In PART 2 of our look at the symptoms and risks associated with heart attacks, renowned cardiologist Dr Michael Lim Chun-Leng, who is the Medical Director of the Singapore Heart, Stroke & Cancer Centre and Dean of the College of the Asian Pacific Society of Cardiology discusses various ways in which you can minimise the risk of developing heart disease.

Q. What factors can help patients reduce the risk of a heart attack?

Diet: The key is to enjoy a sensible diet and eat in moderation. Eat from a wide variety of food – increase intake of complex carbohydrates (rice, potatoes and whole-grain bread) as well as fruits and vegetables. At the same time, reduce consumption of fats, sugar, salt and alcohol. It is also important to drink a lot of water.

Exercise: Exercise is good for the body in general, but it is important not to over strain yourself, especially if you are in your late 30s or 40s. Personally, I would recommend 30 minutes of brisk walking three to four times a week as a relatively safe form of exercise. This helps to keep the body mobile without placing too much stress on the joints.

Regular Medical Review: Regular medical review by the family doctor can aid in controlling risk factors and maintaining a healthy lifestyle. At the same time, it may also mean quicker detection and earlier treatment of other possible ailments.

Q. What about health supplements? Can they help prevent heart disease?

There are many health supplements which claim to have heart attack prevention properties. However, a study in the New England Journal of Medicine showed that there was no difference between people who took these Vitamin B supplements and those who did not in terms of their chances of developing heart attacks. Hence, it would be wise not to buy into these claims unless they are accompanied by results from proper research trials. The only supplement which has data to show benefit is fish oil.

Q. What drugs are used in the prevention and management of coronary heart disease?

The entire group of statins are the primary drugs used. Study results clearly show that patients who had never suffered from any heart attacks, but had elevated cholesterol levels and were treated with statins had a lowered chance of suffering a heart attack or stroke. As technological advances in medicine gradually allow early detection and prevention, medicine will shift from treating diseases to the prevention of disease. The other major group of drugs are the anti-platelet drugs such as aspirin, ticlopidine and clopidogrel. They are used to prevent clot formation when a cholesterol plaque in the heart artery ruptures. Clot formation in the heart artery can result in occlusion of the heart artery and can cause a heart attack.

Q. What are the side effects of the drugs?

Studies have shown that out of every 1000 people who take statins, only about four would develop some elevation in their liver enzymes. One in 10,000 may develop slight elevation in their muscle enzymes. Severe elevation in enzymes is extremely rare, probably only one in a few million patients would suffer from this.

Q. What kind of symptoms indicate an imminent heart attack?

Shortness of breath on exertion, chest tightness or chest pains often precede a heart attack but in reality, many of these patients present with these symptoms only when they are about to have a heart attack. Such symptoms occur when more than 70% of your arteries are clogged up. However, studies have shown that the majority (two thirds) of heart attack patients have only a 40% to 60% diameter narrowing of the heart arteries and do not feel any chest pains until they get a heart attack.

Q. How does advanced technology help with heart disease?

In the last few years, technological advances have made it possible to take X-ray pictures of the heart arteries in three dimensions without the need to put a tube into your body. In the past, the usual non-invasive tests such as treadmill testing, stress echocardiography and nuclear perfusion scans have been used to screen for blockage of the heart arteries. But they can only detect patients with severe blockage, and even then, for those with severe blockage these tests can only pick up 70% to 90% of these patients. Today, CT angiogram of the heart arteries allows us to visualise the arteries within seconds in a safe and non-invasive manner. This test is a painless outpatient X-ray scan. Its greatest advantage is that it will allow doctors to make a more accurate diagnosis and begin earlier treatment of heart disease.

Q. Who is at risk of a heart attack?

The main risk factors are high cholesterol, high blood pressure, diabetes mellitus and smoking. Men, older people, and people with a family history of stroke and heart disease, tend to face a higher risk of cardiovascular disease.

Q. How often should a screening test be taken?

Patients should see their family doctors for annual assessment and to control risk factors. For those who have had a CT angiogram of the heart arteries, it is usually unnecessary to repeat it for at least another five years.

To be continued…

Most of us will be indulging in a little more alcohol this festive season and studies have shown that a little alcohol may actually be good for the heart health – but only in moderation.

Drinking too much alcohol can raise the level of some fats in the blood (triglycerides) and can also lead to high blood pressure, heart failure and an increased calorie intake.  In addition to the dangers such as alcoholism and accidents, excessive alcohol intake has also been linked to liver disease, ………………..to read more about it, get your own copy of Healthy Times Magazine from your nearest bookstands, MPH, Borders, 7-Eleven or order Online Here.