elevated
blood pressure down to acceptable levels.
Antihypertensive medications should be taken
by those people who have: Stage 1 hypertension, or a 24-hour ABPM
average of 130/80 and above, plus any of
the following:
target organ damage;
established cardiovascular disease;
renal disease; or
a 10-year cardiovascular disease risk of 20%
or more. Stage 2 hypertension.
Successful medical treatment of blood pressure
requires regular medical monitoring and
follow-up.
It should be clearly understood that
hypertension is a chronic condition which, in the
majority of cases, requires lifelong treatment.
It is also important to be aware that any
termination of medication will result in a
reappearance of the cardiovascular risk.
The term smoking refers to the use of cigarette,
pipe, cigar and shisha tobacco.
Many people revert to smokeless tobacco, such
as chewing tobacco, spit tobacco, chaw and
snuff, thinking that these are safer because they
dont involve smoking. False! Smokeless tobacco
is highly addictive, delivers twice the nicotine
dose of one cigarette, and causes numerous
health problems.
The US Centers for Disease Control (CDC)
reports that adverse health effects from
tobacco use account for an estimated 443,000
deaths, or nearly one in every five deaths, each
year in the USA.
According to the World Health Organization
(WHO), tobacco kills nearly 6 million people each
year, of whom more than 5 million are users and
ex-users, and more than 600,000 are non-
smokers exposed to second-hand smoke.
More deaths are caused each year by tobacco
use than by all deaths from human
immunodeficiency virus (HIV), illegal drug use,
alcohol use, motor vehicle injuries, suicides and
murders combined. Smoking causes an
estimated 90% of all lung cancer deaths in men,
80% of all lung cancer deaths in women, and is
the cause of an estimated 90% of all deaths from
chronic obstructive lung disease.
Smoking and cardiovascular disease
Smoking is widespread. It increases the risk of
coronary heart disease and can lead to the
development of peripheral vascular disease
resulting in reduced blood circulation.
Cigarette smoking damages the lining of
arteries, leading to a build-up of fatty material
(atheroma) thereby reducing the space for blood
to pass through. The carbon monoxide in
cigarette smoke reduces the amount of oxygen
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Smoking
that the blood can carry to the heart and body.
Nicotine in cigarettes stimulates the body to
produce adrenaline, which increases the heart
rate and raises blood pressure, resulting in the
heart having to work harder. This increases the
tendency for blood to clot.
Smoking decreases exercise tolerance and leads
to a decrease in high density lipoprotein (HDL),
i.e. the good cholesterol. It also increases the
risk of abdominal aortic aneurysm. Studies have
shown that cigarette smoking is an important
risk factor for stroke; inhaling cigarette smoke
produces several effects that can damage the
cerebrovascular system. Women who smoke and
use oral contraceptives are at increased risk of
both coronary heart disease and stroke.
When combined with a family history of heart
disease, cigarette smoking also seems to greatly
increase the risk of cardiovascular disease.
Passive smoking, where non-smokers breathe in
second-hand smoke from people around them,
is also harmful. Research has shown that non-
smokers who live with smokers have a greater
risk of coronary heart disease than those who
do not.
Smoking and respiratory disease
Smoking has been linked to a number of
respiratory diseases, including: chronic obstructive pulmonary (lung) disease
(COPD)a group of diseases including
chronic bronchitis and emphysema; lung cancer and other cancers of the oral
cavity, esophagus and larynx; and asthma.
Smoking and cancer
Smoking is known to cause the following
cancers: bladder cancer; acute myeloid leukaemia; cancer of the cervix; cancer of the oesophagus; kidney cancer; cancer of the larynx (voice box); lung cancer; cancer of the oral cavity (mouth); cancer of the pharynx (throat); stomach cancer; and cancer of the uterus.
Although smokeless tobacco does not produce
respiratory problems or lung cancer because
there is no smoke inhalation, its use had led to
an increased incidence of cancers of the throat,
tongue and mouth. Oral cancer is a particularly
deadly form of cancer, killing 30% to 50% of
newly diagnosed individuals within five years.
Other adverse health effects
Smoking can have adverse affects on
reproduction, pregnancy and small children. It
increases the risk of: infertility; preterm delivery; stillbirth; low birth weight;
sudden infant death syndrome (SIDS); and predisposition of smokers children to
respiratory illnesses (e.g. asthmas, more
frequent colds, etc.).
Dental problems are very common for users of
smokeless tobacco, and include gum and tooth
decay, discoloured teeth, loss of teeth, and bad
breath as well as a decreased sense of taste and
smell. Smokeless tobacco users are also at
higher risk for heart disease and high blood
pressure.
Smoking in the workplace
Employers can improve the health of their
employees by creating a smoke-free workplace
and promoting smoking cessation initiatives.
Smoking in the workplace will commonly target
cigarettes, pipes, cigars and shishas.
Many state and local governments now require
workplaces to be smoke-free and/or designated
areas to be set aside for use as smoking areas.
Benefits of a smoke-free workplace
Benefits for employees include: reduced exposure to cigarette smoke and, as
a consequence, a reduction in the incidence
of smoking-related diseases; saving money; motivation of smokers to stop smoking; and reduced risk of work-related fires.
Benefits for the employer include: promotion of a healthier and safer work
environment; reduced downtime due to smoking breaks; reduced absenteeism; reduce medical expenses; and reduced office maintenance costs (cleaning,
carpets, furniture, etc.).
11
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Smoke-free workplace programme
Steps to creating a smoke-free workplace
include: Developing a policy and a plan: company
management and human resources officials
should work to define a no-smoking policy
and the manner in which it will be
implemented across the workplace.
