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What are the modifiable risk factors?

High blood cholesterol

As high blood cholesterol itself does not cause symptoms, many people may not be aware that their cholesterol level is high.

Therefore, it is important to check your cholesterol level regularly. If the level is high, it should be lowered to reduce your susceptibility to coronary heart disease. The desirable level of cholesterol depends on your pre-existing risk for coronary heart disease.

High blood pressure / hypertension

"Hypertension is one of the major risk factors for coronary heart disease and cerebrovascular disease, such as stroke," say doctors from National Heart Centre Singapore, a member of the SingHealth​ group. ​Hypertension usually occurs without any symptoms. ​​Hypertension, left untreated over the long term, can lead to damage of the heart and blood vessels leading to stroke or heart attack.

When your blood pressure is e​xtremely high, headaches, dizziness or alterations in vision may be experienced. Marginally elevated blood pressure may normalise when you lose weight, exercise more and reduce salt intake. If these measures are not successful, then drug treatment may be needed. Once medication has started, it is essential to continue with the treatment, complemented by a healthy lifestyle.

Treatment of hypertension for most people is lifelong. You should have your blood pressure checked at least once a year.

It is recommended that adults over 40 years should have their blood pressure checked annually, and their blood cholesterol checked once every three years; more frequently if results are abnormal or if there are other risk factors.

Diabetes and abnormal blood glucose (sugar) levels

Diabetes mellitus is a chronic illness. It is often associated with other cardiovascular risk factors, such as high blood pressure, increased total cholesterol and triglyceride levels, decreased HDL-cholesterol levels (“good” cholesterol) and obesity.

The basic treatment strategy is to maintain good control over the amount of glucose in your blood. Maintaining a healthy weight, a balanced diet and a regular exercise routine can prevent the onset of diabetes mellitus.

People with diabetes are 2 to 4 times more likely to develop coronary artery disease and stroke.

Menopause

Many women before menopause seem to be partly protected from coronary heart disease, heart attack and stroke by natural oestrogen.

A woman’s oestrogen level is highest during her childbearing years and declines during menopause. If menopause is caused by surgery to remove the uterus and ovaries, the risk rises sharply.

As a woman ages, the loss of natural oestrogen may contribute to a higher risk of heart disease and stroke.

If menopause occurs naturally, the risk rises gradually. However, routine hormone replacement for women who have undergone natural menopause does not prevent heart disease.

Obesity and overweight

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, and lowers HDL. It is also 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.

As body fat increases when more food calories than required are consumed over a long period of time, weight control (fat loss) is possible by decreasing food intake together with increasing physical activity.

If you burn more calories because of increased physical activity, a gradual decrease in body weight will take place. Diet alone can also cause weight loss, which leads to a decrease in blood pressure, blood glucose and blood cholesterol levels.

Physical inactivity

An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate physical activity helps prevent heart and blood vessel disease if done over a period of time.

Regular exercise may also lead to an improvement in other cardiovascular risk factors, such as weight loss, lower blood pressure, decreased stress and improved cholesterol levels.

Exercise is beneficial especially since the risks involved are minimal. Exercise programmes should start at a slow pace initially to avoid injury to muscles and ligaments.

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 per cent 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. Smoking causes a decrease in HDL-cholesterol.

Smokers have 2 to 3 times the risk of non-smokers for sudden cardiac death.

Stress

Your blood pressure goes up momentarily when you get angry, excited, frightened or when you are under stress.

If you experience constant stress over a prolonged period, you may be at a higher risk of developing high blood pressure, leading to a heart attack.

See previous page for non-modifiable risk factors for coron​ary heart disease.​​

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