SINGAPORE – More than 10,000 Singaporeans aged 40 to 70 will be screened as part of an ambitious large-scale preventive health programme called Project Reset, to find ways of uncovering possible heart disease hidden in seemingly healthy people and help them arrest it.

Heart disease is a top cause of death in Singapore. On average, 34 people have heart attacks and 23 people die from heart disease daily, and the numbers are projected to rise with a rapidly ageing population.

It is estimated that one in three Singaporeans may have underlying early heart disease that remains undetected.

To tackle the pressing challenge of heart disease, Health Minister Ong Ye Kung, who launched the project at the Heart Disease Prevention Symposium at Singapore Marriott Tang Plaza Hotel on Wednesday, said there is a need to move upstream to invest in scientific research and shape lifestyles because delivering very good care for heart disease patients is not enough.

Project Reset, a large-scale collaborative initiative led by Professor Roger Foo and his team behind the Cardiovascular-Metabolic Disease Translational Research Programme, received a $25 million grant at the launch.

“As we know, heart disease is a notorious silent killer. The arteries supplying blood to our heart can quietly clog up slowly, unbeknownst to us due to factors such as unhealthy food intake, lack of physical activity and genetic predisposition,” Mr Ong said.

“Project Reset aims to detect early signs of heart disease by identifying cardio-liver-metabolic biomarkers present in individuals who have heart disease but are still asymptomatic. Hopefully, with these findings, we will (uncover) the silent killer”.

Researchers will leverage artificial intelligence to analyse the data and identify the early warning signals, he added.

At the launch, Prof Foo, a senior consultant at the National University Heart Centre, Singapore, said that because heart disease is a complex condition influenced by a range of factors, the Project Reset team will be capturing a variety of data points, from lifestyle information and clinical data, down to genetic variations, at a scale that has not been done before.

“We want to map the disease and uncover all the associations between the conditions that can put a person at high risk of heart attacks and stroke, including blocked arteries, hypertension, fatty liver and left ventricular fibrosis (scarring of heart muscles),” he said. 

“The results would tell us why a fit marathon runner can suddenly collapse and die, or why a young healthy person can die in his sleep.”

Some people who maintain a healthy lifestyle today may be lulled into thinking they are completely healthy, but fitness and health are not the same thing, said Prof Foo.

For instance, marathon runners are very fit, but when you start looking at their arteries, their livers and their metabolism, it may not be what you expect, he said.

Mr Mike Tan, 64, a retiree, who joined a smaller National University Health System study aimed at finding ways to detect early disease earlier this year, is a good example.

He goes to the gym three to four times a week, hikes, cycles and has taken part in half-marathons, and because of this, he did not watch his diet.

“I have been on low dosage statin for 15 to 20 years for high cholesterol levels and my level is well controlled. It’s like a security blanket,” he said.

“So, I went into the research thinking I was healthy. I did a heart scan and my heart health was good, but I discovered I had fatty liver disease.” 

Project Reset will select 3,000 participants for a five-year follow-up programme, where new technologies will be piloted and deployed to help them tackle their disease. Some of the participants will come from existing smaller heart studies, including the one that Mr Tan is participating in.

They will get to use a smartwatch for five years, and experience a virtual reality program that comes with a glove to allow users to feel their own liver tissue stiffness and heart rate pulse during health discussions.

Project Reset will will also use CardioSight, a digital dashboard that maps the population of those with heart attack risk factors, helping researchers to target the higher-risk groups in the community.

The participants in Project Reset are not those who have already experienced heart failure, stroke and heart attacks.

“We intend to go deep down into the bottom of the iceberg looking at individuals who are apparently healthy. But actually, once we start screening them deeply, they start to reveal all the early signs of disease,” said Prof Foo.

They include people with fatty liver and scarring of heart muscles – two conditions that are not in current risk calculators for heart disease, he said. Up to 40 per cent of adult Singaporeans have fatty liver disease.

“What’s worse (is that) we haven’t yet done enough assessment of the heart and arteries of all of these people,” he said.

“We’re not looking at (just) intermediate cardiac risks. We’re also looking at the whole body phenotype,” said Associate Professor Calvin Chin, deputy director of the National Heart Research Institute Singapore.

“We’re looking at the amount of fat in the liver, the amount of fat in the body that cannot be picked up in the usual screening process.”

Project Reset will bring together public healthcare clusters, medical schools, and industry and community partners to look at how best to help Singaporeans take charge of their heart health.

A key part of the project is to pilot the technologies to help them for this purpose, as Singapore shifts its healthcare focus to preventive care under Healthier SG.

Hence, it will be one of the features at the first-of-its-kind Health District @ Queenstown, where science-backed initiatives are piloted to support residents in leading healthy and purposeful lives.

Prof Foo said the district, being a key pilot site for Project Reset, will be where many of the strategies and interventions will first be deployed, before they are rolled out to the rest of the country.