Employees and management should work
together to define a successful smoke-free
work place programme, and identify areas
that can be designated and clearly marked as
smoking areas. The company should create
awareness and information programmes to
inform staff and employees about the
dangers of smoking, and promote cessation
programmes (e.g. patches, consultations, etc.). Creating a supportive environment:
for example, avoiding discrimination against
smokers, and making sure that the emphasis
is on encouraging smokers to engage with
their health rather than penalizing them for
being tobacco users. Initial studies suggest that electronic
cigarettes do not have negative effects on the
cardiovascular system but do affect lung
functions. Further study will be necessary
before firm conclusions can be drawn about
the safety of electronic cigarettes, and this is
an important reason why any policy for
smoking in closed spaces/offices should apply
to electronic cigarettes as well as real
cigarettes.
IPIECA OGP
12
13
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Metabolic disorders
Cholesterol and triglycerides
Cholesterol and triglycerides are two types of lipid
(or fatty substance) found in all parts of the body,
including the bloodstream. They are essential to
human life but, in excess, can be harmful.
Cholesterol is produced by the liver and is also
consumed in the foods that we eat. It is a
structural component of cell membranes and is
used in the production of hormones, vitamins
and bile acids. The main sources of dietary
cholesterol are meat, poultry, fish, eggs and
dairy products. Certain meats are especially high
in cholesterol content, while foods of plant
origin contain no cholesterol.
Triglycerides are the main form of fat in the
body. Their main purpose is to supply the bodys
energy needs. Consumption of meats, other
fatty foods, and foods that are high in sugars or
starch can increase the levels of triglycerides in
the blood.
Types of cholesterol
Cholesterol and triglycerides are transported
around the body within soluble carriers known
as lipoproteins. There are different types of
lipoproteins, each classified by density; the lower
the density of the lipoprotein the greater the
amount of fats contained within it. This
characteristic is used to identify the different
types of cholesterol in the blood: LDL cholesterol (low density lipoprotein) is
the bad cholesterolelevated levels are
associated with an increased risk of coronary
heart disease, stroke and peripheral arterial
disease. HDL cholesterol (high density lipoprotein) is
the good cholesterolits presence prevents
atherosclerosis by extracting the bad
cholesterol from the artery walls. Total blood cholesterol is the sum of LDL and
HDL cholesterol, and also includes a
percentage of triglycerideselevated levels
of triglycerides are associated with certain
diseases including cardiovascular diseases.
Table 1 The cardiovascular risks associated with different levels of cholesterol and triglycerides in the blood
(internationally accepted normal levels are indicated in bold)
Types of cholesterol / lipid
Levels of cholesterol and triglycerides in the blood
Associated cardiovascular risk
Total cholesterol
Associated cardiovascular risks
Table 1 shows the degree of cardiovascular risk
associated with various concentrations of
cholesterol and triglycerides in the blood. The
internationally accepted norms for cholesterol
and triglyceride levels are indicated in bold text.
Note that increased blood levels of LDL
cholesterol and reduced blood levels of HDL
cholesterol are strongly associated with
cardiovascular disease.
Factors influencing cholesterol andtriglyceride levels
Numerous factors are responsible for increasing
the levels of cholesterol and triglyceride in the
blood, such as diet, obesity, sedentary lifestyle
and smoking.
Several medical conditions, including diabetes,
hypothyroidism (decreased thyroid function),
liver disease, and chronic renal (kidney) failure
can also increase cholesterol levels. Some
medication, especially steroids, can also increase
cholesterol levels.
Diets rich in cholesterol and saturated fats
increase LDL levels. This bad cholesterol is
responsible for the creation of fatty deposits in
blood vessels. Over time these deposits narrow
and obstruct the arteries (atherosclerosissee
image below).
Measures that can be proposed to reduce
elevated cholesterol and triglyceride levels
include: educating the workforce; promoting healthy foods (fruits, vegetables,
fish) and reduced portion size; ensuring that the workforce is aware and
informed of the food sources and risks of
elevated cholesterol and triglyceride levels; providing a visible and appetizing, low-fat
healthy food option, and reducing the
amount of trans fats in workplace menus; educating the workforce concerning the risks
of alcohol and sugar in elevating triglyceride
levels; and encouraging the workforce to identify their
individual risk factors through screening and,
where necessary, to seek medical care for
treatment.
Elevated blood sugar levels
Glucose and its function
Glucose is a sugar that is vital to human health.
When glucose is metabolized in the body it
provides energy to the cells. The muscles and
brain must have a supply of glucose as a source
of energy to function.
Diabetes
Diabetes mellitus, or simply diabetes, is a chronic
metabolic condition where the level of blood
glucose (blood sugar) has become too high. This
occurs when the body does not produce enough
insulin (which helps cells to absorb the glucose
from the blood), or when the body cannot
effectively use the insulin it produces.
Diabetes is characterized by fasting blood sugar
levels of 125 mg/dl (7.0 mmol/l) or higher and,
over time, can lead to serious damage to
several of the bodys organs, especially the
blood vessels and the nerves.
IPIECA OGP
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15
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
In some people, the level of blood glucose may
be higher than normal but not yet high enough
to indicate diabetesin this case the condition
is known as pre-diabetes.
According to World Health Organization, there
are currently 347 million people living with
diabetes worldwide. The number is estimated to
rise to more than 460 million by 2030.
Types of diabetes
There are two main types of diabetes: Type 1 diabetes: previously known as insulin-
dependent diabetes, this develops when the
bodys immune system mistakenly destroys
the insulin-producing cells in the pancreas. As
a result, the body is unable to produce insulin.
