March 2020 - May 2020

MCI (P) 092/09/2019 heartfoundationmyheart.org.sg heartSG

Official Publication of the Singapore Heart Foundation

@singaporeheartfoundation

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您对胆固醇和他汀类药物了解多少?

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Wear Red for Women

Do you understandthe Symptoms of

Myocardial Infarction?

PATRONESM Goh Chok Tong

CHAIRMAN EMERITUSDr Low Lip Ping

SHF 49TH

BOARD OF DIRECTORS

CHAIRMANProf Tan Huay Cheem

VICE-CHAIRMENDr Tan Yong SengMs Tan Lee Chew

HONORARY SECRETARYMr Goh Chiew Seng

ASSISTANT HONORARYSECRETARYDr Mak Koon Hou

HONORARY TREASURERMrs Elsie Foh

MEMBERSProf Terrance ChuaDr Chee Tek SiongMr Chong Chou YuenDr Goh Ping PingMdm Koh Teck SiewDr Bernard KwokMrs Regina LeeProf May LwinMr Peter SimDr C SivathasanAdj Asst Prof Jack Tan

HONORARY ADVISORSProf Koh Tian HaiMr Liak Teng LitMr Lim Soon HockA/Prof Lim Yean TengDr Lily NeoMr Tan Kin LianMr Wong Yew Meng

EDITORIAL COMMITTEE

EDITORMr Patrick Deroose

MEMBERSProf Terrance ChuaDr Chee Tek SiongDr C Sivathasan

SECRETARIATMr Vernon KangMr Teng Chiun HowMs Chng Kheng LengMs Samantha Chan

2 Editor’s Note

heartline is a quarterly publication of the Singapore Heart Foundation.9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837Tel: 6354 9340 • Fax: 6258 5240 • Email: info@heart.org.sg

The information provided in heartline is for educational purposes only. It should not be used for diagnosingor treating a heart problem or a disease, and should not be substituted for professional health care. Opinions expressed by contributors and advertisers do not necessarily reflect those of the SHF.The SHF does not endorse any products or services in heartline advertisements.

All rights reserved. Copyright is held by SHF.No portion of this publication can be reproduced without the permission of SHF.To advertise in heartline, please email info@heart.org.sg or call 6354 9340.Terms and conditions apply.

Want a copy of heartline delivered to your doorstep or emailed to you?Register on myheart.org.sg, via the QR code or call 6354 9360.Designed by: VaCAIN LLP • Printed by: A&D Printhub Pte. Ltd.

DEAR READERS,

As we move into the year 2020, it may be a good time to take a look at what the future has for us. Here are some trends that will affect us: Artificial Intelligence (AI) will be everywhere in our daily life for better or worse, friendly robots will provide emotional support services to the elderly, people living alone; electrical bicycles will cruise our roads; and at death all our acquired knowledge will be transferred to a corporate knowledge base to benefit the next generation (death as we know will not exist anymore).

One of the trends in cardiovascular health is the drive to customise the prevention, diagnosis and treatment of coronary heart disease taking into consideration gender (male, female and transgender) and ethnicity (Chinese, Malay, Indian and Eurasian). This requires the recognition and acceptance that there are differences in the various non-modifiable risk factors. Secondly, appropriate research must be conducted, based on a set of solid and validated outcome criteria. The researchers must have a clear vision on what they hope to achieve. This intellectual rigor differentiates the “google” research from peer reviewed research. Some of the articles in this issue tackle these difficult matters.

The Singapore Heart Foundation (SHF) is ideally positioned to participate in this serious research. Over the years, we have gathered a wealth of information to create preventive health education programmes that cover every stratum of Singapore society, which may offer us insights in the future. Didn’t the great Greek poet of

antiquity Sophocles, through one of his characters Antigone proclaim: “For these things are not of today or yesterday, but

for all times”. Let’s harness our rich heritage and contribute to our future.

I would also like to take the opportunity to thank our readers for walking with us through our last 50 years. May we continue to fight against Cardiovascular Disease and towards more 50 years together.

Patrick Deroose

3Feature

Article adapted from American Heart Association.

Myocardial Infarction?Do you understand the Symptoms of

An evaluation of clinical symptoms is a major part of the risk stratification of patients presenting to the emergency

department with suspected acute coronary syndrome.

The accurate interpretation of clinical symptoms has implications for patient triage, treatment, and subsequent management.

The last 2 revisions of the universal definition of myocardial infarction recommend the use of sex-specific troponin thresholds for the diagnosis of myocardial infarction. Use of sex-specific thresholds has identified a population of patients with previously unrecognised myocardial infarction. These patients would not have been included in previous study populations

investigating sex differences in symptom presentation. Atypical symptom presentations associated with myocardial infarction in women are thought to contribute to lower rates of diagnosis and treatment, and worst outcomes compared with men with myocardial infarction. International guidelines reinforce the view that women are more likely to present with atypical symptoms, such as epigastric pain, dyspepsia, or breathlessness. It is unknown how identification of these newly identified patients will impact the symptom profile of patients with myocardial infarction.

CliniCal PerSPeCtive

WhAt iS NEW?

• The fourth universal definition of myocardial infarction now recommends the use of sex-specific diagnostic criteria, but the impact of these criteria on the presentation and clinical features of men and women with suspected acute coronary syndrome is unknown.

• Many previous students have relied on clinician-reported symptoms that may be susceptible to ascertainment bias, whereas we prospectively recorded patient-reported symptoms in 1,941 patients with suspected acute coronary syndrome.

