​Heart disease – is it preventable, even if you have a family history? Is your risk of developing heart disease lower when you're younger or higher? What can you do to prevent heart disease if you already have high blood pressure, high cholesterol or type 2 diabetes?

Dr Liew Boon Wah, Consultant at the Department of Cardiology, Changi General Hospital (CGH), a member of the SingHealth group, answers these questions and more in a forum.

Posted by seah (Republished by Forum Admin)

Dear Dr Liew,

Before I had my baby (4 months ago), I was slim, exercising regularly (pilates, 10K steps a day, jogging) and eating healthfully (siu dai everything, brown rice, lean proteins). But even then, my cholesterol profile was not great (total: 205mg/dL, HDL: 77mg/dL, LDL: 117mg/dL). During pregnancy, I couldn’t exercise (due to threatened abortion) and after the 2nd trimester, drank formula to gain weight (because I lost a lot of weight due to hyperemesis gravidarum). Now I have some belly fat and have not been my healthiest (sleep deprivation, irregular meals when I’m alone with baby, no exercise due to c-section wound). I feel crappy physically, like pregnancy totally messed up my body/sleeping pattern/health. Have I worsened my cholesterol profile during and post pregnancy? Can I reverse the damage through exercise? Also do you think mummy tummy is bad for your heart? I read somewhere that belly fat puts you at higher risk of heart disease.

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear seah,

It does sound like you have been through a lot lately. But you have also identified the differences in lifestyle pre- and post-natal.

The cholesterol profile will fluctuate according to lifestyle and eating habits. Once you get back to your regular routine and eating habits, the cholesterol panel will be more reflective of your usual health.

What may be more relevant in your situation will be to work out a daily routine during your maternity leave period such that you can get start making healthy changes to your diet. Taking a stroll on a daily basis once you are fit to do so will help you clock some exercises and de-stress at the same time. This will also be a good time to get out of the house and yet bond with your baby.

Yes truncal obesity is associated with cardiac diseases, but do give yourself some time to get your routine back up before you start stressing yourself about the belly fat. 

Posted by yullian (Republished by Forum Admin)

Hi Dr Liew Boon Wah.

I’m a bit concerned about my dad (65y/o). He had stents last year and ever since, he’s been given the all clear, he’s been back to his old eating ways (nasi padang every other day). He’s on high cholesterol and high blood pressure meds so he thinks its ok to eat what he likes. We tried hard and soft approaches to encourage him to eat healthier but he's so stubborn. If we mix white with brown rice, he complain cannot swallow. He won’t eat fruits unless we cut for him. He’s a kind, loving man and I’d like him to live long enough to see my kids grow up. Is it true that he can eat what he likes when he's on medication? His parents died of stroke and heart attack.

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear yullian,

It is heartening to see that you are actively involved in the care of your father’s health.
I presume the all clear given meant he did not require any further procedures for treatment of ischaemic heart disease. However, it has been shown in studies that lifestyle changes (after treatment of ischaemic heart disease) together with good adherence to medications play the most important role in preventing future recurrent cardiac events.

Regular moderate intensity exercise programs and healthy eating are things that the patient can undertake on their part. You can find out regarding the possibility of enrolling your father in a cardiac rehabilitation program in consultation with his cardiologist.

Diets low in saturated fat and trans fat will aid in reducing the LDL-cholesterol (“bad” cholesterol).

Perhaps it will be useful to start small and negotiate baby steps in replacing one meal a day with something healthier that is low in saturated/trans fats and yet high in fibre. Having regular fruit snacks together as a family helps in bonding and encouraging him so he does not feel like he can only eat healthy foods.

Posted by jen23 (Republished by Forum Admin)

Dear Dr Liew, I have neighbours who smoke above and below my flat. And I can smell it even when I shut my windows. Will 2nd hand smoke put me at risk of heart disease? In our old flat, the neighbor below us smokes too. My mum who was an athlete and never smoked, had lung cancer 4 years ago. I suspect the 2nd hand smoke was a factor.

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear jen23,

Based on the observational studies that were reported in the medical literature, second hand smoke (or also known as Environmental Tobacco smoke (ETS)) was thought to be associated with a general increased risk of coronary heart disease by about 25%.

However, a large population study done in California, USA had suggested that the effect of ETS on the heart may be smaller than previously thought. All in all, I believe there is some increased risk of CHD with exposure to ETS and hence such exposure should be reduced as far as possible.

