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 (Cardiovascular) 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.
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
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
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 Test | Recommended 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 score | Recommended 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 angiography | Uncertain 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 thickness | Not 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 measurement | Once 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 |
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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.
Follow-up on the Results of Screening for Cardiovascular Disease and Risk Factors
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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