Health Matters: Cardiovascular Disease & Screening.

We live in an era of unparalleled advance, and by all impressions, things only look set to get better. Advances in science and technology have spurred many modern medical breakthroughs .Life expectancies continue to grow, and our overall health has improved. In the past, infectious diseases such as pneumonia and sepsis were the major causes of death, and polio used to be the major cause of disability. In the modern age of antibiotics and vaccines, these threats have all but disappeared.

Instead, over the decades, we’ve seen the rise of new global health issues. A more sedentary lifestyle has lead to an increase in chronic cardiovascular diseases such as diabetes and hypertension. Chronic diseases take time to develop, often years to decades. In the early stages they may not cause any symptoms to the patient. Many cases are only diagnosed much later, when complications have arisen and irreversible damage has already occurred.

This need not be the case. Cardiovascular diseases may not cause may symptoms but they do have telling signs that can be picked up via screening. With early detection and intervention, we can reduce the risk of cardiovascular diseases and assure the patient of a full, healthy life.

Chronic cardiovascular diseases

Chronic cardiovascular diseases (CVDs) are a group of metabolic conditions that cause damage of the blood vessels (amongst other things) and eventually lead to heart attacks or stroke. The commonly encountered cardiovascular diseases in Singapore are:

  1. Hypertension ( 23.5% of the population)

  2. Diabetes mellitus ( 11.3% of the population)

  3. Dyslipidemia ( 17.4% of the population)

  4. Obesity ( 10.8% of the population)

CVDs usually have a degree of inheritance i.e. if your parents have hypertension, there’s a higher chance you will have hypertension. What’s unusual is the degree of environmental variation that can be exhibited. As stated by the World Health Organization (WHO):

Behavioral risk factors are responsible for about 80% of coronary heart disease and cerebrovascular disease”WHO Global status report on noncommunicable diseases, 2010.

In other words, your family history may give you an increased chance for developing these chronic diseases but ultimately it’s what you do that makes the difference.


Unfortunately, most CVDs remain silent for a long time. Often CVDs are only discovered when end-stage complications arise. Some signs that may point to particular CVDs are:

Hypertension: Headache, giddiness, fatigue.

Dyslipidemia: Fatty deposits known as xanthelesma, typically seen around the eye.

Diabetes: Fatigue, thirst, unexplained loss of weight, frequent urination, unusually frothy or bubbly urine.

Disease complications and outcomes

CVDs cause blood vessel damage that can affect many of our organs. Conditions that can arise from CVDs are:

  1. Heart attacks

Damage to the muscles of the heart occurs when the blood vessels supplying oxygen to them are damaged or obstructed. This can cause death or permanent weakening of the heart.

  1. Strokes

Strokes occur when blood vessels supplying the brain are blocked or rupture. The can result in death or permanent disability.

  1. Renal failure

Damage to the blood vessels supplying the kidney can cause damage to the tissues rendering it unable to filter the blood and excrete toxic metabolites. Diabetics are even more prone to kidney damage owing to the increased excretion of protein and glucose across the delicate nephrotic membranes, which can cause tearing and damage. Advanced stages of renal failure may require lifelong dialysis or a kidney transplant

  1. Visual problems

Both diabetes and hypertension can damage the vessels of the eye, causing permanent impairment in vision. Additionally diabetics are more prone to suffering from cataracts or clouding of the lens of the eye, increasing the chances of visual impariment

  1. Immunosuppression.

CVDs, particularly diabetes tend to affect the immune system over time, makind people more susceptible to infections and hospitalisation. The exact mechanism of this is not fully understood

  1. Nerve damage (Diabetes)

Chronic diabetics may suffer from peripheral nerve damage, which may cause either a tingling sensation, pain or numbness, usually starting at the extremities. Loss of sensation may make it easier to injure oneself, which combined with the immunosuppression makes wound infections more severe. Often many poorly controlled diabetics have to undergo amputation of toes or even the entire leg because of severe infections starting off from an unrecognised injury to the numb extremity.


Many of the complications of CVDs greatly affect the quality of life and are irreversible. Fortunately, many studies have shown that early action can greatly reduce the risk of these complications. Here are some tips.

  1. Eat right

Numerous studies have shown the link between a poorly balanced diet and the rise of CVDs. Generally, its best to cut down on starchy, fatty foods and increase the intake of fresh fruits, grains and vegetables. There are many online resources available to help plan a better diet plan. See the Health Promotion Board‘s portal for some useful tips.

  1. Exercise

Exercise has many useful benefits for the body. Exercise helps to lose unhealthy body fat, improves muscle tone and resting body metabolism, meaning you burn more calories at rest. Aerobic exercise also helps strengthen the heart. The official recommendation is to have 150 minutes of exercise per week.