Posted by ktong (Republished by Forum Admin)

Hi Doctor, my husband travels 2–3 weeks in a month for work and has been doing so for the past 2 years. Recently, he complains of chest pain, especially at night, or after a jog. He’s younger than me (he’s 34) and has a family history of heart disease (dad has 90% blockage and 3 stents inserted, maternal grandad died of heart attack at 41). Do you think frequent flying and stress puts you more at risk of heart disease? What should I look out for to know if his chest pain is serious? Thanks.

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear ktong,

Lack of rest and high stress levels have been shown in some studies to have a link with increase in heart diseases though it was not a proven cause-effect relationship.

You should encourage him to get an evaluation for his chest symptoms given his family history. This will be important as he is often not within the country and access to medical care may be less consistent. Briefly from your description, I will certainly advise that he gets a formal evaluation by a medical professional.

Posted by Raymond (Republished by Forum Admin)

Dear Doctor,

I have Afib and have undergone ablation. Can Afib be completely cured? Must a patient with Afib be put on RivaRoxaban and Bisoprolol for live?

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear Raymond,

Afib or atrial fibrillation is a condition where the heart rhythm is irregular. This leads to reduction in blood flow within the heart and can pre-dispose to blood clot forming within the chamber of the heart. Taking Rivaroxaban (a form of anticoagulant or blood thinner) will reduce the chance of such blood clot formation. The studies that have been done showed that appropriate taking of these blood thinning medications/anticoagulants have been very effectively in reducing the risk of stroke.

Patient can develop recurrence of atrial fibrillation even after ablation (recurrence rate varies according to individual patient profile) hence it is advised that patients remain on the anticoagulants to prevent stroke events due to the possibility of silent recurrence of atrial fibrillation.

Bisoprolol belongs to a class of medications known as beta-blockers. The use of Bisoprolol is mainly for heart rate control in the event that one develops atrial fibrillation again as the heart rate tends to be high during atrial fibrillation.

Posted by Foo Chuanboon (Republished by Forum Admin)

Hi Doctor,

1. I have not been taking medicine that my doctor prescribed, and I have been watching my diet, eating oats daily, and doing some jogging and I see an improvement in my cholesterol level. But my doctor still ask me to take medicine, but will that cause my body to dependent on the medicine… and let’s say, if I miss a day of my medication, will my body not be able to take it and cause a worst effect? Pls advise.
2. Is vitamin C crucial to our body? Does our body produces vitamin C. Is it true that animals do not have heart attack. And why is it so? What is lacking in our body system that causes the difference btw humans and animals?
3. How often should we test our cholesterol?
4. What is the best food for reducing cholesterol?
5. Does lowering cholesterol result in better blood flow?
6. Are having frequent headaches a symptom of high cholesterol? But that normally happens to me after my night shifts. Could they be linked?
7. All along, our family diet is no oily food, only lean meat and vegetables. But I have a family history of high cholesterol. But with family history, will that be less severe as this is caused by genes.
8. Can a person with high cholesterol be considered suitable for blood donation?

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear Foo Chuanboon,

Thank you for your very interesting questions.

1. The decision whether to start on medications for hypercholesterolaemia will depend on your risk profile and level of your cholesterol. As such, you should engage your doctor for a deeper discussion as to what targets should you be aiming for. This will help you decide when to start back on your medications. Cholesterol lowering medications have good data in the scientific literature for prevention of strokes and heart attacks. They do not cause you to become dependent on them.
2. Vitamin C deficiency in humans are due to an absent enzyme activity that is necessary for Vitamin C synthesis. AS a result, we need to have vitamin C supplement through our diet. It is necessary for a range of body functions eg repair and growth of tissues. There are fewer reports of heart attacks in animals also because the presentation of heart disease is different compared to humans. It is difficult to ascertain a particular factor why humans and animals behave differently with regards to heart disease as there are many confounding factors eg diet, lifestyle and genetic make-up.
3. The Singapore guidelines recommend to check your blood cholesterol levels every 3 yearly for those who have cholesterol readings within the targets for your risk profile.
4. We encourage diet rich in vegetables, fruits, legumes, whole grain, unsaturated fats as well as food low in trans fat.
5. Lowering your blood cholesterol levels will reduce fatty plaque deposits in the walls of your arteries. Less of such fatty deposits will reduce the narrowing of your arteries and in turn not compromise blood flow.
6. Symptoms such as headache are often very non-specific and can be caused by multiple factors. If you have persistent recurrent headaches, I will suggest to have your doctor review that. Hypercholesterolaemia itself does not result in such headaches usually as they are often silent.
7. Familial hypercholesterolaemia due to genetic alterations can result in earlier onset of coronary heart disease as these patients generally start experiencing changes in their arteries at a younger age as well. The risk for heart disease is not lower simply because it is a genetically linked cause.
8. Patients with hypercholesterolaemia, on medications, are still eligible for blood donation provided there are no cardiovascular complications.