• We report that typical symptoms are more common and have greater predictive value in women than in men with myocardial infarction, whether diagnosed using sex-specific or uniform criteria.

WhAt ARE thE CliNiCAl impliCAtioNS?

• International guidelines currently state that women with myocardial infarction commonly present with atypical symptoms, which is contrary to evidence supported in this study. • The accurate interpretation of clinical symptoms has implications for patient triage, treatment, and subsequent management. • Women with myocardial infarction are at risk of underdiagnosis and undertreatment if correct symptom presentations are not recognised.

Our aim was to prospectively evaluate the frequency and predictive value of patient-reported symptoms in men and women with suspected acute coronary syndrome and to determine whether symptoms differ when the diagnosis of myocardial infarction is based on sex-specific criteria.

4 Feature

Join us for the upcoming Pledge Your Heart Walk 2020, held in conjunction with the annual Go Red for Women campaign, on 20th June 2020, where we encourage a heart healthy lifestyle amongst women.

Check out the last page for more information.

SymPtom CharaCteriStiCS

Chest pain was the most common presenting symptom, reported by 92% of women and 91% of men with suspected acute coronary syndrome. Pain with typical nature descriptors, the presence of radiation, and the presence of additional symptoms were all more common in women with suspected acute coronary syndrome. Women, compared with men, more often reported palpitations as a presenting symptom. Women were also more likely to report that their pain radiated to the left arm, the back or to the neck or jaw than were men, and were more likely to report associated nausea.

The adjudicated diagnosis was type 2 myocardial infarction in 5.1% of women and 3.2% of men. Chest pain remained the most common presenting symptom for women and men with type 2 myocardial infarction but was less likely to have radiating pain, and more likely to present with palpitations when compared with patients with type 1 myocardial infarction. Consistent with our finding in those with type 1 myocardial infarction, typical symptom features (pain with typical nature descriptors, the presence of radiation, and the presence of additional symptoms) were more frequently reported in women than in men with type 2 myocardial infarction.

ConCluSion

Women more frequently describe pain of a typical nature than do men, and typical symptoms are more predictive of a diagnosis of myocardial infarction in women than in men. We advocate that guidelines and educational material be updated to minimise the risk of underdiagnosis and treatment of women with myocardial infarction.

Typical chest pain is more likely the presentation. While women are likely to present typical chest pain for heart attack, the likelihood for atypical symptom presentation is more common among women.

The reason for the difference in the article quoted is perhaps the way in which typical and atypical symptoms are being described. Many of the women who complains of dyspnea / palpitation would have been called 'typical' in this study as opposed to our usual classification as atypical.

Atypical pain was classified in patients reporting epigastric or back pain or pain that was burning, stabbing, indigestion-like, or any other pain description or presentation. Guidelines also state that radiation of pain and the presence of associated symptoms form part of a typical presentation; therefore the presence of radiation (right arm, left arm, neck, jaw, back) and presence of any associated feature (nausea, vomiting, sweating, dyspnea, palpitations) was also documented.

CommENtARy by pRof tAN huAy ChEEmChAiRmAN, SiNgApoRE hEARt fouNDAtioNSENioR CoNSultANt, DEpARtmENt of CARDiology, NAtioNAl uNivERSity hEARt CENtRE, SiNgApoRE

hyperlipidaemia, or high cholesterol is the top most prevalent risk

factor for coronary artery disease among Singaporeans aged 18 - 69 with a prevalence of 33.6% in 2017, according to statistics released by ministry of health. this is up from 25.2% in 2010.

Effective treatment of hyperlipidaemia has been shown to reduce the incident of cardiovascular events, however physicians often encounter patients with difficulty in effective hyperlipidaemia management and noncompliance due to misconceptions surrounding statins, a cholesterol-lowering drug.

Indeed, a research commissioned by the Singapore Heart Foundation to examine the level of public awareness and identify areas of misconception with regard to cholesterol management, revealed that half of the respondents associated long-term use of statins with damage to the liver and kidney, while a third associated chronic statin use with the development of cancer.

The study, conducted in 2010, involved 365 respondents aged between 30 to 69, consisting of both Singaporeans and Permanent Residents. They were sampled across all five Community Development Council districts to ensure a fair representation of the Singapore population. Among them, 104 had been diagnosed with dyslipidaemia (abnormal level of lipids in their blood).

The respondents were tested on their knowledge on cholesterol and statin, as well as their perception of the causes and effects of high cholesterol.

88% of respondents identified unhealthy food or poor diet as the top cause of high cholesterol, while 10% attributed it to lack of exercise or hereditary causes. 64% of them see heart disease and stroke to be closely related to high cholesterol level.

The result of the study also revealed several misconceptions which could potentially impair effective management or treatment compliance.

Cholesterol and Statins?What do you knoW about

5Feature

Article adapted from Singapore Medical Journal. Originally written by Dr Than Htike Aung, Dr Go Yun Yun, Dr Low Lip Ping and Prof Terrance Chua.

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87.8% of respondents believe diet and exercise

are as effective as medication in lowering cholesterol level.

FACT:Medication is usually more effective in lowering cholesterol as compared to lifestyle changes like diet and exercise. However, for best result, it is recommended to combine diet change and exercise with medication, if a person’s cholesterol level cannot be controlled by lifestyle changes alone.

Slightly more than half believe that long-term use of

statin can cause damage to their liver or kidney or even increase risk of cancer.

FACT:Based on several trials and studies, there is no evidence that statins are a significant cause of liver/kidney failure or cancer.

64% think that people with high cholesterol

usually have symptoms such as breathlessness or chest pain.

