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 (Cardiovascular) Screening

heart screening

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.

risk factors for cardio 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. Individuals 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.

Cardiovascular Risk Assessment

cardiovascular risk assessment

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:

  • Age
  • Sex
  • Ethnicity
  • Smoking status
  • Total and High Density Lipoprotein (HDL) or good cholesterol level
  • Systolic blood pressure

Related: Cholesterol and Your Heart

Additional Screening Tests

additional screening tests

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.

 Additional Screening Tests  Remarks
 Resting Electrocardiogram (ECG)Indicated only in selected individuals e.g., cardiovascular screening in asymptomatic people with high blood pressure
 Exercise Treadmill TestRecommended in individuals without symptoms:
Older than 45 years in males and 55 years in females who plan to start vigorous exercise
Older than 45 years in males and 55 years in females who are at high-risk due to concurrent diseases
With diabetes who plan to start vigorous exercise
 Coronary artery calcium scoreRecommended in patients who have atypical chest pain to rule out ischaemic heart disease (These patients are otherwise considered to be at low-risk of coronary disease)
 Cardiac stress imaging (stress echocardiography)Reserved for individuals with an abnormal exercise ECG
 CT coronary angiographyUncertain value as a screening test even in high-risk individuals. The risks of the test and the possibility that it may lead to further unnecessary tests need to be considered
 Carotid intima-media thicknessNot recommended for routine cardiovascular screening


When should screening for body mass index (BMI), waist circumference, high blood pressure and high cholesterol be done?

 Recommended for  To screen for  Screening test  Screening frequency
Individuals aged 18 years and above Obesity Body Mass Index (BMI)
 Waist Circumference
Once a year
Individuals aged 18 years and above
 High blood pressure Blood pressure measurementOnce every two years or more frequently as advised by your health care provider
Individuals aged 40 years and above
 Diabetes mellitus
 Fasting venous blood glucose
 Non-fasting venous blood glucose test
Once every three years or more frequently as advised by your health care provider
Individuals between 18 to 39 years old
 Diabetes mellitus
 Diabetes Risk Assessment (DRA)
Once in two years

​

Related: Trim the Fat

Pre-exercise Screening

pre-exercise screening

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 5A: Get Active Questionnaire 
The questions in the following table will help to ensure that you have a safe physical activity experience. Please answer YES or NO to each question before you take part in physical activities. If you are unsure about any question, answer YES. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly. 

1) Have you experienced ANY of the following (A to F) within the past six months?
 ​ A. Diagnosis of/treatment for heart disease or stroke, or pain/discomfort/pressure in your chest during activities of daily living or during physical activity?
 Yes​
​ No
  B. Diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher?
 Yes No
  C. Dizziness or lightheadedness during physical activity?
 Yes No
  D. Shortness of breath at rest?
 Yes No
  E. Loss of consciousness/fainting for any reason? 
 Yes No
  F. Concussion?
 Yes No
​2) Do you currently have pain or swelling in any part of your body (such as from an injury, acute flare-up of arthritis, or back pain) that affects your ability to be physically active?
​ Yes
 No​
3) Has a health care provider told you that you should avoid or modify certain types of physical activity?
 Yes No
4) Do you have any other medical or physical condition (such as diabetes, cancer, osteoporosis, asthma, spinal cord injury) that may affect your ability to be physically active? 
 Yes No
If you have answered NO to all questions, you can be reasonably sure that you are at low risk to participate in exercise programmes or events. 

If you answered YES to any question, please refer to the rest of this questionnaire here.  ​ ​

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.

categorisation of sports based on cardio activity

Follow-up on the Results of Screening for Cardiovascular Disease and Risk Factors

follow-up on results for cardio disease and risk

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

 What you can do Recommendations
 Healthy eating

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

 Maintain a healthy weight

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

 Engage in regular physical activity

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

 Cut back on cigarettes

See your doctor if you need help to quit smoking or to discuss more about it

 Limit alcohol use

Avoid alcohol bingeing

Ask your doctor s advice on setting the limits on alcohol consumption

 

Table 8. Prevent and treat your medical conditions

 What you can do Recommendations
 Keep your cholesterol levels in check

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

 Keep your blood pressure levels in check

Normal blood pressure levels are:

Systolic BP Less than 120 mm Hg

Diastolic BP Less than 80 mm Hg

Check with your doctor the levels to set for yourself

 Keep your blood sugar levels in check

Optimal levels for people living with diabetes:

HbA1c 6.5 to 7.0mmol/L

Pre-meal glucose 6.1 8.0 mmol/L

Two-hour post-meal glucose 7.1 10.0 mmol/L

Check with your doctor the levels to set for yourself

 Take your medications regularly

Take your medicines regularly even if you feel well

Check with your doctor on the targets of control if they are not optimal

 Go for regular monitoring if you have chronic medical conditions

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


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