Mr Chua Tiat Beng, 55, who suffered a heart attack in 2009,
is now doing all he can to keep his cholesterol in check. He
exercises twice a week, has cut his intake of cholesterol-rich food
and has reduced the number of cigarettes he smokes.
SINGAPORE - Singaporeans appear to be taking better care of
their heart health, recent national figures suggest.
For instance, cholesterol levels have improved, particularly
levels of so-called "bad" cholesterol, or low-density lipoprotein
(LDL).
The National Health Survey 2010 showed 15.2 per cent of
Singapore residents aged 18 to 69 years had high levels of LDL in
2010, down from 20.3 per cent in 2004 and 29.1per cent in 1998,
after adjusting for an older population as an ageing population
would see higher rates of cholesterol.
It may be one of the reasons that the rate of heart attacks per
100,000 people has fallen, from 230 in 2008 to 217 in 2011, after
adjusting for an older population, according to the Ministry of
Health.
High cholesterol is one of several risk factors for
cardiovascular disease, a leading cause of death worldwide. In
Singapore, it accounted for one in three deaths in 2010.
There are other reasons as to why heart attack rates may have
dropped, noted Dr Raymond Wong, a consultant at the cardiac
department at the National University Heart Centre, Singapore.
The National Health Survey 2010 showed the prevalence of
hypertension dropped from 32.5 per cent in 1998 to 23.5 per cent in
2010, after adjusting for an older population.
However, other risk factors for cardiovascular disease -
obesity, diabetes, smoking and lack of regular exercise - have all
gone up between 2004 and 2010.
These figures show that it is very likely the drop in
cholesterol and hypertension rates are the main contributors to the
fall in heart attack rates, said Dr Wong.
Dangers of high cholesterol
Cholesterol is necessary for the formation of healthy cells but
it also contributes to atherosclerosis, the underlying cause of
many cardiovascular diseases.
In atherosclerosis, excess cholesterol in circulation is
deposited into cells in the artery walls and gradually forms a
fatty deposit called plaque.
Atherosclerosis restricts blood flow through the narrowed
artery, leading to symptoms of chest pain called angina.
When the plaque ruptures, a blood clot will form which may
completely block blood flow in the artery.
LDL cholesterol transports cholesterol from the liver to
tissues of the body. High-density lipoprotein (HDL) cholesterol -
"good" cholesterol - removes excess cholesterol from the tissues
and brings it back to the liver for removal from the body.
What the national survey does not show is how many people with
hyperlipidemia, or high cholesterol levels, have lowered their LDL
levels through taking cholesterol-lowering drugs, said Dr Wong.
So it could well be that those already diagnosed with the
condition are keeping it under control with medication.
Still, doctors are encouraged by the trend, which they feel is a
sign of a population becoming more health conscious and aware of
how to achieve good health.
While obesity, diabetes and high cholesterol all require
a person to adopt healthier lifestyles, some lifestyle changes are
easier to achieve than others.
Dr Wong pointed out that obesity is probably the hardest risk
factor to manage, since there is no "magic bullet or drug" for one
to lose weight.
Dr Tong Khim Leng, the chief of cardiology at Changi General
Hospital (CGH), has observed more people being aware of the
importance of regular exercise and a diet low in saturated
fat.
And more people are finding out their cholesterol levels because
of regular health screenings offered by company health insurance
policies, said Dr Tan Chong Hiok, a senior consultant at Parkway
Heart and Vascular Centre.
He said: "We are able to treat these patients earlier and data
has shown that treating them with statin results in a relative risk
reduction of up to 50 per cent in preventing cardiovascular
disease."
Target cholesterol levels
Doctors say routine screening for cholesterol should start from
40 years of age, and even earlier for people with heart disease or
multiple risk factors.
A person's target cholesterol level is dependent on his risk
of cardiovascular disease, based on well-known risk factors such as
age, ethnic group, smoking status, cholesterol and blood pressure.
This can be calculated with a local version of the Framingham risk
score.
The higher a person's risk, the lower will be the goal level for
LDL cholesterol.
For instance, a high-risk patient, such as one who has heart
disease, will need to keep his LDL cholesterol under 2.6 millimoles
of cholesterol per litre of blood (mmol/L), compared with a
low-risk patient whose target LDL cholesterol is under
4.1mmol/L.
Adjunct Assistant Professor David Foo, the head of the
department of cardiology at Tan Tock Seng Hospital, said diabetes
and smoking, coupled with high cholesterol, raise a person's
cardiovascular risk because they damage blood vessel walls and make
it more likely for blood clots to form.
Patients
will always be advised to make lifestyle changes - lose weight,
exercise regularly, stop smoking and drink alcohol in
moderation.
If these do not improve their cholesterol levels enough,
medication is prescribed, said doctors here.
Statins is the most common class of cholesterol-lowering
medication, said doctors, with seven or eight out of 10 patients
being put on statins.
In April 2009, businessman Chua Tiat Beng, 55, was behind the
wheel of his car when he broke out in cold sweat and felt a
tightness in his chest.
The father of two went straight to a general practitioner, who
recognised the signs of an impending heart attack. At Tan Tock Seng
Hospital, Mr Chua underwent an emergency angioplasty to unclog a
blocked artery. While in hospital, he learned that the first health
screening he had been to just a week before had picked up high
cholesterol levels.
As he was also a smoker and above 45 years old, he was at high
risk of developing cardiovascular disease.
He said:
"When people are not sick, they never heed good
advice."
He now smokes less, watches his diet, jogs twice a week and
takes cholesterol-lowering medication and aspirin to prevent clots
from forming around the stent. A blood test last December gave him
a clean bill of health.
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