FACT:For most people, high cholesterol has no symptoms. However, when it causes plaque to build up in the larger arteries in your heart, coronary artery disease will result, along with angina, chest pain, arrhythmia (an irregular heart beat), and shortness of breath.

58% believe that patients cannot stop taking cholesterol

medication once they have started.

FACT:Statins are typically very successful at lowering cholesterol, but they only work when you are taking them. If you would like to stop, you should do so with guidance from your doctor, as the statin may be protecting you and lowering your risk of heart attack.

However, if you would like to stop, you can do so with guidance from your doctor, as it can be very dangerous and can cause serious health risks.

Albeit a small sample size limiting the generalisability of the findings, the study offered insight to the gaps in public awareness and understanding of cholesterol management in Singapore. This sets as a reminder for healthcare providers to listen to the community, understand their concerns and expectations. Singapore Heart Foundation will also continue to work on programmes that can correct misconceptions and raise awareness of heart health in Singapore more effectively.

As SHF celebrates our 50th Anniversary this year, we hope to bring the community together to fight against cardiovascular disease and build a Heart Healthier Singapore!

The original article can be found on Singapore Medical Journal. [Aung TH, Go YY, Low LP, Chua T. Public perceptions, knowledge and awareness of cholesterol management in Singapore: a prospective pilot study. Singapore Med J 2013; 54(1): 32-5. http://dx.doi.org/10.11622/smedj.2013008]

The Singapore Heart Foundation would like to take this opportunity to thank Prof Terrance Chua, one of the co-authors of this article, for leading the Foundation from June 2007 to August 2019 when he handed his baton to Prof Tan Huay Cheem. Together, we hope Prof Chua, who is currently still in our Board of Directors and Ex-Officio, will continue to work with us in our heart health movement.

Thank you, Prof Chua!

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One-third of the respondents perceive herbal medicine to be more effective than

Western medication.

FACT:Although many people opt for traditional or herbal medication to lower their cholesterol levels, the long-term effects of these medications have not been extensively studied.

Moreover, any possible side-effects from these traditional or herbal medications (either mild or serious) are not known.

5

Myths & Facts

Feature

7Health Bites

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Health Bites

It is often viewed that women are generally good at multitasking, managing various responsibilities including family, motherhood and career.

Very often, they get tired from juggling so many things that they

are left with little energy to pay attention to their own health. This

can be detrimental to their physical and mental health in the long run.

It is important that these “superwomen” realise that they should be in tip top condition before they attend to the multiple priorities in their lives.

At the Singapore Heart Foundation, we have been working hard to educate women that heart disease does not only afflict males. In fact, the disease is the #1 killer in the world, with 1 in 3 Singaporean women dying from heart disease and stroke yearly.

The tricky bit is that when a heart attack strikes, women – more often than men – may have subtler, less recognisable symptoms. They include upper abdominal discomfort, light-headedness, nausea and unusual fatigue. Women can improve their chances of recovery if they recognise these symptoms and get medical attention in a timely manner.

Join us to Go Red for Women as we empower women with the right knowledge and tools to take better care of their hearts and their families.

A common fact that we know is that statins lower your blood cholesterol level, especially the bad cholesterol (LDL). A high level of LDL can increase your risk for heart attack and stroke.

Your risk is even higher if you have high cholesterol together

with other risk factors such as advanced age, high blood pressure, high

blood sugar, obesity, family history of heart attack, smoking, heavy alcohol consumption.

Unfortunately, there has been much “fake news” in recent years suggesting that statins should not be taken due to side effects.

The benefits of statins far outweigh the risks, especially for patients with proven heart disease, according to a scientific statement from the American Heart Association based on

new analysis of decades of scientific research published in Arteriosclerosis, Thrombosis and Vascular Biology.

For patients with proven coronary artery disease, such as those with heart attacks, bypass surgery or stents for narrowed arteries, moderate to high dose statins are strongly recommended to reduce re-narrowing of arteries and the risk of heart attack, in addition to diet and exercise. For patients without proven heart disease, the decision whether to take a statin will be based on the overall assessment of cardiac risk, such as whether the patient has diabetes, high blood pressure and high cholesterol.

As with any other medication, statins should be taken after consultation with your doctor. Side effects such as muscle ache and higher blood sugar have been reported but are rarely serious and will resolve on stopping the medication. For patients at increased risk of heart attack, the benefits substantially outweigh the risks.

Based on a Talking Point episode shown on Channel 5, it is interesting to find out that the nutritional facts about your bread might not appear like what you thought it might be.

Increased whole-grain intake has been associated with a

reduced risk of type 2 diabetes and cardiovascular disease, including stroke.

However, mass-produced bread is defined as ultra-processed food, and this belongs in the same category as sausages and instant noodles.

The term “ultra-processed food” refers to foods that have gone through substantial industrial processing and typically

contain high amounts of sugar, salt and saturated fat, which help to make the bread texture “a bit softer”, according to Senior Principal Dietician Gladys Wong of Khoo Teck Puat Hospital.

But fear not, here are 2 simple shopping tips to help you select the healthier bread option:

1. Look out for the Healthier Choice Symbol on the packaging, as items with the logo contains at least 25% more whole-grains.

2. Check the ingredients list to ensure that wholemeal is one of the first few ingredients, as ingredients are usually listed in order of the quantity used.

For more information, you can find out on CNA insider.

Ensuring our “superwomen” are in the pink of health

Which is the healthier bread choice?

Are Statins the right choice for you?

The Heart Wellness Centres conduct regular education talks for our heart wellness clients and members of the public. The

objectives are to educate them on the importance of heart health and what are some preventive measures they can undertake. One of them was a sharing by Mr Stuart Shee, author of Work of Heart on 16th November 2019.

