Cardiovascular disease is the top killer for women in Singapore but many are still unaware of the dangers posed by this “silent killer”.

The risk of women having heart disease is lower than men during their childbearing years but rises sharply after their menopause due to the loss of oestrogen protection. In addition, women are more likely to experience atypical symptoms such as shortness of breath, nausea, vomiting and epigastric pain.

Dr Paul Chiam and Dr See Chai Keat, Consultants from the Department of Cardiology at National Heart Centre Singapore, give detailed answers to your questions.

Question by christineyeo

Hi Drs

Everything morning when I walked up the hillslope to work, I felt short of breathand tightness and pain of the chest.

Is this the indication of heart problem.

I usually take long walk over the weekend and do not have such feelings.

Kindly advise.


Answered by Dr Paul Chiam, Consultant, Department of Cardiology, National Heart Centre Singapore

It’s difficult to be sure. The breathlessness and chest tightness on walking uphill to work is certainly a cause for concern as it may be due to underlying heart disease. It would be advisable to seek early medical attention.

Is the intensity of the weekend long walk different from the uphill walk? That may account for the difference in symptoms.

Question by judylin

Dear Doctors,

I believe nowadays all women and men face the threat of heart diseases. But are there any difference between men and women in terms of heart disease and heart attack symptoms?

I am currently on birth control pills. However, I heard from my colleague that taking birth control pills will actually increase our risk of contracting heart disease? Is that true? How does it affect us? Please advice.

Thanks and look forward to your reply.


Answered by Dr Paul Chiam, Consultant, Department of Cardiology, National Heart Centre Singapore

Women do face the same lifetime risk of heart disease as men but the incidence is delayed by about 10 years.

The heart attack symptoms women face can be more atypical: vague chest pains, breathlessness, epigastric (upper abdominal) pain, neck or back pain and nausea/vomiting.

The older generation birth control pills did increase the risk of cardiac events slightly, but the latest (3rd generation) ones do not appear to do so. Consult your gynaecologist to verify the type of birth control pills used.

Question by rachel

I attended your 'Fabulous from 40!' talk last week.

Can I just check : if my cholesterol is now low, does that mean I will not get a heart attack, altho I am slightly overweight? My last check was last year - ttl Cholesterol:170; HDL:60, LDL: 90. trigylcerides : 110.

Recently , I feel slightly breathless when I walk up more than one flight of stairs. Is this cause for concern?

I do go walking in the evenings about 2 - 3 times a week as exercise, although must admit at a rather leisurely pace....

Are the blood test indications good enough, or do I need to go for any test/scan. I do recall you saying not to go for unnecessary scans.

Look forward to your opinion.

Thanks much.

Answered by Dr Paul Chiam, Consultant, Department of Cardiology, National Heart Centre Singapore

The low cholesterol level you have reduce the likelihood of heart attack but the risk is NOT zero.

The breathlessness on walking up a flight of stairs should be investigated. There are many possible causes, some of which may not be due to underlying heart disease.

No test has been shown to be able to consistently predict the risk of heart attack in a low risk patient like you, especially if there are no risk factors such as high blood pressure, diabetes or high cholesterol.

For screening purposes, blood tests to detect diabetes and high cholesterol would be sufficient, in addition to checking of blood pressure.

Question by unclesam97

Hi Drs,

My name is Samuel Goh, 76 yrs. In year 2000, the heart surgeon found that I have a 70% stenosis of the proximal LAD. This was dilated and stented with a 3.5 x 13mm velocity BX stent with excellent results which reduced the stenosis to 0%. In year 2001, there was however a mid segment 20% plague in the mid LAD with no critical lesion. Over the last eight years and still is, with medication, I have no serious problem except I cannot stress or exert myself like brisk walking which gives me chess pain, hence I stopped exercising for the last 3 years.

Question: Recently, I've seen a local doctor from Raffles Medical that there's a new drug that can unclog/open or remove the plague in the arteries on the stent. Is there such a drug and what's your recommendation for my case? FYI, I'm also a diabetic.

Best regards
Samuel Goh

Answered by Dr Paul Chiam, Consultant, Department of Cardiology, National Heart Centre Singapore

I am not aware of any drug that can remove plaque from the artery or stent. At best, optimal medical therapy can only stabilise the narrowing.

Question by pearlynwan

does smoking increase my risk of having heart attack ? I am 35 years old now and my family does have a history of heart attack.

Answered by Dr See Chai Keat, Consultant, Department of Cardiology, National Heart Centre Singapore

Smoking is a major modifiable clinical risk factor for coronary artery disease. Based on the INTERHEART study (Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries) by S.Yusuf et al, published in Lancet 2004, persons who smoked has nearly 3 fold increased risk of having acute heart attack compared to non-smokers.

Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary artery disease. Those who smoke cigars or pipes also have higher risk of death from coronary heart disease. Other important risk factors for coronary artery disease include diabetes mellitus, high cholesterol, high blood pressure, family history of premature coronary artery disease and abdominal obesity.