Type 1 diabetes is usually diagnosed in
children and young adults. Type 2 diabetes: previously known as non-
insulin dependent diabetes, this occurs when
the body does not produce enough insulin, or
when the body becomes unable to use the
insulin it produces (insulin resistance). It is the
most common form of diabetes, representing
90% of diabetes cases worldwide, and can
develop at any age. It is often associated with
obesity, lack of physical activities and poor diet.
Diabetes may also occur during pregnancy,
when some women produce higher than normal
levels of glucose in the blood. When diabetes is
diagnosed during pregnancy it is referred to as
gestational diabetes.
Pre-diabetic state
Pre-diabetic individuals are those people with a
fasting blood glucose level between 100 mg/dl
(5.55 mmol/l) and 125 mg/dl (6.94 mmol/L) and
are at significant risk of developing type 2
diabetes within the next 10 years.
The following text deals exclusively with type 2
diabetes, the most common form encountered
globally and within the oil and gas industry, and
which is mainly lifestyle dependent.
Signs and symptoms of diabetes
A large number of people with elevated blood
sugar levels have no symptoms. When symptoms
occur, the following are common: increased thirst; frequent urination; excessive hunger; weight change; increased fatigue; changes in vision; tingling or numbness in the hands or feet; and recurring skin or other infections.
Managing elevated blood glucose levels
Type 2 diabetics can initially be managed with
a combination of diet and increased physical
activity, followed by medication if necessary
(oral medication or insulin injection). Careful medical management through weight
loss and lifestyle improvement may not only
reduce the need for medication but, in some
cases, may also retard the progression of the
disease and normalize blood sugar levels. The same factors can prevent a pre-diabetic
condition from evolving to full blown diabetes. The management of metabolic syndrome may
be necessary; this occurs when a range of
metabolic risk factors occur together in an
individual causing increased risk of heart
disease, stroke and diabetes. The set of risk
factors for metabolic syndrome includes:
Left: a diabetic
patient measuring
glucose levels in the
blood using a blood
glucose meter
HDL (good) cholesterol of less than
40 mg/dl (1.04 mmol/l) in men or less than
50 mg/dl (1.30 mmol/l) in women;
a triglyceride level of 150 mg/dl
(1.69 mmol/l) or greater;
high blood sugar levels with fasting blood
glucose of 100 mg/dl (5.55 mmol/l) or greater;
insulin resistance or glucose intolerance
due to improper functioning of insulin; and
abdominal obesity (i.e. excess body fat
around the waist).
Complications of diabetes
Long-term complications may include: cardiovascular disease (heart attack, heart
failure, stroke, etc.); chronic kidney failure; eye damage leading to blindness (e.g.
cataract, retinopathy, glaucoma); nerve damage; vascular disease of the limbs (i.e. leading to
gangrene and amputation); erectile dysfunction in men; and increased rate of infections.
What can the oil and gas industry do?
The following approaches are recommended to
provide awareness of the risks from metabolic
disorders and to help individuals avoid them: Create and sponsor company wellness and
healthy lifestyle programmes. Increase risk-based health promotion and
health education. Encourage health awareness, e.g. via a
diabetes awareness day or reduce obesity day. Promote healthy eating in company-
controlled catering facilities, e.g. through the
provision of free dietary consultations. Promote physical activity by setting up on-
site exercise facilities (in locations with large
numbers of employees) or subsidizing gym
membership, encouraging walking, jogging
and cycling. Provide free periodic medical checks for all
employees and their spouses.
IPIECA OGP
16
Near right: diabetes
can lead to a range
of complications in
addition to
cardiovascular
disease, including
for example eye
damge due to
cataracts,
retinopathy and
glaucoma.
Far right: providing
access to gym
facilities is just one
of a number of ways
in which the
industry can help its
employees reduce
the risks from
metabolic disorders.
17
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Physical inactivity
Individuals who do not undertake the minimum
recommended amount of daily physical exercise
required to maintain good health are said to be
physically inactive.
General day-to-day physical activity includes
walking, climbing stairs or cycling, occupational
(i.e. at work) and household activities, and
games. Physical activity may also include
scheduled sports or aerobic activity and/or
muscle-strengthening exercises that are usually
designed specifically to improve and/or maintain
physical fitness.
Health impacts of physical inactivity
Studies have demonstrated that physical
inactivity, also referred to as a sedentary lifestyle,
is associated with a number of illnesses including
cardiovascular diseases. The WHO indicates that
physical inactivity has been identified as the
fourth leading risk factor for global mortality,
and may account for an estimated 3.2 million
deaths globally. Physical inactivity is also
estimated to be the main cause of approximately
30% of heart attacks worldwide.
The health benefits of regular physical activity are
strongly supported by epidemiological studies:
regular physical activity is highly beneficial in
preventing CVDs (and in reducing the severity of
symptoms with individuals already suffering from
a CVD), whether people maintain an active daily
lifestyle and/or participate in scheduled physical
activity. Research shows that as much as half of
the functional decline between the ages of 30
and 70 is due not to ageing itself but to an
inactive way of life.
The direct and/or indirect benefits of regular
physical activity in reducing CVD risk factors are
summarized below: Improved blood flow to the heart muscle. Reduced blood pressure: regular exercising
mainly aerobic activitycan help to reduce
systolic (and, to a lesser extent, diastolic)
blood pressure by up 10 to 15 mm Hg. This is
achievable over a period of several months. Reduced blood fat levels: regular exercising
can decrease triglycerides and increase HDL
(good) cholesterol. A decrease in total and
LDL (bad) cholesterol is reported only when
weight loss and/or a reduction in dietary fats
are associated with regular physical activity. Improved body mass index (BMI), and healthy
changes in body composition towards more
lean muscle and less fat: regular physical
activityespecially when combined with a
lower calory dietcan contribute to losing
weight and reducing body fat. Improved blood sugar levels and decreased
insulin requirements. Reduced inflammatory biomarkers: regular
physical activity has a chronic anti-
inflammatory effect, triggering a reduction in
C-reactive protein (CRP) and other
inflammatory markers.
