How to manage your cholesterol

​Data from the National Population Health Survey 2020 showed the prevalence of high cholesterol in Singapore’s population increased from 25.2% in 2010 to 39.1% in 2020. In 2019, high cholesterol was the second most common risk factor for heart attacks in Singapore, after high blood pressure. Prof Tan Huay Cheem, Senior Consultant at National University Heart Centre, Singapore (NUHCS) and Chairman of the Singapore Heart Foundation, said cholesterol levels could be lowered by 10% to 20% after three to six months of changes in diet and exercise. A list of 10 ways to improve cholesterol levels was featured to help readers moderate cholesterol levels.

如何减少钠摄取量？(How to reduce sodium intake?)

​Prof Tan Huay Cheem, Senior Consultant, Department of Cardiology, National University Heart Centre Singapore and Chairman of Singapore Heart Foundation, discussed how people can replace their regular salt with lower-sodium alternatives to prevent hypertension and cardiovascular disease. 

Body SOS小毛病大问题 (Season 11 Episode 17)

​Prof Tan Huay Cheem, Senior Consultant, Department of Cardiology, National University Heart Centre Singapore discussed hyperlipidaemia which refers to excess cholesterol or triglycerides in the blood.  Prof Tan also debunked the myth that drugs designed to lower cholesterol might cause memory loss.

射血分数保留型 心衰如何治疗？(How to treat heart failure with preserved ejection fraction?)

​Dr Lin Weiqin, Consultant and Clinical Director of the Heart Failure Programme, Department of Cardiology, National University Heart Centre, Singapore and Assistant Professor at NUS Yong Loo Lin School of Medicine, shared that a recent study showed that doctors can now treat heart failure with preserved ejection fraction with the oral drug Empagliflozin.

本地研究：寒流气温降1摄氏度 年长者心肌梗塞风险高 (Study: Older people at higher risk of myocardial infarction with one degree Celsius drop in cold snap)

​Prof Tan Huay Cheem, Senior Consultant, Department of Cardiology, National University Heart Centre Singapore, commented that it is very rare for myocardial infarction (heart attack) to occur when the tropical climate drops by one degree Celsius. Although there may be some correlation between the two, it is only in winter and colder climates when there is higher risk of myocardial infarction.

医治老年心脏病患 应从病人角度出发 (Medical treatment for older patients with heart disease should start from patient’s perspective)

​Commentary by Prof Tan Huay Cheem, Senior Consultant, Department of Cardiology, National University Heart Centre Singapore, highlighted his thoughts about geriatric cardiology. Prof Tan explained that geriatric cardiology requires comprehensive and detailed training for doctors to acquire the essential skills for effective medical care of older patients. He opined the key element of geriatric cardiology is to focus on patient-centeredness, and this should be integrated into the doctor’s clinical practice.

医治老年病患 须考虑另六大因素 (Another six factors to be considered when treating senior patients)

​Commentary by Prof Tan Huay Cheem, Senior Consultant, Department of Cardiology, National University Heart Centre Singapore, highlighted that it is estimated that by 2030, the population of people aged 65 years old in Singapore will account for 25 per cent of the total population, reaching about 900,000 people.  With the ageing of the population, the prevention, diagnosis and treatment of most senior people suffering from heart disease and cardiovascular diseases will also change. The traditional treatment model emphasises precise diagnosis, prescription of the right medicine, and eradication of the disease. However, more factors will have to be considered in the treatment of senior patients. 

男子患感染性心内膜炎 中风半瘫动手术捡一命 国大研究：通过血培养确定原菌有助治疗 (Surgery saves endocarditis patient who was partially paralysed after stroke – NUHCS study: Identifying bacteria early through blood cultures may help in treatment)

​A worldwide study on bacteria endocarditis led by Asst Prof William Kong, Senior Consultant, and A/Prof Poh Kian Keong, Director of Research and Senior Consultant, Department of Cardiology, National University Heart Centre, Singapore, has found that among patients with bacteria endocarditis, the mortality rate was about 5 per cent higher in patients with negative blood culture than patients with positive blood culture within 30 days. Asst Prof Kong shared that it is important to raise awareness of bacterial endocarditis.  He encouraged the public to practice good oral hygiene habits and urged high-risk patients to check with their doctors on antibiotics consumption before undergoing invasive medical treatment to reduce the risk of bacterial endocarditis.   

NUHCS cardiologists embarked on worldwide study on infective endocarditis

研究：心内膜炎病患中 血液培养阴性患者死亡率高出5% (Study: 5% higher mortality rate among endocarditis patients with negative blood cultures)

小毛病大问题：静脉曲张 (Body SOS: Varicose veins)

​Mediacorp Channel 8’s health programme, “Body SOS”, featured Dr Peter Chang, Senior Consultant, Department of Cardiology, National University Heart Centre Singapore, who elaborated on the common symptoms and risk factors for varicose veins, as well as treatments available. 