Cigarette smoking acts with the above risk factors to greatly increase the risk of coronary heart disease. In order to assess individual patient’s risk of having coronary artery disease, we use a risk score called Framingham Risk Score which will classify individuals into low (<10%), moderate (10%-20%) or high risk (>20%) of cardiovascular events over a 10-year period. Estimation of the 10-year coronary artery disease risk requires individual’s age, smoking status, total cholesterol and HDL cholesterol level and systolic blood pressure.

Thus, to answer your question, yes, smoking will increase your risk of having heart attack and you are strongly encouraged to quit smoking. In order to further assess your risk of developing heart events over a 10-year period, you need to have your blood pressure and cholesterol checked.

Question by dorisghtan

Hi, I been monitoring my blood pressure for the past week and that it is rather erratic. Readings are as follow:-

SYS - 130 - 140

DIA - 76-80

Pulse - 65 - 60

Please advise


Answered by Dr See Chai Keat, Consultant, Department of Cardiology, National Heart Centre Singapore

Base on your blood pressure (BP) reading, you fall into category between normal to high-normal blood pressure. Normal blood pressure group is defined as BP of <130/80mmHg and the high-normal group is defined as BP from 130/80 to 139/89mmHg based on Singapore MOH Clinical Practice Guidelines on Hypertension. Bear in mind that our BP is characterised by large spontaneous variations. It is important that diagnosis of high blood pressure should be based on multiple blood pressure measurements taken on several separate occasions.

Proper ways of measuring the BP are important too. Patient should sit or lie down for several minutes before measuring BP and he or she should avoid smoking or drinking caffeinated drinks 30 minutes preceding the BP measurement. Proper cuff size and positioning the cuff at the heart level will reduce error in measurement.

Base on your BP reading, there is no indication to start high blood pressure medication. Adopting healthy lifestyle habits like avoiding salty and oily food, exercising regularly to keep optimum body weight and not smoking are important first step measures in both preventing and controlling the high blood pressure.

Question by pony

Dear Drs

My blood pressure is 110/70 and Total cholesterol is 192mg/dl with no family history of heart disease. However, I am diagnosed with palpitation/skip heartbeat in 2010 and currently on medication. I would like to know the followings:

  1. Am I on the high side of getting heart disease in old age?
  2. What is the consequences of skip or taking the medication?
  3. Is there other ways to reduce the palpitation/skip heartbeat other than taking the medication?
  4. Does taking Omega 3 or fish oil helps per my conditions?
  5. Does carbonated drinks increase heartbeat/palpitation as I don't feel comfortable or feeling breathless (need to keep coughing) after drinking it?


Answered by Dr See Chai Keat, Consultant, Department of Cardiology, National Heart Centre Singapore

  1. Your blood pressure (BP) and total cholesterol level are normal and you don’t have family history of coronary artery disease. Other important information required to further assess your risk of developing coronary artery disease include diabetes and smoking status, your age and gender.
  2. Palpitations or missed beats are due to irregular heart beats which have various causes. Depending on the underlying causes, skipping medications may have various consequences. The frequency of palpitation may increase and the patient may develop breathlessness or abnormal chest pain sensation. The seriousness depends on the underlying causes. The patient may develop adverse reaction to medications taken depend on class of the medications.
  3. The non-pharmacological method of reducing palpitations depends on the underlying causes of the palpitations.
  4. Omega 3 fatty acids benefit the heart of healthy people and those at high risk and those who have cardiovascular disease. Research has shown that it can decrease risk of abnormal heart beats. It also decreases triglyceride level. If your triglyceride level is high and you are not keen on taking other medications, Omega 3 fatty acids is a reasonable alternative.
  5. You should avoid drinking carbonated drinks as they may contain various levels of caffeine that may aggravate your palpitation symptoms. Each can of soft drinks may contain about 20-70 mg of caffeine. If consumed regularly, may cause stomach upset and heartburn.

Question by healthblur

My husband, aged just above 50, had high cholesterol readings for quite a while - slightly above 300.

He went to the cardiologist at NHC over a period of two years and started on highly improved diet and lifestyle. Thankfully, his cholesteerol came under control - without medication - and the doctor had 'discharged' him last year. i.e. said he is okay.

Q: If he continues with his current much healthier lifestyle, does that mean he does not have to go for another heart check? Or, after how long should he go for another follow up check up? Look forward to your advice.


Answered by Dr See Chai Keat, Consultant, Department of Cardiology, National Heart Centre Singapore

Base on the information given, your husband’s previous total cholesterol level of 300mg/dl is high (normal should be less than 200mg/dl).

If his current level is below 200mg/dl, that will be optimum for him. Please continue the healthy lifestyle and proper low cholesterol diet which is of paramount importance in reducing risk of coronary artery disease.

In order to further assess his coronary risk, he should check his fasting blood sugar and blood pressure. Based on age, gender, systolic blood pressure, total cholesterol and HDL level and smoking status, we can then calculate the estimated 10-year coronary artery disease risk using the Framingham Risk Score. This risk score will classify individuals into low risk (<10%), intermediate risk (10%-20%) or high risk (>20%) of cardiovascular events over a 10-year period.

Ref: U11