In addition to reducing CVD risk factors, the
practice of a regular physical activity has a number
of other positive effects such as reducing the risk of
breast and colon cancer, improving control ofor
even preventingnon-insulin dependent diabetes
mellitus. It also contributes to maintaining a
healthier musculoskeletal system, including
prevention of osteoporosis. Last but not least,
exercising reduces stress, and improves energy
levels, sleep and well-being, lowering the risk of
developing anxiety or depression.
Studies have shown
that individuals who
do not remain
physically active,
either through daily
activities or
scheduled exercising,
are at greater risk of
cardiovascular
disease.
How much physical activity do weneed?
Health agencies are actively promoting aphysically active lifestyle and have set a minimumrecommended amount of physical activity: A baseline average of 20 to 30 min of physical
activity every day in addition to the physicalactivity performed as part of the job functionand/or routine duties at home (for examplecooking or doing the laundry, walking to thecar park, or shopping).
Walking is probably the safest and easiestactivity that can be performed by everyone,and this could be optimized by simplepractices such as parking the car away fromthe office and/or taking the stairs instead ofthe elevators. Also consider the following tips: If you elect to engage in physical activities,
choose a practice you enjoy and set goals.This could involve playing golf, orswimming, etc.
Get into a routinego to the pool or gym,join a fitness class, or plan a regular run:this will ensure that you get somescheduled exercise.
Keep movingwhenever you can, walk,cycle or run instead of taking the car.
Limit the time you spend watching TV orsitting in front of a computer during leisuretime.
Spread your sessions of moderate tovigorous aerobic activity throughout theweek. Do at least 10 minutes of physicalactivity at a time.
Join a team or exercise with anotherpersontake part in sports and recreationactivities in groups.
A greater amount of physical activity beyondthe above baseline recommendations willprovide even greater health benefits.
Employers have a leading role to play in
promoting an active lifestyle. Creating a gym
within the office facilities or subsidizing
membership in health clubs, sponsoring walking
and/or cycling events, and/or providing
pedometers are good examples of simple but
very effective initiatives. Leaders have a role in
supporting workplace activity, demonstrating
healthy behaviour and encouraging others to
make time for physical activity.
Risks and benefits of physical activity
Epidemiological studies clearly demonstrate the
benefits of sustained physical activity over time.
It is recommended that all individuals planning
to embark on any form of exercise programme
consult with a health-care professional before
doing so.
IPIECA OGP
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19
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Obesity
Obesity is a global epidemic that presents
significant health risks to virtually all age groups
in both developed and developing countries. It
also poses particular challenges for the health-
care community when assessing the suitability
of workers for different occupational roles.
Epidemiological evidence suggests that levels of
obesity will continue to increase worldwide
unless a concerted global effort is undertaken to
address this ongoing problem.
Most people can check to see whether their
weight is healthy by using a measure known as
the body mass index (BMI). A persons BMI is
calculated by dividing their weight (in kilograms)
by their height (in metres) squared. For example,
an adult who weighs 70 kg and is 1.75 m tall will
have a BMI of: 70 (1.75 x 1.75) = 22.9 kg/m2
Obesity is generally indicated by a BMI above 30 (a
BMI of 25 indicates overweight). Current estimates
by the WHO indicate that almost one in 10 of the
worlds adult population is obese. In the oil and
gas industry, a conservative estimate is that more
than one-third of the workforce is overweight or
obese, and this is considered to be increasing.
There are several indicators for obesity, including
BMI and the measurement of the waist
circumference. The latter is the thought to be the
best indicator of cardiovascular risk, because BMI
is subject to variations in interpretation in
different populations and in varying individual
circumstances. For example, scientific evidence
shows that Asians tend to develop CVDs and
diabetes at lower BMIs than European people,
and bodybuilders and pregnant women have a
clear justification for the additional weight
relative to their height.
Although obesity can pose certain health and
safety risks it is imperative that such individuals
are not discriminated against in the work
environment. It is essential that oil and gas
companies put in place weight loss programmes
to address this issue, and where possible, work
categories should be tailored to accommodate
those who are overweight or obese.
Psychosocial origins of the epidemic
Below are some examples of changes which,
over the years, have driven a cultural shift
towards obesity: The development of modern transportation
and urbanization. Mass marketing and the availability of cheap,
abundant, high-calorie foods (i.e. fast food). The non-sustenance role of food. An increase in sedentary lifestyle and the
24-hour availability of food.
Overweight or obese people have a greater
frequency of suffering: high blood pressure; heart attacks; strokes; diabetes; sleep apnoea; osteoarthrosis of the hips and knees; and greater predisposition to some diseases (e.g.
certain cancers).
Obesity has become
an issue of epidemic
proportions around
the globe, and
presents a
considerable health
and safety risk.
IPIECA OGP
20
In addition, overweight and obese individuals
are often considered to be predisposed to: increased absenteeism; increased medical expenditures; and decreased life expectancy.
Obesity and the oil and gas workforce
Challenges specific to the oil and gas workforce
include the following: Many oil and gas operations take place in
remote locations (e.g. on offshore platforms)
which may be situated at a considerable
distance from the nearest specialist treatment
centre; the provision of medical assistance to
address problems related to obesity (as well
as other health problems) may therefore be
particularly challenging. Obesity can be considered a safety risk and
may influence fitness for duty in certain
circumstances (e.g. offshore vessels, confined
or narrow stairs, fire brigade rescue
operations, evacuation by lifeboat and
helicopter, etc.).
