February 26, 2025
MANILA – Heart attacks and strokes are among the most well-known medical conditions in the Philippines, yet they remain the country’s leading causes of death. Year after year, they claim countless lives and impose a heavy burden on survivors and their families.
Heart attacks and strokes are serious consequences of atherosclerotic cardiovascular disease (ASCVD), a condition caused by the buildup of fatty deposits, cholesterol, and other substances — collectively known as plaque — along artery walls.
This process, called atherosclerosis, narrows the arteries, reducing blood flow and restricting oxygen-rich blood from reaching vital organs. As a result, it significantly increases the risk of life-threatening conditions such as coronary heart disease (CHD) and cerebrovascular disease.
In the first month of 2024, ischaemic heart disease — another term for CHD — was the top cause of death in the country, accounting for 49,577 deaths.
Cerebrovascular diseases, generally known as stroke, had the third highest number of deaths, claiming 25,186 lives.
Beyond the physiological effects of ASCVD, many patients who survived their first ASCVD event reported that the condition has deeply affected their emotional well-being and mental health, often leaving scars that go unnoticed.
“ASCVD events do not always end in death and it could impact the patient’s life for many years,” said Dr. Janet Chavez, a medical advisor at Novartis Healthcare Philippines, Inc.
Aside from the emotional and mental health toll on patients, one of the biggest challenges heart attack and stroke survivors — and their families — face is the financial strain and impact on their livelihood.
Economic burden
A leading Filipino insurance company estimates that the cost of managing an acute heart attack can reach approximately P1 million within the first ten years. This estimate includes:
- P98,300 for initial diagnosis
- P540,000 for treatments, including tests, procedures, and hospital admissions
- P342,000 for post-attack rehabilitation, which may involve physical therapy and maintenance medications.
GRAPHICS: PHILIPPINE DAILY INQUIRER
For stroke patients, the economic burden is equally, if not more, significant.
In the research article “The Real Stroke Burden in the Philippines,” neurologist Dr. Jose Navarro and his co-authors highlighted that stroke care in the country is largely privatized, with patients and their families shouldering most of the costs out-of-pocket.
Their findings estimated that approximately half a million Filipinos would be affected by stroke, with medical expenses ranging from $350 million to $1.2 billion (around P19.6 billion to P67.3 billion).
Currently, the Philippine Health Insurance Corporation (PhilHealth) provides limited financial assistance for stroke patients, covering only P28,000 for ischemic stroke and P38,000 for hemorrhagic stroke. These amounts, which include payments for medical professionals and hospital services, often fall short of the actual treatment costs.
A survey by the Stroke Society of the Philippines found that the cost of thrombolysis for acute ischemic stroke in private hospitals ranges from P136,688 to P228,678. In contrast, government hospitals offer significantly lower treatment costs, ranging from P3,239 to P35,903.
Meanwhile, a separate study led by Dr. Jose Danilo Diestro, a clinical investigator and assistant professor at the University of Toronto’s Department of Medicine, found that the average cost of stroke-related hospitalization at a public tertiary hospital in the Philippines is P17,141.50.
However, for more complex cases, expenses can rise significantly, reaching up to P95,693.50.
“The expenses incurred in the private hospitals alone can cost several months of salary based on the average annual Filipino family income of […] P313,000. These costs can even become catastrophic, particularly in families belonging to the lower-income classes,” said Dr. Maria Epifania Collantes, who co-authored the study “Current State of Stroke Care in the Philippines” alongside eight other health experts.
GRAPHICS: PHILIPPINE DAILY INQUIRER
Joel, a 59-year-old development consultant, content creator, and stroke survivor, shared how his hospitalization in October 2024 cost him P36,000 for a five-day stay at a private hospital in Malolos, Bulacan — even after PhilHealth discounts.
Adding to the grim reality of the economic toll of ASCVD events, these costs cover only medical-related expenses and do not account for any lost income due to the inability to return to work, which can add another layer of stress for patients.
Fortunately, Joel’s projects continued during his hospitalization, allowing him to maintain financial stability despite the high costs. However, many stroke survivors are not as lucky, often facing the added burden of lost income during recovery.
“I resigned from work because of the stroke. I used to work, but I had to leave because I couldn’t write, I was slurring, constantly dizzy, and had difficulty walking,” said Noah (not his real name) in a Facebook group for Filipino stroke survivors.
Despite these challenges, he made a conscious effort to live as normally as possible. While his wife provided strong support, Noah understood the importance of actively participating in his recovery. He gradually resumed daily activities, and over time, he noticed significant improvements.
“Now, even though I still get dizzy, I can drive a car and a tricycle, chop wood, and sweep outside. At first, it was really difficult […] but just keep going — we learn from our experiences. God will also restore what we have lost,” he added.
Health experts like Dr. Marc Del Rosario, head of the Cardiac Catheterization Laboratory at the Asian Hospital and Medical Center, have also long emphasized the importance of preventing a second event after the first, as it is not only more life-threatening but also significantly more expensive.
He noted that hospitalization for a second ASCVD event can be far costlier than the first.
“So preventing the second event is actually not just clinically helpful but also cost-effective. It’s something that sometimes we do not appreciate [enough].”
‘Risk-based’ understanding
While the physical, emotional, and financial toll of ASCVD events may seem daunting, identifying and addressing key risk factors can greatly reduce the chances of developing these life-altering conditions.