During the talk with beneficiaries of SHF Heart Wellness Programme and members of the public, Mr Stuart Shee shared about his life as a heart patient and how he got over various challenges after his condition.

Around 30 participants attended the talk held at the Heart Wellness Centre @ Fortune Centre, where they also learnt about CPR+AED from SHF CPR+AED instructor.

To show his appreciation and support towards SHF, Mr Stuart also contributed $15,000 (earnings from his book sales) to the Foundation.

On 18th November 2019, Singapore Heart Foundation (SHF), Singapore Civil Defence Force (SCDF) and HDT

Singapore Taxi launched the second run of the AED on Wheels Programme at the Kampung Admiralty Community Plaza.

The Guest of Honour for the launch was Mr Amrin Amin, Senior Parliamentary Secretary, Ministry of Home Affairs & Ministry of

Health and MP for Sembawang GRC.

At the event, SHF launched the installation of 50 AEDs in the HDT

Singapore Taxi. 50 taxi drivers from HDT Singapore Taxi joined

the family of community first responders, where they were trained in CPR+AED and first aid. On top of the 50

AEDs, each of these taxis were also equipped with first aid kits and fire extinguishers. The first AED on Wheels Programme was in partnership with SMRT Taxis in 2015, where SHF installed 100 AEDs in SMRT taxis.

The AED on Wheels Programme equips taxi drivers with AEDs and dispatches them in the event of a cardiac emergency. These drivers are equipped with the skills of CPR+AED and also the myResponder app, which will notify users of any cardiac arrest incident within a 1.5km radius of their taxi location. Upon arrival, these participating drivers will administer CPR+AED until the paramedics take over, thus improving survival rates.

W orkof Heart

2nd AED on Wheels Programme

9Event Reviews

Scan the QR code to purchase a copy of Work of Heart.

To kick start the challenge, male colleagues at SHF came together to challenge each other. Watch this video to see how they did!

On 19th January 2020, Singapore Heart Foundation organised the National Life Saving Day 2020 Symposium cum Appreciation Lunch at Suntec

Singapore Convention and Exhibition Centre, where we invited close to 360 CPR+AED instructors from various healthcare institutions and training centres to thank them for their efforts to spread the importance of learning CPR and AED.

SHF’s Heart Safe mission is to improve the out-of-hospital sudden cardiac arrest survival rate in Singapore by creating an environment for more effective use of CPR and AED in the community. The Foundation was honoured to have speakers from People's Association, Singapore Civil Defence Force, Singapore Red Cross Society, SingHealth (which include KK Women's and Children's Hospital, National Heart Centre Singapore, Singapore General Hospital), Sport Singapore, St John Singapore and Unit of Prehospital Emergency Care who shared various topics related to adult resuscitation, neonatal resuscitation, new devices such as mechanical CPR, drowning and water safety.

There were also two interesting demonstrations on High Performance CPR and Neonatal resuscitation, conducted by the Team from SCDF Jurong Fire Station and SGH’s Neonatal Team respectively. During the event, Prof Tan Huay Cheem, SHF's chairman, announced that SHF will be giving away 50 AEDs to 50 social service agencies in celebration of our 50th Anniversary. These agencies were selected based on location where cardiac arrest rates are higher, as well as the number of AED coverage in the area.

We like to thank all our partners for making this event a success. And together, we hope to create a Nation of Lifesavers.

SHF went (Go)for MenRed

National Life Saving Day 2020

Supported by:

11Event Reviews

While we remind ladies to take care of their hearts

in the Go Red for Women campaign every year, we have not forgotten the men. On 19th November last year in conjunction with International Men's Day, the Singapore Heart Foundation initiated the Go Red for Men campaign where we issued a push-up challenge to complete more than 40 push-ups in 2 minutes.

According to a research in the Journal of the American Medical Association, participants who were able to complete more than 40 push-ups in 2 minutes were associated with a significantly lower risk of incident Cardiovascular Disease (CVD) event compared to those completing fewer than 10 push-ups.

SHF would like to thank our supportive corporate partners like Force 21, Hougang Primary School, HTM Medico, Manulife, Meridian Primary School and ZOLL who joined us in making this campaign a success. Lastly, we are also appreciative of those who participated in the campaign, both males and females. Till the next Go Red for Men, let’s work together to pump hard for your heart.

Event Review | SHF 50th Anniversary12

BPPhotoContest

Upper Primary Student applying her

newly gained skills of measuring BP.

A father learning more about BP through

our BP Initiative @ Schools booklet.

Upper Primary Student asking her

father to measure his BP.

50 years of caring for your heart

From a group of 13 cardiologists and philanthropists who came together with a common goal to tackle cardiovascular disease,

the Singapore Heart Foundation (SHF) has grown from strength to strength in the past 50 years, to become a well-established, reputable social service agency with local and international links.

In a recent video interview with SHF, one of our founding members, now Emeritus Chairman Dr Low Lip Ping recalled: “The first challenge in the earlier years was that we didn’t have a home. The secretariat used to operate from the office of whoever was the Honorary Secretary.”

“Initially we were also operating on something like a few thousand dollars a year. Fortunately, we had well-wishers who donated to SHF and we had to prove to them that their donations were well used.”

Indeed, with great support from the public, government bodies and generous benefactors, SHF is able to continue its increasingly important role in saving lives and promoting heart health in Singapore and the region through its various programmes.

