Ministry of Health Singapore. All Rights Reserved.
Early detection prevents complication such as heart failure, stroke, kidney disease and artery disease. This article details an individual's risk of the disease as well as recommendations for prevention
Heart disease is a leading cause of death worldwide, and affects not only the heart but other major parts of the body. Early detection prevents complication such as heart failure, stroke, kidney disease and artery disease.
Heart disease is a broad term that describes a range of diseases of the heart and blood vessels. Heart disease is often used interchangeably with cardiovascular disease.
The disease is a leading cause of deaths worldwide and refers to disorders of the blood vessels supplying the heart and other major parts of the body. Early detection reduces suffering and prevents complications such as heart failure, stroke and kidney disease through early treatment.Why is cardiovascular screening important?Cardiovascular disease begins with damage to the body from lifestyle factors of smoking, physical inactivity and unhealthy diet. This progresses to the development of high-risk diseases such as obesity, high blood pressure and diabetes.
Screening identifies those at risk of future cardiovascular events of the heart and other major body organs. It also identifies those with modifiable risk factors, which are reversible and reduce one' s risk of developing cardiovascular disease.
Who should go for screening of cardiovascular risk factors?Every adult aged 18 years and above should go for screening of cardiovascular risk factors. Patients with diabetes, high blood pressure and long-standing kidney disease have a higher risk for cardiovascular disease and should be screened regularly based on their doctor's advice.
What is global cardiovascular risk assessment?Global cardiovascular risk assessment involves assessing a patient's total cardiovascular risk rather than just assessing risk factors (high cholesterol, blood pressure, diabetes or obesity) in isolation.
The best known global cardiovascular risk assessment tool is the Framingham Risk Score (FRS). Based on the FRS adapted for local use, the risk for an asymptomatic individual is classified as:• Low-risk corresponding to <10% risk of vascular events* over a ten-year period• Intermediate-risk corresponding to 10-20% risk of vascular events over a ten-year period• High-risk corresponding to >20% risk of vascular events over a ten-year period*These vascular events include heart attack and coronary death.It should be done every five years starting from the age of 18 years. For individuals at risk but who have no symptoms, the assessment is followed by advice on making certain lifestyle changes such as cutting back on cigarettes, eating healthy foods and exercising regularly and, where appropriate, medicines are given to treat high blood pressure, high lipids and diabetes. Individuals at low risk should continue to lead a healthy lifestyle. More frequent assessment is recommended for those who are diabetic, chronic smokers or obese.
How to calculate the ten-year coronary artery disease risk?It is calculated based on:
Related: Cholesterol and Your Heart
What additional screening tests may be needed following global cardiovascular risk screening?These additional tests may be needed for cardiovascular evaluation of individuals at moderate and high risk without any symptoms.
When should screening for body mass index (BMI), waist circumference, high blood pressure and high cholesterol be done?
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What is pre-exercise screening?
It helps identify those at risk for a cardiovascular event during exercise. The questionnaire below is recommended for safety reasons before participating in any physical activity.
Table 5: Physical Activity Readiness Questionnaire (PAR-Q)Before you exercise, please read each question carefully and answer Yes or No to your best knowledge.
2) Has your doctor informed you that you have any of these conditions? (check all that apply)
Physical activities are categorised into Category 1 and Category 2 (Table 6) based on the requirement of cardiovascular fitness.
For Category 2 activities, greater cardiovascular fitness is needed along with a physical fitness clearance by a doctor
For Category 1 activities, physical fitness is still an important consideration
For example, for a physically fit 55-year-old adult, Category 1 activities will pose no problem whereas an unfit person with congestive heart failure may not be able to tolerate such activities.
Related: Tailor Your Exercise to Fit Your Age
Talk about the results of your screening with your doctor and know what you can do to live a healthy lifestyle (Table 7) as well as ways to prevent and treat your medical conditions (Table 8).
Table 7. Live a healthy lifestyle
Eat five to seven servings of rice and alternatives daily (of which two to three servings should be wholegrain products)
Eat two servings of fruits and two servings of vegetables daily
Eat two to three servings of meat and alternatives daily (of which half a serving should come from dairy or other high calcium products)
Use fats, oils and salt sparingly to flavour food
Drink six to eight glasses of fluid (1.5 to 2.0 litres) daily
Target to have your BMI between 18.3 to 22.9 kg/m2
Keep your waist circumference equal or less than
80 cm for women
90 cm for men
If you are overweight, aim to lose only 0.5 kg per week.
A slow and steady weight management is healthier and easier on the body
If you are not exercising regularly, start today with ten minutes of brisk walking and build up as your physical fitness improves. You will enjoy the better health that comes with regular exercise
Target to exercise regularly e.g. brisk walking 30 minutes a day five days a week, or a pedometer reading of 10,000 steps a day
If you enjoy doing other exercises, be regular in doing them
See your doctor if you need help to quit smoking or to discuss more about it
Avoid alcohol bingeing
Ask your doctor s advice on setting the limits on alcohol consumption
Table 8. Prevent and treat your medical conditions
Desirable levels are:
Total Cholesterol Less than 5.2 mmol/L (200 mg/dL)
HDL-cholesterol Equal or greater than 1.0 mmol/L (40 mg/dL)
LDL-cholesterol Less than 3.4 mmol/L (130 mg/dL)
Triglycerides Less than 2.3 mmol/L (200 mg/dL)
Check with your doctor the levels to set for yourself
Normal blood pressure levels are:
Systolic BP Less than 130 mm Hg
Diastolic BP Less than 80 mm Hg
Optimal (target goal for majority of patients) are:
HbA1c 6.5 7.0%
Pre-meal glucose 6.1 8.0 mmol/L
Two-hour post-meal glucose 7.1 10.0 mmol/L
Take your medicines regularly even if you feel well
Check with your doctor on the targets of control if they are not optimal
You need regular monitoring if you have high cholesterol levels, high blood pressure or diabetes
Check with your doctor on the desired frequency of regular monitoring
Keep up to date on your screening appointments for you and your family using HealthHub myHealth.
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This article was last reviewed on
Wednesday, August 29, 2018
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