Study: 1 in 10 heart attack patients has no standard risk factors

​A study conducted by a team of clinicians from National University Heart Centre Singapore has found that around 10% of patients with heart attack in Singapore did not have standard cardiovascular risk factors and yet had worse short-term mortality compared to those who suffered from at least one risk factor. This calls for greater focus on patients with family history of premature coronary artery disease or with significant chest pain symptom and no apparent risk factors. This unexpectedly high-risk subgroup of patients, while belonging to the minority, should seek immediate attention from healthcare professionals when chest pain-related symptoms arise. The team of clinicians involved in the study include Prof Tan Huay Cheem, Senior Consultant, Dr Loh Poay Huan, Senior Consultant & Clinical Lead, Acute Myocardial Infarction Service and Dr Nicholas Chew, Senior Resident, Department of Cardiology, National University Heart Centre Singapore.

Lianhe Zaobao quoted Prof Tan who highlighted that patients without risk factors are more likely to have delayed treatment or misdiagnosis. Therefore anyone with chronic breathing difficulties, abdominal discomfort, or symptoms of angina, cold sweat or vomiting after exercise should seek medical attention immediately.

The Straits Times also quoted Dr Loh who commented that the findings contradict the common perception that significant coronary artery disease is an unlikely health concern for those without conventional risk factors. Dr Chew added that the message to the general public is really to not ignore symptoms of chest pain, even in those without risk factors. He added that further studies are needed to assist clinicians to identify such at-risk people. 

The media also interviewed an National University Heart Centre Singapore patient, Mr Zhao Chun, who presented himself at Ng Teng Fong General Hospital with back pain and breathing difficulties after a soccer session in end June. Mr Zhao was diagnosed with a heart attack and underwent angiogram and angioplasty. He was fit for discharge the next day after the procedure and is currently on a month of medical leave.

• The Straits Times Online, 8 July 2022, Study finds heart attack patients without conventional risk factors fare worse
  
• CNA, 8 July 2022, Nearly 10% of people with heart attacks do not have risk factors: Study
  
• Lianhe Zaobao, 9 July 2022, Page 7, 国大心脏中心研究：近一成病患没危险因素 但早死于心脏病概率仍高 (NUHCS Study: Nearly 10% of patients without risk factors are still at high risk of dying from heart attack early)
  
• Mediacorp 8world, 8 July 2022, 本地研究发现：没危险因素也会得心脏病 死亡几率还高出八成 (Local study finds 80% higher chance of dying from heart attack without risk factors)
• Shin Min Daily News, 8 July 2022, Page 4, 家族病史 男子踢足球后 心脏病发获救 (No family history of heart attack; Man save from heart attack after soccer session)

静脉曲张或危及性命 (Varicose veins may put lives at risk)

​Dr Peter Chang, Consultant, Department of Cardiology, National University Heart Centre Singapore, shared that varicose veins are caused by a deterioration of the valves in the leg veins, making it difficult for blood to be pumped back to the heart. An individual should get up and move around from time to time, after prolonged standing or sitting. Dr Chang added that if bruises or worm-like veins appear on the legs, individuals should seek early treatment to avoid serious life-threatening embolism.

Heartbreak can kill

​Prof Tan Huay Cheem, Senior Consultant, Department of Cardiology, National University Heart Centre Singapore, said that broken heart syndrome was not well recognised in Singapore until the last one or two decades. Prof Tan noted that the first case was reported in 2005 at National University Hospital (NUH), and there were about two to three cases a year among the 600 heart attack cases at NUH.

• Tamil Murasu, 1 July 2022, Depression raises risk of early death
  

急性心脏病发个案 过去11年增近六成 (Acute heart attack cases increase by nearly 60% in the past 11 years)

​The National Registry of Diseases recently released its latest Acute Heart Attack 2020 report. The number of acute myocardial infarction (AMI) cases in Singapore increased from 7,344 in year 2010 to 11,631 in year 2020, an increase of nearly 60%. Prof Tan Huay Cheem, Senior Consultant, National University Heart Centre Singapore, said that the circuit breaker in 2020 had delayed non-emergency surgery during the period, but there was no significant reduction in both emergency surgeries and AMI cases admitted to National University Hospital. Prof Tan pointed out that healthcare systems in some western countries were overwhelmed during the pandemic, and the number of AMI cases admitted did decrease significantly, while the death rate of AMI outside the hospital increased, but Singapore’s healthcare system did not collapse and had relatively good pressure-bearing capacity. In his opinion, more data for the next few years is needed before concluding the cause of the slight decrease in 2020’s cases.