“Since its founding, SHF has really raised awareness of heart disease and how to prevent it in Singapore. It also runs annual events like National Heart Week, pushed for initiatives such as CPR training, public access to defibrillators, and helped to set up programmes that exist today such as the Myocardial Infarction Directory. I’m very proud to be part of this organisation. I’m confident the Singapore Heart Foundation will continue to grow to greater heights under its new chairman, Prof Tan Huay Cheem,” former Chairman Prof Terrance Chua said.

Setting the future direction for SHF, Chairman Prof Tan Huay Cheem intends to focus on three key pillars – Advocacy, Education and Manpower Upskilling.

On active advocacy, Prof Tan said SHF must work with various stakeholders to generate knowledge and information for the public to get to know about heart disease.

“Given the flux of fake medical news over social media, it is important for SHF to work with relevant authorities and international heart associations, to educate the public with scientifically-proven, evidence-based medical facts. We want to be the source of right medical information to our patients, as well as to the public.”

He also wants to build a culture of continual learning in SHF, such that staff will always be mission-ready, professional and competent in tasks they are carrying out.

We look forward to the next 50 years of touching hearts!

Our Golden Jubilee

BP Initiative @ Schools, by the Singapore Heart Foundation (SHF), is an ongoing blood pressure (BP) awareness workshop for upper primary students (preferably primary 5) to empower

them with the essential tools and knowledge to lead a healthy lifestyle. This programme aims to inculcate in students the importance of healthy BP reading (less than 130/80 mmHg) and to motivate behavioural changes towards better heart health. As part of their applied learning, each student gets to bring home a loaned BP monitor for a day to take the BP measurements of their adult family members and to share their newly acquired knowledge.

From 1st July to 30th November 2019, SHF conducted the “Share Your BP Experience” Photo Contest on both Facebook and Instagram, where adult family members shared what they learned from their child and have their BP measured. Three lucky families won a jump session for 4 at BOUNCE Singapore, where they had a fun-filled cardio workout at the different zones (such as slam dunk, dodgeball) in the trampoline park.

SHF would like to thank BOUNCE Singapore for their kind sponsorship in supporting and encouraging healthy living through exercise.

Special Thanks to:

13

Shf: hello uncle Raymon, can you tell us about your heart condition?

Raymon (R): I had my first heart attack in 1983 when I was in Kuala Lumpur for the annual badminton game between Singapore Broadcasting Corporation (SBC) (now Mediacorp) and Radio Televisyen Malaysia (RTM). I was then a staff of SBC.

On the day of the game, I was feeling unwell with flu, and made the wrong decision to continue with the game. Throughout the day, I suffered three heart attacks, with symptoms like cold sweat, nauseous, weak limbs and tight chest. It felt like 10 elephants were sitting on my chest. By the third attack, my friends decided to send me to the University Hospital in Petaling Jaya, where I was admitted for 26 days just for observation and rest.

In January 1984, a cardiologist at Singapore General Hospital, Prof Arthur Tan, reviewed my condition and discovered three of my arteries were about 70 – 85% blocked. I was then referred to do a surgery in Sydney, Australia as the mortality rate there was much lower than Singapore at that time.

On 24 February 1984, I did my bypass operation on four blocked arteries, with the fourth artery being identified during the operation.

Shf: how do you feel now after so many years?

R: I think I am very fortunate, as not many people’s bypass can last so long after their operations. A lot of my friends had to go through another bypass after 9 to 15 years.

I am feeling generally okay, just that I am frailer now. I will need a walking stick, as I fell about 4 times in the past two year.

I am still part of the Rotary Club of Singapore, where I contribute an article once a month. Other than that I try to do light exercises and reading at home to keep myself active.

Shf: What was your memory about volunteering for the then Singapore National heart Association?

R: My recollection dated back to 1985, when SNHA used to have a small office at Pasir Panjang with just one secretary and one assistant secretary. A fellow bypass operation friend, Mr Fred Sabapathy, and I helped out often. Dr Low was the then-chairman.

In fact, I started voluntary work in 1947 with the Chinese YMCA (now called Metropolitan YMCA). Since then, I have been a Board and Executive Committee Member for close to 20 social service agencies.

Shf: Any advice for people who may be keen to volunteer?

R: Always remember the 3Ts.

Time – You can always make time if you want.

Talent – Share your talent with the community, nothing is too small to share.

Treasure – Treasure what you have and help those whose needs are greater than ours.

A heart attack survivor and a SHF volunteer in the 1980s, Mr Raymon Huang, now 93-year-

old, vividly recounts the day 37 years ago when he suffered his heart attack, and shares his thoughts on why people should give back to the society.

Join the SHF’s big family by being a volunteer. If you are into photography, videography, designing or writing, please share your talent with our Communications team! Scan the QR code to register now:

Heart of GoldSurvivor With a

Volunteerism

Share your talent withthe community, nothing is

too small to share.

Did you know that in 2018, 27.2% of women died from CVD in Singapore, which means that almost 1 out of 3 female deaths is

due to CVD.

Wear Red Day, celebrated every year on the first Friday of February, hopes to unite the country for a common goal - the eradication of cardiovascular disease (CVD, includes heart diseases and stroke), the #1 killer among women worldwide.

Hence, on 7th February 2020, Singapore Heart Foundation (SHF) staff came to work in touch of red or white with a red dress pin in support of women’s heart health and to create awareness about CVD.

It is time for us to unite and put our hearts together as we Go Red for Women, so that women can live longer and stronger lives!

The dress is an international symbol for women and red symbolises the colour of health, life and vibrancy. However, it can also serve as a warning, a red alert and it is important NOT to ignore the red flags i.e. the warning signs and symptoms of CVD.

