According to the World Health Organization, cardiovascular disease – a term that encompasses all types of heart disease and stroke – is the leading cause of death worldwide. It takes an estimated 17.9 million lives each year, representing 32% of global deaths.
In Singapore, 21 people die from cardiovascular disease every day. In 2021, cardiovascular disease accounted for 32% – or around one in three – of all local deaths.
While the local statistics are aligned with the global ones, there is much room for improvement. In particular, heart failure is highly prevalent in Singapore. Some 4.5% of Singaporeans live with heart failure compared to 1 – 2% in the United States and Europe. While this discrepancy can be partly explained by our ageing population, other risk factors such as physical inactivity, smoking, obesity, diabetes and hypertension are also to blame.
The mortality rate for heart failure is high. A study done in Singapore shows that the one-year mortality rate is about 21%. Overall, the mortality rate for heart failure is similar to that for common cancers, and the prognosis for end-stage heart failure is poor.
Furthermore, several studies shown a significant association between heart failure and dementia. A person with heart failure has a higher risk of dementia, increasing by up to 20%. This association is stronger in men and in patients who are less than 70 years old. However, heart failure does not appear to be linked directly to Alzheimer’s disease.
Heart failure and vascular dementia, a common type of dementia caused by restricted blood flow to the brain, share common risk factors. Both conditions are debilitating, and levy enormous costs on individuals, their families, and the healthcare system.
In contrast to these grim statistics, the good news is that heart disease is highly preventable and highly treatable. Early diagnosis and treatment can save lives and elevate the quality of life for early-stage patients. And as an added bonus, it may help arrest the progression of many related conditions with common risk factors, known as comorbidities.
Another important factor to consider is that the precursors to heart failure are often asymptomatic, meaning that they show no obvious symptoms. Hence the importance of prevention and early detection through regular heart health screening cannot be overstated.
The risk factors that determine your likelihood of developing heart disease fall into two categories: unmodifiable and modifiable. You have no control over unmodifiable risk factors like age, gender, ethnicity and family history. However, you are in control of modifiable lifestyle related risk factors such as poor diet, smoking and physical inactivity.
Age increases a person’s susceptibility to heart disease. In women, the effects of menopause, including the loss of the hormone oestrogen, appear to increase the risk of coronary heart disease and stroke.
Men are three to five times more likely to have heart disease than women. However, the risk for women increases after menopause. By about five to 10 years following menopause, the risk of heart disease for women increases to the same rate as men.
The risk for heart disease varies across different ethnic groups. In Singapore, the likelihood of coronary heart disease is highest amongst South Asians. Compared with the Chinese, South Asians are three times, and Malays are two times more likely to suffer from coronary heart disease.
In addition, a family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age.
Poor dietary choices can increase the risk of heart diseases and related risk factors, such as high blood pressure and high cholesterol. Foods that have found to be linked with worse outcomes for heart health include red meat, processed meat, animal oils like butter, foods with a high glycaemic index (GI) and refined starchy foods.
People with excess body fat – especially around the waist – are more prone to developing heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart, raises blood pressure, blood cholesterol and triglyceride levels, lowers ‘good’ HDL-cholesterol, and is associated with the development of diabetes mellitus. Family history and environment play a part in determining obesity. Physical inactivity and a high fat diet also contribute to obesity.
An inactive lifestyle is a risk factor for heart disease. However, people with known coronary artery disease or those above 40 years of age who have been inactive should seek medical advice before starting a regular exercise programme. Smoking Smokers account for 40% of deaths caused by heart disease in patients younger than 65 years. Smoking also leads to heart attack, stroke, high blood pressure, blood vessel disease, cancer and lung disease, and lowers HDL-cholesterol.
When two or more chronic conditions are present in one person, they are known as comorbidities, or multimorbidity. Multimorbidity can impede survival and complicate the diagnosis, treatment and outcomes of patients with heart failure.
Comorbidities that frequently co-exist with heart disease include:
A recent study on heart failure patients in Asia identified a pattern of heart failure among lean diabetics in Southeast Asia, particularly in Singapore and Malaysia.
Previous studies had shown that the prevalence of diabetes is increasing among Asians, and that on average they develop it a far lower body mass index (BMI) than their Caucasian counterparts.
In Singapore, cardiovascular (CVD) diseases account for more than half the mortality and morbidity among diabetic patients, regardless of their BMI. CVD-related complications of diabetes lead to disability, reduced quality of life, and frequent hospitalisation. It is an alarming fact that Southeast Asia has the highest rate of diabetes in the world, and Singapore has the highest risk of diabetic limb amputations in the world. Furthermore, treating patients with diabetes and CVD is 112% higher in cost than treating diabetics without complications.