Increasing incidence in heart artery disease

We’ve certainly seen a rise in the incidence of heart disease, a problem that is occurring in younger patients too, Dr Chiam says.

The main reason for this increase is the lifestyle we lead. As the country gets socioeconomically richer, we’ve seen the intake of food shifting to a western kind of diet, which is high in saturated fat, high in refined sugars and low in fiber, fruits and vegetables, Dr Chiam explains. “Of course with a very stressful lifestyle, we have less time to exercise, and I think the stress itself together with a lack of exercise also contributes a fair bit to rising incidence of heart disease.”

At the same time there’s a rising incidence of diabetes and high blood pressure, as well as high cholesterol rates, and taking up smoking at a younger age - all these add up to the problem of rising heart disease in our population.

How do we treat patients with heart artery blockages?

• Lifestyle change – this forms the basis of treatment, and that means a better diet, low in saturated fat, low in salt and refined sugars and high in fiber, especially fruits and vegetables.
• Stopping smoking.
• Getting enough exercise. Exercise doesn’t mean that you need to do long distance running – brisk walking is a good exercise for most people to start with.

Apart from that, we have medications that try to control or treat people with heart artery blockages. There are a couple of medications that are very important, that we will use for almost every single patient.

The first group is drugs that thin the blood, like aspirin, which makes the blood less sticky. This kind of drug has been shown to reduce the risk of future heart events or heart attacks in patients with pre-existing heart artery narrowing.

The other drug is a drug that lowers cholesterol, a group of drugs called statins. These drugs not only lower cholesterol, they also stabilize the cholesterol deposits in the arteries and therefore reduce the incidence of heart attacks in the future.

For some patients, despite best medical therapy, they still have symptoms. That’s where people like an interventional cardiologist comes in. We can balloon or perform an angioplasty of the artery, where we balloon and subsequently put a stent in the artery to relieve symptoms.

Of course in a small proportion of patients, it is not possible for us to open every single artery and if there are multiple blockages in all three-heart arteries, then for some of these patients a heart bypass operation may be the solution for them.

Dr Paul T.L. Chiam is a consultant cardiologist with a subspecialty interest in interventional cardiology. He is in private practice at The Heart and Vascular Centre at Mount Elizabeth Medical Centre in Singapore and can be reached at +65 6735 3022.