2020

Edwards lifesciences’ go Red for Women and Celebration

For the 8th year running, Edward Lifesciences supported the annual Wear Red Day through sales of merchandise within their

office compound to raise funds amongst their employees as well as to promote heart health awareness. On 7th February this year, SHF was invited to be part of their Every Heartbeat Matters celebration

by having a heart health educational booth. Employees gained useful knowledge through SHF educational posters when they complete a heart health quiz. Together with outright donations, a total of $28,227

was raised throughout the week, allowing SHF to help provide treatment for underprivileged women suffering from cardiovascular disease.

– Karen Murray, chair of the American Heart Association's Women and Heart

Disease Advisory Group

Go Red for Women14

We can no longer ignore heartdisease. While awareness is important, it’s

time for women to take action now – to love and protect their hearts while maintaining

healthier lifestyles. To that end, Go Red encourages women to not only join the

movement but also take simple, everyday steps to protect their hearts.

Wear RedDay

文章改编自美国心脏协会

对因疑似急性冠状动脉综合征而被送到急诊科的

患者进行临床症状评估，是风险分层的主要组

成部分。

准确解释临床症状，对患者的分流、治疗和后续管理

均具有意义。

心肌梗塞统一定义的最后2次修订，建议使用性别特

异性肌钙蛋白阈值来诊断心肌梗塞。性别特异性阈值

的使用，已经确诊了一批先前未被确诊为心肌梗塞的

患者。这些患者未被包括在先前研究性别差异症状表

现的抽样群体中。女性心肌梗塞的非典型症状表现，

被认为是导致其诊断率和治疗率低于男性心肌梗塞患

者 ， 且 预 后 更 差 的 原 因 。 一 些 国 际 指 导 准 则 强 化 了

这一观点，即女性更有可能出现非典型症状，如上腹

痛、消化不良或呼吸困难。这些新确诊患者的确诊，

对心肌梗塞患者的症状谱有何影响，目前尚不清楚。

临床前景展望

最新动态？

• 心肌梗塞统一定义的第四版，目前推荐采用性别特

异性诊断标准，但这些标准对男女性疑似急性冠状

动脉综合征患者的临床表现和临床特征有何影响，

目前尚不确定。

• 过去许多研究人员依赖于临床医生报告的症状，而

这些症状可能易受确认偏倚的影响。但我们前瞻性

地记录了1 ,941名疑似急性冠状动脉综合征患者的

症状。

• 我们的报告显示，无论是采用性别特异性标准还是

统一标准，与男性心肌梗塞患者相比，女性心肌梗

塞患者的典型症状更为常见且预测值更高。

有什么临床意义？

• 一些当前的国际指导准则指出，女性

心肌梗塞患者通常表现出非典型症状，这

与该项研究中所支持的证据大相径庭。

• 对 临 床 症 状 的 准 确 解 释 对 患 者 的 分

流、治疗和后续管理均具有意义。

• 如果正确的症状表现未得到确诊，女

性心肌梗塞患者将面临诊断不足和治疗

不足的风险。

我们的目标在于前瞻性地评估急性冠状动脉

综合征的男女疑似病患所报告症状的频率和

预测值，并确定当按照性别特异性标准进行

心肌梗塞诊断时，症状是否存在差异。

特写 15

采用男女性别特异性主要症状标准

诊断心肌梗塞

配合一年一度的珍爱女人心(Go Red for Women)活动，新加坡心脏基金将在2020年6月20日举行

Pledge Your Heart Walk义走，旨在鼓励女性养成健康的生活方式。快报名参加，一起维持健康的心！

欲知更多详情，请翻阅封底。

症状特征

胸痛是最常见的主要症状。92%的女性疑似急

性冠状动脉综合征患者和91%的男性疑似急性

冠状动脉综合征患者，都出现胸痛症状。典

型性质的疼痛、蔓延性疼痛和其他症状在女

性疑似患者中更为普遍。相比男性患者，女

性患者更常把心悸报告为主要症状。女性

患者也比男性患者更有可能报告其疼痛至

左臂、背部、颈部或下巴处，而且更有可

能报告伴随有恶心症状。

最终裁定诊断为2型心肌梗塞的患者中，

女性患者占5.1%，男性患者占3.2%。虽

然胸痛仍然是男女性2型心肌梗塞患者

最常见的主要症状，但与1型心肌梗塞

患者相比，2型心肌梗塞患者出现蔓延性疼痛的可

能性较低，出现心悸的可能性更高。就2型心肌梗塞而言，女性患者

报告典型症状特征（典型性质的疼痛、存在蔓延性疼痛和存在其他症状）的频率要高于

男性患者。这与我们对1型心肌梗塞患者所进行调查的结果一致。

结论

女性患者比男性患者描述典型性质疼痛的频率更高，而且典型症状对女性心肌梗塞患者的诊断预测率高于男性

患者。我们主张对指导准则和教育材料进行更新，以尽量降低女性心肌梗塞患者诊断不足和治疗不足的风险。

新加坡心脏基金董事会主席、

新加坡国立大学心脏中心心内科高级顾问陈淮沁教授评论

典型胸痛是可能性更高的临床表现。虽然女性患者可能存在心脏病发作时

的典型胸痛症状，但她们出现非典型症状表现的可能性更高。

上述文章中提及的差异，可能是描述典型症状和非典型症状的方式不同。

许多女性患者报告的呼吸困难/心悸在此项研究中会被称作“典型”症状，

而我们通常会将它们划分为非典型，因此截然相反。

非典型性疼痛被分为上腹部痛、背部疼痛、灼烧痛、刺痛、类似消化不良

的疼痛、或任何其他疼痛的描述或表现。一些指导准则还指出，蔓延性疼

痛和表现出伴随症状属于典型症状表现；因此，存在蔓延性疼痛（右臂、左臂、颈部、下巴和背部）

以及存在任何伴随特征（恶心、呕吐、出汗、呼吸困难、心悸）也被记录下来。

16 特写

SPONSORSHIP TIERS

