To develop precise prevention, diagnosis and treatment plans for heart diseases in Asians, NHCS researchers are examining the genetics of local multi-ethnic population and more.

By Assoc Prof Yeo Khung Kheong, Senior Consultant, and Dr Kenneth Chew, Senior Resident, Department of Cardiology

Heart disease is a modern epidemic, with cardiovascular disease as a leading cause of death in Singapore, contributing close to 30% of total mortality in 20181. Similarly, this trend is noted globally with significant worldwide contribution towards morbidity and mortality.

The current understanding of heart diseases has evolved into a multifactorial one, encompassing genetic programming, epigenetics, lifestyle (including fitness, physical activity and diet) and clinical ‘phenotype’ (such as a positive electrocardiogram (ECG) test or a cardiac magnetic resonance imaging (MRI) scan of a structurally abnormal heart.

Correspondingly, conventional knowledge of predisposing risk factors for cardiovascular disease had been derived from large, prospective, population based studies in Western cohorts, such as the landmark Framingham Heart Study2, from which total cholesterol (comprising low-density lipoprotein cholesterol (LDL-C) and highdensity lipoprotein cholesterol (HDL-C)), blood pressure, smoking, diabetes and age were identified as risk factors in a population free from overt coronary heart disease.

Lack of Data in Asian Ethnic Groups

Ethnicity, with its accompanying differences in culture and diet, has long been known to be a contributing factor towards cardiovascular conditions.  An example is the penchant of heart failure with preserved ejection fraction in younger Asians with multiple
comorbidities3. With various other clear evidence on a unique Asian disease profile, further and advanced research is needed.

In the West, attempts have been made to improve traditional understanding of cardiovascular risk factors and include a wider array of patients, such as the Pooled Cohort, a key contemporary study group from the United States and from which the 2013 American College of Cardiology/ American Heart Association (ACC/AHA)’s Atherosclerotic Cardiovascular Disease risk calculator was derived from. 

Despite these attempts, the ACC/AHA 2013 Prevention Guideline highlighted areas of need, such as the insufficient study data on non-white or non-African American ethnic groups, alternative risk factors and novel biomarkers.

Reviewing the Unique Asian Profile

Recognising the gap in research on Asian ethnic groups, the SingHEART  study aims to shed light on our uniquely Asian population, elucidating at risk groups and informing the wider medical community on risk reduction. Significantly, it will help clinicians and scientists understand the interaction on genes and lifestyle, for the causes of heart diseases.

SingHEART is led by Assoc Prof Yeo Khung Keong, Senior Consultant from Department of Cardiology at the NHCS, and uses the NHCS Biobank, which tracks the health of local participants between the ages of 18 and 65 from all ethnic groups in Singapore.
The SingHEART study also partners with SingHealth Duke-NUS Institute of Precision Medicine (PRISM), to perform the complex genetic and metabolomic analyses in the study. PRISM, led by Prof Patrick Tan, is a joint institute between SingHealth and Duke-NUS Medical School to develop precise medical therapy for each individual patient, using a combination of genetics and other advanced technologies.


The SingHEART study has a threefold objective:

  1. To characterise cardiovascular health specifically in Asians. 
  2. To assess and validate pre-existing biomarkers (lipid markers, family history), measurements of cardiorespiratory fitness, and imaging studies identifying subclinical cardiovascular disease, all in Asian populations.
  3. To use both traditional statistical analysis and newer data analytics (machine learning).

The SingHEART Study – A Unique Asian Study

SingHEART is the first population-based study in Asia, which involves a multi-ethnic, healthy Asian population, and uses the latest technologies – including genomics, lipidomics, advanced imaging, wearable data and data analytics. Its target is to recruit 5,000 patients based on feasibility and funding availability.

As of December 2019, more than 920 patients have been recruited.

The SingHEART programme welcomes any forms of public participation or support such as study volunteers or funding. Such contributions will provide significant impact and help future generations have better and healthier lives through breakthrough prevention, diagnosis and treatment plans for heart diseases.

Principle Causes of Death. Ministry of Health, Singapore. 2018.
2 Wilson PWF et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97:1837-47.
3 Tromp J et al; ASIAN-HF Investigators. Heart failure with preserved ejection fraction in Asia. European Journal of Heart Failure (2019) 21, 2336

This article is from Murmurs Issue 35 (September – December 2019). Click here to read the full issue.