What can the oil and gas industry do?
Where possible, companies should: identify overweight and obese employees; raise awareness about the effects of overweight/
obesity, and the less well-known waist-to-
height ratio as well as BMI as a measure of risk. inform about, and promote, a healthy diet; require catering staff to provide healthy foods
that are identified as such (i.e. low in calories,
fat, sugar, salt, etc.), and encourage healthy
food habits (e.g. reducing calories, using well
prepared and tasty vegetables and desserts)
and a reduction in portion size; require catering companies to remove
artificial trans fats; encourage company walks, and distribute
pedometers; encourage the use of gyms, fitness clubs and
safe areas at work locations; reassign severely obese employees when
safety issues have been identified with regard
to their weight; and provide leadership to demonstrate support
for healthy eating and fitness.
Figure 5 Estimated obesity (BMI 30 kg/m2) prevalence (%), in males aged 15 and over (2010 data)
Source: adapted from Ono, T.,Guthold, R., Strong, K. WHO GlobalComparable Estimates, 2005. Theboundaries and names shown and thedesignations used on this map do notimply the expression of any opinionwhatsoever on the part of the WorldHealth Organization concerning thelegal status of any country, territory,city or area or of its authorities, orconcerning the delimitation of itsfrontiers or boundaries. Dotted lineson maps represent approximateborder lines for which there may notyet be full agreement. WHO 2012.All rights reserved.
21
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Nutrition and diet
Fuelled by urbanization and the growth of the
global economy, many developed and
developing nations are foregoing their
traditional patterns of eating in favour of a
Western diet typically high in animal products
and refined carbohydrates, and low in whole
grains, fruits and vegetables.
An unhealthy diet can have a direct impact on
many conditions that increase the risk of CVD,
including blood cholesterol levels, body weight,
blood pressure and blood glucose levels.
Adopting a healthy diet together with a healthy
lifestyle can reduce the risk of heart disease,
heart attacks and strokes, and can help to avoid
conditions that may eventually lead to heart
disease.
Nutrition and cardiovasculardiseasepractical behaviouralchanges
The following guidelines for healthy food and
nutrition can help to reduce or even eliminate
some cardiovascular risk factors.
Reduce salt intake
The amount of dietary salt consumed by an
individual has a direct impact on blood pressure
and cardiovascular risk. The WHO recommends a
salt intake of less than five grams (about one
teaspoon) per person per day. Adding salt to
food and eating foods containing high salt
levels, particularly processed foods, frequently
contribute to exceeding the recommended
intake of salt.
Reduce consumption of fats
It is important to limit saturated fats and trans
fats such as beef, pork, lamb, bacon, high-fat
dairy products, butter and most processed foods.
Preference should be given to monounsaturated
and polyunsaturated fats found in olive oil,
canola (rapeseed) oil, nuts, olives and avocados.
Tips to help reduce dietary cholesterol include: reduce the number of eggs consumed to two
per week ; remove skin from poultry before eating; remove fat from red meat before eating; choose non-fat or low-fat cheeses; limit total cheese intake to three meals
weekly; choose broth in preference to cream-based
soups; limit high-fat dairy foods; choose non-fat or
low-fat varieties; and favour grilling, boiling, steaming or
microwave cooking over frying and roasting.
Increase intake of dietary fibre
This can be achieved by: increasing consumption of fresh fruits and
vegetables; and consuming cereals, and whole grain breads,
crackers, pasta and brown rice.
Reduce intake of sugars and sweeteners
Tips to reduce intake of dietary sugars include: avoid sugar-sweetened beverages like sodas
or soft drinks, energy drinks, fruit drinks,
sweetened milk or milk alternatives; reduce the amount of sugar added during
meal preparation or baking; avoid foods with added sugars or sweeteners
(check labels for added sweeteners, e.g. cane
juice, glucose, maltose, fructose, high fructose
corn syrup and molasses); limit or eliminate candy, sweets and baked
products; favour foods such as fruits, vegetables, lean
proteins and whole grains in meals and snacks; reduce or eliminate processed foods, which
are often high in added sugar as well as fats
and sodium (salt).
Increase consumption of fruits, vegetables,legumes and nuts
Adequate consumption of fruit, vegetables and
legumes (beans, lentils, peas, etc.) reduces the risk
of cardiovascular disease, some cancers and other
chronic diseases, such as obesity and type 2
diabetes. Nuts are high in monounsaturated fat,
and can help to reduce the bad cholesterol and
prevent heart disease. Tips include: eat plenty of fruit and vegetables; aim for 1/2 cup of legumes at least four times
weekly; and
choose fresh or dry roasted, unsalted nuts
and natural peanut butter for maximum heart
protection. Avoid sugared, salted or oil
roasted varieties.
Substitute plant protein for animal protein
Replacing animal protein with plant protein and
fish can provide a range of health benefits and
reduce the risk of CVD. Tips include: choose legumes, dark leafy green vegetables
or quinoa as good sources of plant protein; reduce intake of animal proteins; and eat more non-fried fish.
Further advice
General advice for encouraging a healthy eating
plan includes the following: Skipping meals is not recommended Divide calories into 46 smaller meals. Avoid heavy meals before going to sleep. Practice portion control an awareness of
the recommended portion sizes for certain
types of foods can help maintain a good
eating plan.
What can the oil and gas industry do?
