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Taming cholesterol

The proportion of people with high 'bad' cholesterol levels has dropped in the last decade, a national survey has found
The Straits Times - May 2, 2013
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Taming cholesterol
By Joan Chew

Singaporeans appear to be taking better care of their heart health, recent national figures suggest.

For instance, cholesterol levels have improved, particularly levels of so-called "bad" cholesterol, or low-density lipoprotein (LDL).

The National Health Survey 2010 showed 15.2 per cent of Singapore residents aged 18 to 69 years had high levels of LDL in 2010, down from 20.3 per cent in 2004 and 29.1per cent in 1998, after adjusting for an older population as an ageing population would see higher rates of cholesterol.

It may be one of the reasons that the rate of heart attacks per 100,000 people has fallen, from 230 in 2008 to 217 in 2011, after adjusting for an older population, according to the Ministry of Health.

High cholesterol is one of several risk factors for cardiovascular disease, a leading cause of death worldwide. In Singapore, it accounted for one in three deaths in 2010.

There are other reasons as to why heart attack rates may have dropped, noted DrRaymond Wong, a consultant at the cardiac department at the National University Heart Centre, Singapore.

The National Health Survey 2010 showed the prevalence of hypertension dropped from 32.5 per cent in 1998 to 23.5 per cent in 2010, after adjusting for an older population.

However, other risk factors for cardiovascular disease - obesity, diabetes, smoking and lack of regular exercise - have all gone up between 2004 and 2010.

These figures show that it is very likely the drop in cholesterol and hypertension rates are the main contributors to the fall in heart attack rates, said Dr Wong.

DANGERS OF HIGH CHOLESTEROL

Cholesterol is necessary for the formation of healthy cells but it also contributes to atherosclerosis, the underlying cause of many cardiovascular diseases.

In atherosclerosis, excess cholesterol in circulation is deposited into cells in the artery walls and gradually forms a fatty deposit called plaque.

Atherosclerosis restricts blood flow through the narrowed artery, leading to symptoms of chest pain called angina.

When the plaque ruptures, a blood clot will form which may completely block blood flow in the artery.

LDL cholesterol transports cholesterol from the liver to tissues of the body. High-density lipoprotein (HDL) cholesterol - "good" cholesterol - removes excess cholesterol from the tissues and brings it back to the liver for removal from the body.

What the national survey does not show is how many people with hyperlipidemia, or high cholesterol levels, have lowered their LDL levels through taking cholesterol-lowering drugs, said Dr Wong.

So it could well be that those already diagnosed with the condition are keeping it under control with medication.

Still, doctors are encouraged by the trend, which they feel is a sign of a population becoming more health conscious and aware of how to achieve good health.

While obesity, diabetes and high cholesterol all require a person to adopt healthier lifestyles, some lifestyle changes are easier to achieve than others.

Dr Wong pointed out that obesity is probably the hardest risk factor to manage, since there is no "magic bullet or drug" for one to lose weight.

Dr Tong Khim Leng, the chief of cardiology at Changi General Hospital (CGH), has observed more people being aware of the importance of regular exercise and a diet low in saturated fat.

And more people are finding out their cholesterol levels because of regular health screenings offered by company health insurance policies, said Dr Tan Chong Hiok, a senior consultant at Parkway Heart and Vascular Centre.

He said: "We are able to treat these patients earlier and data has shown that treating them with statin results in a relative risk reduction of up to 50 per cent in preventing cardiovascular disease."

TARGET CHOLESTEROL LEVELS

Doctors say routine screening for cholesterol should start from 40 years of age, and even earlier for people with heart disease or multiple risk factors.

A person's target cholesterol level is dependent on his risk of cardiovascular disease, based on well-known risk factors such as age, ethnic group, smoking status, cholesterol and blood pressure. This can be calculated with a local version of the Framingham risk score.

The higher a person's risk, the lower will be the goal level for LDL cholesterol.

For instance, a high-risk patient, such as one who has heart disease, will need to keep his LDL cholesterol under 2.6 millimoles of cholesterol per litre of blood (mmol/L), compared with a low-risk patient whose target LDL cholesterol is under 4.1mmol/L.

Adjunct Assistant Professor David Foo, the head of the department of cardiology at Tan Tock Seng Hospital, said diabetes and smoking, coupled with high cholesterol, raise a person's cardiovascular risk because they damage blood vessel walls and make it more likely for blood clots to form.

Patients will always be advised to make lifestyle changes - lose weight, exercise regularly, stop smoking and drink alcohol in moderation.

If these do not improve their cholesterol levels enough, medication is prescribed, said doctors here.

Statins is the most common class of cholesterol-lowering medication, said doctors, with seven or eight out of 10 patients being put on statins.

In April 2009, businessman Chua Tiat Beng, 55, was behind the wheel of his car when he broke out in cold sweat and felt a tightness in his chest.

The father of two went straight to a general practitioner, who recognised the signs of an impending heart attack. At Tan Tock Seng Hospital, Mr Chua underwent an emergency angioplasty to unclog a blocked artery. While in hospital, he learned that the first health screening he had been to just a week before had picked up high cholesterol levels.

As he was also a smoker and above 45 years old, he was at high risk of developing cardiovascular disease.

He said: "When people are not sick, they never heed good advice."

He now smokes less, watches his diet, jogs twice a week and takes cholesterol-lowering medication and aspirin to prevent clots from forming around the stent. A blood test last December gave him a clean bill of health.

joanchew@sph.com.sg

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