$50,000 Co-naming rights 8 invitations to dinner 1 complimentary invitation

Logo acknowledgement on all event collaterals

$10,000

$5,000

4 invitations to dinnerLogo acknowledgement on event collaterals

For more information or to secure your sponsorship, please call Ms Vikki Chan or Ms Julia Hoh at 6354 9345/52 or email to: shf-fr@heart.org.sg. All proceeds & donations will go to Singapore Heart Foundation and be eligible for 2.5 times tax deduction - subjected to changes in prevailing law, if any. *Advertiser, Hole-in-One and Event In-Kind Sponsorships are not tax deductible. Registration closes on 10 June 2020.

DATE

10 JULY 2020FRIDAY

VENUESICC

(Island Course)

GUEST-OF-HONOUR E

C

GUEST OF HONOUR

SPONSORSHIP TIERS

$50,000 Co-naming rights 8 invitations to dinner 1 complimentary invitation

Logo acknowledgement on all event collaterals

$10,000

$5,000

4 invitations to dinnerLogo acknowledgement on event collaterals

For more information or to secure your sponsorship, please call Ms Vikki Chan or Ms Julia Hoh at 6354 9345/52 or email to: shf-fr@heart.org.sg. All proceeds & donations will go to Singapore Heart Foundation and be eligible for 2.5 times tax deduction - subjected to changes in prevailing law, if any. *Advertiser, Hole-in-One and Event In-Kind Sponsorships are not tax deductible. Registration closes on 10 June 2020.

DATE

10 JULY 2020FRIDAY

VENUESICC

(Island Course)

GUEST-OF-HONOUR E

C

GUEST OF HONOUR

根据新加坡卫生部发布的统计数据，高

脂血症或高胆固醇是年龄介于18到

69岁的新加坡人罹患冠心病的第一大风

险因素，2017年的患病率为33.6%。这

一数字较2010年的25.2%，有大幅上

升。

研究表明，高脂血症的有效治疗有助

于降低心血管疾病的发病率，然而，

医生经常会遇到患者难以有效控制自

己的高血脂水平，以及因对他汀类药物

(一种降低胆固醇的药物)有误解而未遵

从治疗计划的情况。

事实上，一项由新加坡心脏基金委托进行、针

对胆固醇控制方面的公众意识水平和相关误区的调查

显示，半数的调查对象认为长期服用他汀类药物会损

害肝脏和肾脏，而三分之一的调查对象认为长期服用

他汀类药物会致癌。

这项调查于2010年进行，共有365位年龄介于30到69

岁的新加坡人和永久居民参与了调查。这些调查对象

抽样来自全部5个社区发展理事会区域，确保能够公允

代表新加坡人口。其中，有104位调查对

象被诊断出血脂异常(即血液中血脂水平

异常)。

调查主要测试民众对胆固醇和他汀类药

物的知识水平，以及他们对高胆固醇的

起因与后果的认知。

88%的调查对象认为，不健康的食物或不良的饮食习

惯是高胆固醇第一大导因，而10%的调查对象认为，

缺乏运动或遗传基因是主要导因。64%的调查对象认

为心脏病和中风与高胆固醇密切相关。

这项调查的结果还揭示出，可能损害有效治疗或治疗

依从性的几个误区。

本文改编自《新加坡医疗期刊》(Singapore Medical Journal)。

18 特写

特写 19

87.8%的调查对象认为

在 降 低 胆 固 醇 水 平 方

面 ， 饮 食 和 运 动 与 药 物 一

样有效。

真相：

在降低胆固醇方面，药物通

常比饮食和运动等生活方式

改变更有效。然而，若一个

人的胆固醇水平无法仅仅通

过改变生活方式得到控制，

建议将饮食改变和运动与药

物相结合，以达到最佳的降

胆固醇效果。

略超过一半的调查对象认为长

期服用他汀类药物会损害肝脏

和肾脏，甚至会增加患癌风险。

真相：

多项临床试验和研究结果表明，

没有证据表明他汀类药物是导致

肝功能/肾功能衰竭或癌症的重

要诱因。

6 4 % 的 调 查 对 象

认 为 高 胆 固 醇 患

者 通 常 有 呼 吸 困 难 或

胸痛等症状。

真相：

大 多 数 高 胆 固 醇 者 没

有 任 何 症 状 。 然 而 ，

当 高 胆 固 醇 导 致 斑 块

在 心 脏 的 大 动 脉 中 逐

渐 积 聚 时 ， 将 诱 发 冠

心 病 并 伴 有 心 绞 痛 、

胸痛、心律失常(不规

则心脏搏动)和气短等

症状。

58%的调查对象认为，患者

一旦开始服用降胆固醇药物

就无法停药。

真相：

他 汀 类 药 物 通 常 在 降 低 胆 固 醇

方面非常有效，但仅在服用时有

效。若要停止服用，应在医生的

指导下停药，因为他汀类药物可

以为您提供保护并降低您的心脏

病发作风险。

然而，若要停止服用，可以在医

生的指导下停药，因为停药可能

会非常危险，并可能导致严重的

健康风险。

尽管样本量小，限制了调查结果的普遍性，但是这项调查就新加坡公众对胆固醇控制的认识和理解上的差距，

提供了见解。该项调查是一项提醒，提醒医疗服务提供者倾听社区的声音，了解他们的关切和期望。新加坡心

脏基金也将继续致力于纠正误区,并更高效地提高新加坡人对心脏健康的认识。

今年正值新加坡心脏基金成立50周年，我们希望推动社会各界同心协力，共同对抗心血管疾病，建设一个民众

心脏更健康的新加坡！

原始文章参见《新加坡医疗期刊》(Singapore Medical Journal)。[Aung TH, Go YY, Low LP, Chua T.“新加坡公众对