Tips available from the Health Promotion Board  may help you to add exercise routines into your daily life.

  1. Sleep

Every day our minds and bodies undergo constant strain and damage from day to day activities. Researchers recommend 7-8 hours of uninterrupted sleep per night for adults.

  1. Hydrate

An often forgotten health point. Water is the universal balm to many ailments. You should aim to have at least 7-8 glasses of water a day, more so if you are doing strenuous activity or taking substances like caffeine that act as diuretics. One simple tip is to replace soft drinks with plain water or fresh fruit juices during mealtimes.

  1. Cut down on alcohol and tobacco.

The health hazards of tobacco smoke and excessive alcohol intake are a long list that expand beyond chronic cardiovascular diseases. Studies have shown small amounts of alcohol, particularly red wine, may help the heart, but moderation is essential. Quitting tobacco may be hard but there are many tools and programs available to assist. A perk of cutting down on tobacco and alcohol is the amount of money it can save you. Start now.

  1. Screen your health regularly.

Last but not least, it is absolutely essential to routinely check to make sure you remain in the pink of health. Routine screening can help detect the presence of CVDs well before the onset of complications. Here are some screening tips to consider:

  1. Body Mass Index (BMI):

    This calculation is derived by taking your weight in (kg) and dividing by the square of your height in (m). The derived value is an indicator of CVD risk.

BMI Value


CVD risk



*Risk of nutritional def.


Optimal weight








  1. Blood pressure (BP) monitoring:

Ideally all adults should be keeping an eye on their blood pressure from the age of 35. Routine BP checks can be done at your GP or at home with electronic BP machines. You should visit your doctor every 6 months to a year to calibrate the BP machine as well as review your pressure values. The optimal average blood pressure reading should be below 140/90 mmHg for the average individual, though lower readings may be recommended for patients with increased risk of cardiovascular disease.

  1. Fasting blood glucose (FBS) levels:

Routine assessments of fasting blood glucose can screen for early onset diabetes or pre-diabetic conditions. Generally FBS should be 4.0-6.0 mmol/l. Values higher than 7.0 mmol/l may indicate diabetes, while intermediate values between 6.1-6.9 mmol/l should be tested further to assess for pre-diabetes or early diabetes. Individuals should screen annually from the age of 35. Those at increased risk ( strong family history of diabetes, symptoms suggestive of diabetes etc) may need to undergo screening earlier or more frequently.

  1. Fasting blood cholesterol levels:

Elevated fasting blood cholesterol levels lead to build-up of fatty plaques on blood vessels, which may rupture, leading to heart attacks and strokes. There are 3 main components that are assessed : the High-Density Lipoproteins (HDLs), Low-Density Lipoproteins (LDLs) and triglycerides or free fatty acid. High LDL and triglyceride levels tend to increase cardiovascular risk while high HDL levels are actually cardio-protective to some degree . Generally, individuals should aim for a low total cholesterol level ( <5.2 mmol/l) and a low LDL: total cholesterol ratio. As with blood glucose, it is a good idea to screen annually from 35 years of age. Individuals with high risk may need to screen earlier or more frequently.

  1. Cardiovascular Health assessment:

Patients who have increased risk factors for heart disease (e.g. strong family history of early onset heart disease,presence of one or more CVDs) or who have clinically suspicious symptoms for heart disease may benefit from a cardiovascular screen. These range from a simple resting ECG to arranging for a coronary angiogram, based on the likelihood of disease.

Some investigations that may be useful are:

a) Resting ECG

b) Stress Treadmill: a dynamic ECG capture of the heart as the patient undergoes aerobic exertion

c) hs-CRP values: Blood assay of a protein specific for heart damage

d) Calcium scoring: A non-invasive way to assess for coronary disease, calcium scoring uses specialized techniques to identify calcified plaque deposits on coronary vessels.

  1. Renal function assessment:

This is recommended for patients who have a strong family history of kidney disease as well as patients who have medical conditions such as diabetes or hypertension who are at risk of developing renal impairment. Screening can be done in union with the fasting blood glucose and cholesterol tests. Tests may be done on blood, urine or both.

  1. Eye Assessment

A good eye assessment can be crucial to preserving sight. Eye assessments should include visual acuity assessment, near vision and colour vision assessment to assess visual function and retinal photography to assess early retinal damage for patients at risk (e.g. those with diabetes, hypertension etc). It is strongly recommended that patients with diabetes undergo yearly retinal photography and assessment.

Good health should not be taken for granted. It is vital we do our part to maintain our health. A ounce of prevention today will prevent a lot of heartache down the road. Do your part to stay in the pink of health. Get yourself screened today.



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