Oil and gas companies can have a positive
impact on the nutrition environment by
providing a worksite that is physically designed
to encourage good health. Examples include: Increasing the visibility and availability of
healthy food options where food is provided
in the workplace (e.g. in vending machines,
cafeterias, snack bars, common areas, and at
meetings and company-sponsored events. Utilizing marketing techniques at the point of
sale in company cafeterias to promote healthy
diet and food choices. Social marketing
techniques can be helpful in this respect. Providing adequate resources for refrigeration
and heating of foods so that employees can
bring healthy meals to work from home.
Promoting healthy
food in company-
controlled catering
facilities can help to
encourage good
health in the
workplace.
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22
23
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Alcohol
Alcohol contains nothing of nutritional value
no vitamins, no minerals and no proteins. But
with seven calories per gram, it does contain a lot
of calories. One standard-size glass of wine,
whisky or beer contains 12 grams of alcoholthe
equivalent of 84 calories. This explains why heavy
drinkers gain weight and develop a beer belly.
Chronic or excessive consumption of alcohol
causes digestive problems (gastritis, gastric
ulcers, and pancreatitis), increases the risk of
digestive cancers (mouth, tongue, throat,
esophagus, pancreas, colon and rectum) and
damages the liver, leading to cirrhosis.
Even moderate drinking affects cognitive
functioning; binge drinking and excessive
repeated consumption can cause brain damage
such as memory loss. Alcohol reduces libido and
sexual performance and, along with smoking, is a
major cause of impotency. Exposure of fetuses to
alcohol during pregnancy is the primary cause of
birth defects, especially for cognitive development.
Alcohol is a drug that can lead to dependency
and cause withdrawal symptoms. Dependence
on alcohol, i.e. alcoholism, is a progressive
disease that can be fatal.
Drinking alcohol also increases the likelihood of
having a driving accident because of decreased
awareness, visual perception, reflexes and overall
performance. Brain activity is slowed while
reaction time is increased, which explains the
high number of alcohol-related traffic fatalities.
A glass of wine or beer every now and then is fine
for many people. It can reduce tension and stress
and help people to relax. Certain studies indicate
that moderate drinking may have cardiovascular
benefits. However, it should also be remembered
that alcohol consumption can lead to increased
blood pressureone of the most important risk
factors for cardiovascular disease.
Alcohol contains nothing of value as far as
nutrition is concerned. Despite the fact that
some studies indicate that moderate drinking
may have cardiovascular benefits, alcohol is a
drug; even moderate drinking affects cognitive
functioning, whilst drinking in excess increases
cardiovascular risk.
Lack of sleep is a worldwide problem which
began with the invention of the electric light
bulb and has become increasingly prevalent
with the advent of modern screen-based
technology (e.g. televisions, computers,
smartphones, tablets, etc.).
Sleep disorders
There are many types of sleep disorders,
including insomnia, sleep apnoea, restless leg
syndrome, narcolepsy and circadian rhythm
disorders. Two of the most common are: Insomnia: the inability to fall asleep or remain
asleep. This results in the sufferer not getting
the amount of sleep needed to wake up
feeling rested. This is the most common
sleep-related complaint. Sleep apnoea: the most common type of
sleep apnoea is obstructive sleep apnoea
(OSA). OSA is responsible for pauses in
breathing accompanied by snoring, fatigue
the following day, decreased alertness and
heart attacks. The problem is often noticed by
the individuals partner and can be confirmed
by sleep studies.
How sleep affects your heart
The average sleep requirement for adults is
considered to be around 7 to 8 hours, although
what is considered normal sleep varies from one
person to another. The actual amount of sleep a
person needs will depend on various factors,
including age and genetics.
Insufficient sleep can contribute to: heart disease; high blood pressure; heart rate modifications; insulin resistance (which can lead to type 2
diabetes and obesity); compromised immune response; and hormonal imbalance.
Practical behavioural changes
While some sleep disorders require a visit to a
sleep specialist, individuals with minor sleep
disturbances can improve some problems on
their own. Recommendations to help overcome
sleep disturbances include the following: Keep a sleep diary to track your symptoms
and sleep patterns. This can create a starting
place for dialogue with your physician or a
specialist. Improve your sleep hygiene and daytime
habits:
Develop a bedtime routinethis will teach
your body to wind down before sleeping.
Keep a regular sleep schedule, including
during weekends.
Use a timer to record TV programmes that
are broadcast after scheduled bedtime, and
turn off gadgets before going to sleep.
Use the bedroom only for sleeping and sex.
Set aside enough time for sleep. Most
people need at least 7 to 8 hours to enable
them to wake up feeling refreshed.
If problems and stress are contributing to
lost sleep, develop a relaxation plan, e.g.
exercising regularly early in the day can
improve sleep at night by reducing stress.
Dont go to bed hungry; but be cautious of
overeating, since indigestion may disrupt
sleep.
Drink caffeinated beverages in moderation
and avoid alcohol at bedtime. The effects of
caffeine can take up to eight hours to
subside and alcohol can act as a stimulant.
Shift workers may need to explain to
friends and family the importance of
getting sufficient sleep, and the
consequences of tiredness on health and
safety.
Before bed, avoid the use of alcohol and
medicines, such as sleeping pills.
Eat sensibly, exercise, and maintain a
healthy body weight.
IPIECA OGP
24
Lack of sleep
25
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
What can the oil and gas industry do?
Disrupted sleep and fatigue have had a
significant impact on employee health and safety
at the worksite as well as on worker productivity.
A Fatigue Risk Management System (FRMS) can
identify sleep issues among employees and
reduce accident and injury rates significantly.
FRMSs need to be incorporated into corporate
policies and standards.