Posted by Alex Yip (Republished by Forum Admin)

Dear Dr Liew, 

I am 59 years old to date.

I had an heart attack in 2014 while doing my run on the treadmill in SAFRA Mt Faber.

The SAFRA instructor used an AED to bring my heart beat back and follow by the Cardio Doctor in Alexander Hospital (under NTFGH) in Aug 2014.

My question to you is, am I allowed to participate in a marathon, eg 10 or 15km run, probably not as fast as before, but at a slower pace. Is there a risk if I start going to the gym to train slowly and get back my form?

Thank you and hope to hear your opinion.

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear Alex Yip,

It is fortunate that you were attended to expediently when you developed the cardiac arrest.

The ability to resume moderate-high intensity exercise depends also on the extent of your heart disease and how much treatment was done for the artery narrowing. The extent of damage to your heart muscle and the current function of your heart pump (usually assessed by an ultrasound of the heart) will also affect how much exercise you can tolerate.

I will suggest discussing with your cardiologist, based on your cardiac history (extent of coronary artery disease as well as residual heart pump function), the safety of resuming your exercises. There are available cardiac rehabilitation programs in all hospitals that cater to patients with cardiac disease who are looking to resume exercising as well.

Posted by Chy Ibeazor (Republished by Forum Admin)

How do I prevent heart disease when there is no high cholesterol, no high blood pressure nor heart attack?

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear Chy Ibeazor,

It is heartening to hear you have no abnormality with your blood pressure as well as blood cholesterol levels.

The modifiable risk factors of heart disease include:

Early detection and treatment of these risk factors by means of regular health screening will reduce the risk of developing a heart attack. Adopting an active lifestyle with regular exercises will also help in controlling the risk factors for heart disease.

Posted by Peter Chong (Republished by Forum Admin)

Dear Dr. Liew, good morning.

I’m 66 and I think I’m healthy by this age group. My BP is around 130/80, kidneys are healthy, cholesterol level is border line (I think it is in the gene as I could not bring it down even with excessive exercise and disciplined diet), and I’m not taking any medicine.

I walk daily to keep myself healthy. Though feeling healthy, I have always wanted to do an angiogram to confirm that there is no blockage, or potential blockage in my arteries. My late father had a stroke and that worries me. He passed away at 72 in mid 70s.

I have a few questions about angiogram:

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear Peter Chong,

It is good to hear that you are currently in the pink of health and that you are taking active steps to stay healthy.

1. Coronary angiogram is a procedure that we perform in patients whom we suspect has coronary artery disease. It is an invasive procedure which may be performed in the setting of day surgery. However as the procedure requires the use of contrast material injection as well as exposure to radiation, we will advise that the procedure be done based on clinical need. There are other ways to assess your risk for cardiovascular disease which may be less invasive. You can approach your doctor/cardiologist for further discussion regarding your options after a clinical assessment by your doctor.
2. Coronary angiogram is the gold standard for assessing for any disease involving the major arteries supplying your heart muscle.
3. The cost of an angiogram depends on the hospital that you are seeing as well as the class of treatment you are under. The cost can be off-set with your Medisave subject to the limits for that class of treatment.

Posted by Ong (Republished by Forum Admin)

Dear Dr Liew,

I recently experienced chest pain (sharp poking on the middle of chest area) and went for a check at A&E. After ECG, Blood Test and X-Ray, I was discharged and given muscle relaxation medication.

My friend told me that he also experienced similar pain, went to A&E and got discharge. But he was found to have 95% blocked on 1 artery after cardiac catheterisation test.

Should I be required to do the similar test? Would the check by A&E be enough to determine that I am not a risk of heart disease? Thank you.

Answered by Dr Liew Boon Wah, Consultant, Department of Cardiology, Changi General Hospital.

Dear Ong,

It was right for you to have gone for further evaluation of your chest pain symptoms. Rightfully, the blood test and ECG will be able to rule out any heart attack.

However, these tests cannot predict if there is any artery narrowing unless the narrowing had resulted in heart attack.

The decision whether further test will be required is dependent on the clinical risk profile of each patient and the presenting symptoms. Hence it will be difficult to extrapolate the results of your friend’s test to your case. If there is any doubt, you may consider getting a review with your doctor/cardiologist.