Unfortunately, many individuals, including Filipinos, are unaware of their personal risk levels, making them more vulnerable to these serious health threats.
“[O]ne misconception that I get from the patients [about ASCVD and atherosclerosis]: people think this happens overnight, na ngayon normal ugat mo, bukas barado na siya (that today your arteries are normal, and tomorrow they’re already clogged). That couldn’t be farther from the truth,” said Del Rosario.
Mayo Clinic, a US-based health institution, explained that atherosclerosis can begin in childhood and gradually worsen over time, often starting with damage to the artery’s inner lining. This damage, caused by various risk factors, allows plaque to build up, which may eventually rupture and form a blood clot.
GRAPHICS: PHILIPPINE DAILY INQUIRER
“[It is] sometimes a journey of forty years; it could be as short as ten years, or as long as eighty years. What I’m saying is that this disease process starts slowly over time, and what happened to [ASCVD patients was already the] last step — the tipping point,” said Del Rosario.
“Pero bago sila umabot doon, resulta ‘yun ng napakaraming nangyari sa buhay nila: from decisions they made to family history and genetics that they were born with from the very beginning. All of these led them to that point. This is why it is very important for us to manage the risks — ano ba ‘yung nagpadala sa kanila sa puntong ‘yun?” he added.
(But before they reached that point, it was the result of so many things in their lives: from the decisions they made to the family history and genetics they were born with from the very beginning. All of these led them to that point. This is why it’s very important for us to manage the risks — what brought them to that point?)
According to Dr. Debora David Ona, president of the Philippine Lipid and Atherosclerosis Society (PLAS), atherosclerosis is driven by both modifiable and non-modifiable risk factors.
Unmodifiable risk factors are those that cannot be changed, yet remain crucial in determining the risk of ASCVD. These include:
- Age
- Gender
- Family history of cardiovascular disease
- Personal history of cardiovascular disease
In contrast, modifiable risk factors are changeable and are often associated with one’s lifestyle or lifestyle-related conditions. These include:
- Hypertension (high blood pressure)
- Diabetes (high blood sugar levels)
- Obesity
- Diet
- Abnormal blood lipid (cholesterol, triglycerides) levels
- Physical inactivity
- Smoking
- Chronic inflammation
Additionally, the Cleveland Clinic lists stress as a non-modifiable risk factor. Environmental factors, income, and social isolation are also considered as social determinants that can impact the risk of atherosclerosis.
In Joel’s case, he shared that before his first ASCVD event, he was already living with high blood pressure. While he made efforts to avoid foods that could worsen his risk for hypertension and ASCVD, he acknowledged that his overall lifestyle still played a role in the development of his condition.
“I normally shy away from fatty and salty food, even before my stroke. I’m also a musician and composer of original songs. I was a drinker and smoker. Thus, the stroke,” he said.
Leading risk factors, ‘silent killers’
Among the modifiable risk factors, Ona and Del Rosario — citing local data from the Department of Health (DOH) — identified uncontrolled hypertension (high blood pressure) and an unhealthy diet as the leading contributors to ASCVD.
“Why [unhealthy diet]? Because it affects everything. It affects your sugar [levels], your blood pressure, [and] cholesterol,” Del Rosario said.
Meanwhile, a paper titled “Coronary Heart Disease (Sakit sa Puso) in the Philippines: A Guide to Patient Education, Prevention, and Treatment,” published by Stanford Medicine, explains that hypertension increases the risk of heart disease by damaging blood vessels, “setting the stage for atherosclerosis.”
What makes hypertension particularly dangerous, however, is its lack of noticeable symptoms. It can go undetected for years while silently causing changes in the blood vessels — earning it the title “silent killer” — unless individuals routinely monitor their blood pressure.
“The most common presentation of hypertension is asymptomatic. Walang nararamdaman. Most patients with hypertension do not know it or do not feel it until they get their blood pressure checked,” said Del Rosario.
Even more concerning, another modifiable condition ranks among the leading risk factors for atherosclerosis — one that, like hypertension, often goes undetected: hypercholesterolemia, another silent killer.
GRAPHICS: PHILIPPINE DAILY INQUIRER
Hypercholesterolemia, commonly called high cholesterol, is characterized by elevated levels of low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, in the blood.
The Cleveland Clinic warns that high levels of LDL cholesterol can lead to the buildup of fat and plaque in the arteries, contributing to severe atherosclerosis and significantly increasing the risk of heart attack and stroke.
Despite its risks, hypercholesterolemia affects 1 in 20 people worldwide yet often goes undiagnosed due to its lack of symptoms. Many individuals remain unaware of their condition until they suffer a serious cardiovascular event.
Regular check-ups, such as annual physical exams and lipid panel blood tests, are essential for early detection and management.
“Kaya nga tayo may APE sa trabaho, kaya tayo may health screening sa barangay, dahil kahit wala ka pang nararamdaman pwedeng may sakit ka na. That is the reason why we need to shift from crisis-based to risk-based,” said Del Rosario.
(That’s why we have annual physical exams (APE) at work and health screenings at the barangay level — even if you don’t feel anything, you might already be sick.)
(NEXT: High bad cholesterol: A silent threat, maintaining cholesterol levels, know your risk score)
This article is part of the Unblock Your Heart Health Reporting initiative, supported by the Philippine Press Institute and Novartis, to improve health literacy on cardiovascular diseases. Know your numbers, understand your risks, and consult your doctor—so no Filipino heart is lost too soon.