Sleep management is an integral part of an
FRMS which includes: workload-staffing balance; shift or duty rest scheduling; employee fatigue training; sleep disorder management; workplace environment design; and alertness monitoring and links to fitness for
duty.
Ideally, an FMRS will also include: appropriate staffing levels and hours of work
limits; fatigue identification, sleep management and
alertness training; accountability and regular review structures; continuous improvement processes; and metrics.
Senior leadership should acknowledge the
importance of the issue and actively provide
their support in addressing it. Senior leaders
should ensure that the workforce is provided
with education and awareness about managing
fatigue-related risks associated with shift-work.
Additionally, leaders should support the
environmental changes needed to reduce the
risks to safety.
Identification of the environmental issues, and
elimination of associated risks, are critical when
addressing fatigue. For example, important
questions may include: Do production platform sleeping quarters
provide an optimal place for sleeping; is the
temperature optimum; is it too noisy; and is
there a TV located in the room? If sleep schedules are specified for shift
workers, are they successful in optimizing
sleeping patterns or do they hinder them?
Fatigue can have
a significant
impact on
employee health
and safety at the
worksite as well
as on worker
productivity.
Stress is a normal part of life and is fundamental
to successful human performance. Stress can
give us a push to do our best in challenging
situations and to increase and maximize
performance and productivity. However,
unalleviated stress can affect our bodies, minds
and behaviour.
Unmanaged stress can lead to an increase in the
risk of heart disease. Learning how to recognize
the signs of stress and taking action to reduce its
harmful effects are important steps to
maintaining a healthy cardiovascular system.
What is stress?
Stress is the bodys reaction to any change that
requires an adjustment or response. The body
reacts to these changes with physical, mental
and emotional responses. There are two main
types of stresspositive and negative.
Positive stress typically results in an increase in
performance, focus and efficiency, while
negative stress is either an ongoing cycle that
becomes a way of life or a singular heightened
response to a situation where the stress
response is not called for (i.e. heightened stress
to being stuck in trafficas if our lives were in
danger when no danger exists).
Stress is affected by emotional and external
factors. Emotional factors involve a persons
evaluation of stressors, real or imagined. Examples
are hostility, anger, depression and anxiety.
External factors are stressors in ones environment,
such as natural disasters, work, change and
uncertainty, disease, marital and financial
problems, responsibility for others, everyday
annoyances and frustrations that accumulate and
overwhelm.
Stress can affect a person both instantly (acute
stress) and over a period of time (chronic stress),
as described below: Acute stress: this occurs when a person is
faced with an immediate threat or a need to
adapt, for example in the event of a personal
attack or a sudden noise. The threat may be
an actual danger or just something that is
perceived as threatening. The acute stress
response is commonly referred to as the fight
or flight response, and is inherited from our
distant ancestors who would frequently have
had to either fight or flee to protect
themselves from attack by marauding
invaders or wild animals. Chronic stress: this is ongoing and often
results from stressors encountered in modern
day living, such as financial concerns, job
pressures or relationship problems. This type
of stress suppresses the fight or flight
response, resulting in prolonged responses in
the body that prevent recovery and repair.
Each individual responds to lifes problems,
difficulties and everyday annoyances in their
own personal ways. For example, given the same
situations, some individuals will respond with
frustration and anger while others remain
relaxed and even-tempered. Evidence suggests
that it is the individuals reaction to situations,
crises and everyday eventsrather than the
stress itselfthat is the real problem.
IPIECA OGP
26
Stress
Chronic stress,
resulting from the
pressures of
modern-day living,
can have a
prolonged
detrimental effect
on the body if not
addressed.
27
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
How stress affects the heart
Stress alone does not provoke heart attacks. It is
the individuals poor response to stress over time
that can lead to heart disease.
Stress is also known to worsen other risk factors
such as high levels of cholesterol and high
blood pressure. Stress changes the way blood
clots develop and can increase the risk of a
heart attack if it continues without relief.
Frequently, many factors cluster together to
increase disease risk. For example, when people
are under stress their blood pressure goes up,
they may overeat and exercise less, and they
may be more likely to smoke.
Poor responses to stress often include increased
smoking, excessive eating, increased caffeine
intake, lack of sleep, increased alcohol and drug
abuse including excessive use of tranquilizers
and sleeping pills.
Good responses to stress include healthy eating,
physical activity and relaxation periods, and
sufficient sleep.
Warning signs of stress
Common signs and symptoms of stress include: physical signs: dizziness, general aches and
pains, grinding teeth, clenched jaws,
headaches, indigestion, muscle tension,
difficulty sleeping, racing heart, ringing in the
ears, stooped posture, sweaty palms,
tiredness, exhaustion, trembling, weight gain
or loss, upset stomach; mental signs: constant worry, difficulty
making decisions, forgetfulness, inability to
concentrate, lack of creativity, loss of sense of
humour, poor memory; emotional signs: anger, anxiety, crying,
depression, feeling powerless, frequent mood
swings, irritability, loneliness, negative
thinking, nervousness, sadness; and
behavioural signs: bossiness, compulsiveeating, critical attitude towards others,
explosive actions, frequent job changes,
impulsive actions, increased use of alcohol or
drugs, withdrawal from relationships or social
situations.
Employees role in stress reduction
There are a number of ways in which the
employee can manage his or her response to
stress. Some useful recommendations include: healthy eating; drinking in moderation; regular activity and/or exercise; avoiding excessive caffeine intake and the
consumption of energizing drinks; smoking cessation; and ensuring adequate sleep and rest.
Additional recommendations include: knowing and accepting ones limits; recognizing and admitting to ones mistakes; asserting oneself and assuming responsibility; managing time effectively; setting priorities; thinking positively and setting realistic
personal goals and expectations; and taking advantage of support groups,
including family, friends, colleagues, etc.
Stress can manifest
itself in a variety of
physical, mental,
emotional and
behavioural ways,
and in severe cases
can lead to more
frequent use of
alcohol and drugs,
thereby increasing
cardiovascular risk.
What can the oil and gas industry do?
Workplace leaders and managers are architects
of the work environment and need to attend to
those elements in the workplace that can
contribute unnecessarily to unalleviated stress.
Below are some specific areas that workplace
leaders need to pay attention to: Control over work: How much do employees
or workers actually understand about their
work? How engaged are they in the goals of
the work? How much control do they have
over how the work gets done? Are employees
working hours monitored with the aim of
avoiding excessive time spent working? Roles and responsibilities: Do workers
understand their roles and how their
responsibilities fit with the roles of their
co-workers? Communications: Does the workplace have a
commitment to clear and regular
communications about changes in the work
or organization? Is management available for
regular communications with employees?
Diversity: Is the workplace free fromprejudice, bullying and harassment? Are
workers open to, and respectful of, each
others differences? Recognition of positive performance: Is the
workplace an environment where the
achievements of work teams and individual
workers are celebrated and recognized? Conflict management: When differences
arise between workers, is there a clear avenue
for the reconciliation of these differences? Work/life balance: Is the company cognizant
of work/life boundaries? Do employees
perceive that managers and leaders
appreciate and honour the fact that they have
personal responsibilities and commitments?
These workplace variables are key to the
development of an environment where
unnecessary stress is reduced.
Good relationships
with management
and colleagues, and
a recognition of
employees
commitments and
responsibilities are
important aspects
of managing
workplace stress.
IPIECA OGP
28
29
PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
The ageing workforce and cardiovascular risk
It is not easy to define an older worker. The WHO
defines 45 years and over as the dividing line
between younger and older workers.
Ageing is not a disease but a biological process
that starts at birth. Although exercise, a proper
diet and good lifestyle choices have been shown
to slow down the ageing process, they cannot
reverse it.
In general, individuals may not have the same
strength or physical abilities at age 50 or 60 that
they had at 25 or 30.
However, age should not determine fitness to
work. There can be a significant difference
between the employees chronological age and
their physiological age. For example, a 60-year-
old individual may be fitter than a 40-year-old.
Characteristics of the olderworkforce
The consensus is that knowledge, skills and
experience are advantages for retaining older
workers. Older employees also have the
potential to provide training as well as to act as
role models for the younger generation of
employees.
Older workers are potentially as adaptable and
flexible in learning new technologies and coping
with change and stress as the younger
workforce.
However, duration of absenteeism and recovery
may be more significant and costly following
injury or illness in employees over 45 years of age.
The ageing process will result in increased
arteriosclerosis (hardening of the arteries),
hypertension and increased frequency of
cardiovascular illnesses (heart attacks and
strokes) as well as an increased frequency of
other chronic diseases (e.g. diabetes,
musculoskeletal disorders, cancer, kidney
diseases). These medical issues can be
responsible for work limitations or restrictions.
Emphasis should be placed on the
implementation of employee wellness
programmes that can contribute to allowing the
ageing workforce to work and be productive for
a prolonged period of time.
Health assessments and fitness-for-task
examinations should place adequate emphasis
on the following in the ageing population: blood pressure and the cardiac function; musculoskeletal strength; coordination and physical flexibility; visual acuity; hearing; and potential side-effects of medication taken for
chronic illness.
The oil and gas industry will be faced with an
ageing workforce in the coming years as the
number of older workers continues to increase
relative to the number of younger employees.
Age should not
determine fitness to
work: a 60-year-old
individual can be
just as physically fit
as a 40-year-old,
and knowledge,
skills and experience
are good reasons for
retaining older staff.
Why should companies address theissue?
The global trend among young people today is
towards getting fatter, eating more junk food,
drinking more soft drinks, increasing screen time
and reducing physical activity. The generation of
new employees coming into the oil and gas
industry reflects this worldwide trend.
It is essential for companies to put in place risk-
based health promotion programmes that are
capable of addressing this lifestyle problem.
Without such efforts, the repercussions in years
to come are likely to have a negative impact on
the industrys business.
What can companies do?
Specific recommendations appear continuously
throughout this document. General examples of
how companies can promote well-being and
reduce cardiovascular risk factors include: effective company leadership and
commitment; health assessments and screening; awareness, education and training; promotion of risk factor reduction,
addressing:
smokingsmoking cessation programmes;
no-smoking environments;
foodcontracting catering companies that
are capable of implementing healthy
eating programmes (e.g. using less salt, less
fat, less sugar, more vegetables, more fruit,
tasty and attractive foods, etc.);
beveragesdiscourage soft drinks and
provide a plentiful supply of fresh water;
alcoholprovide education on the risks
and effects;
inactivityencourage fitness days; promote
the use of gyms and fitness clubs; promote
walking, including the use of stairs;
stressfocus on prevention and managing
the root causes of work-related stress at the
organizational level; provide training and
awareness at the employee level, and
access to counselling where possible; and
fatigueoperate an effective fatigue
management system. involving families where possiblee.g.
inviting families to fitness days; encouraging
spouses and families to favour healthy food
options when shopping, cooking and eating.
Initiatives to promote well-being need to be
sustained over the long term. It is essential to
understand that the risk of cardiovascular disease
is a global problem and is likely to worsen in the
oil and gas industry over the coming years. Data
on the issue should be collected over time and
used to coordinate ongoing efforts and provide
feedback to management.
IPIECA OGP
30
What oil and gas companie