胆固醇控制的认知、了解和意识”：前瞻性试点研究。《新加坡医疗期刊》，2013年，第54期第(1)卷：第32-5

页。http://dx.doi.org/10.11622/smedj.2013008]

1

4

2 3

三分之一的调查对象认为草药比西药

更有效。

真相：

虽然许多人选择传统药物或草药来降低他

们的胆固醇水平，但这些药物的长期疗效

尚未得到广泛研究。

而且，这些传统药物或草药可能产生的何

种副作用(轻微或严重)目前尚不清楚。

5

误区与真相

Congratulations to all winners* and thank you for your participation!*Winners have been notified via phone or email.

ANSWERS(Dec 2019 – Feb 2020)

20 Nutrition

EatingWell this festiveseason

1. Use the Heart Smart Eating Plate as a guide to have a _______ and _________ diet.

2. Control your portion by using a ________ plate and skipping second servings.

3. ______ items such as side dishes and desserts instead of consuming the full portion.

4. Liquid calories count too. Enjoy ___________ drinks and _________ drinks in moderation.

5. The daily limit for alcohol is no more than _____ standard drinks for men and no more than ____ standard drink for women.

1 standard drink: - A can (330 ml) of regular beer with 5% alcohol content - Half glass (100 ml) of wine with 15% alcohol content - A shot (30 ml) of spirits with 40% alcohol content6. Include _____ from wholegrains, fruits and vegetables to help you feel full and prevent overeating.

7. Choose lower fat cooking methods such as _______, braising, and _____ instead of deep-frying.

8. Go for _______ meat cuts to reduce your saturated fat intake.

9. Season your food with herbs and spices, in replacement of salt and sauces, to reduce your ________ intake.

10. Minimise _______ like chips and cookies in between meals.

healthysmaller

Share

sweetened

fibre

leaner

snackssodium

steamgrill

alcoholic two

one

balanced

Simply email/fax this page to heartline@heart.org.sg / 6258 5240 by 31 may 2020.

Name: _____________________________________________________________________________________________________

Email: ______________________________________________ Mobile: ______________________________________________

All winners will be notified via phone or email. Good luck!

Look out for the answers in the next issue of heartline or visit www.myheart.org.sg after 1 June 2020.

Submit your correct answers and 5 lucky winners will receive a Your Heart Matters book by Dr Mak Koon Hou and Louisa Zhangin our lucky draw.

Nutrition

1. light Soy SAuCE a. 530mgb. 690mg c. 860mg

2. oyStER SAuCE a. 580mgb. 740mgc. 910mg

3. KECAp mANiS (SWEEt Soy SAuCE)a. 157mgb. 227mgc. 367mg

4. fiSh SAuCEa. 632mgb. 872mgc. 1012mg

5. Chili SAuCE a. 220mgb. 230mgc. 240mg

6. SAmbAl bElAChAN

a. 590ngb. 690mgc. 790mg

7. tomAto SAuCEa. 200mgb. 210mgc. 220mg

8. mAyoNNAiSEa. 95mgb. 105mgc. 115mg

Excessive sodium intake can lead to numerous health issues. The Health Promotion Board Singapore recommends a daily intake

of less than 2,000mg of sodium, that is equivalent to less than 1 teaspoon of salt per day. Our extra sodium intake usually comes from seasonings and processed food. Guess the amount of sodium present in some of the commonly used sauces. Hint: Visit myheart.org.sg or scan the QR code for clues!

21

Are youtoo salty?

per tablespoon:

22 Editorial

The popularity of whole-grains is on the rise! The latest National Nutrition Survey 2018 revealed that Singaporeans are consuming more whole-grains, fruits and vegetables.

Whole-grains, such as oats, and items made from whole-grains contain the entire grain kernel including the endosperm, germ and bran. This makes the product higher in fibre, vitamins, and minerals.

Oats are rich in beta glucan, a type of soluble fibre, which dissolves in water to form a gel-like

substance. It can help to lower blood cholesterol levels and reduce the risk of cardiovascular diseases. The fibre in oats also promotes satiety, which prevents overeating and helps in weight management.

Rolled oats are low in glycemic index (GI), meaning it produces a gentler rise in blood glucose levels, making it a healthier option, especially for

people with diabetes. Low GI foods have shown to improve energy levels and mood.

Oats are a popular option for whole-grains and can be easily incorporated in many recipes, from snacks to main meals. So, enjoy some oats today to reap the benefits of whole-grains!

So Good!OatEndosperm

Bran

Germ

Recipe 23

Method 做法: 1. Preheat oven to 170°C.

Grind the instant rolled oats, roughly, in blender and add to mixing bowl.

将烤箱预热至170°C。将即食原粒燕麦片放入搅拌机中进行粗磨，然后倒入碗中。

2. Add wheat flour, baking powder and baking soda to oats in the mixing bowl and mix well.

在碗中加入面粉、发酵粉和苏打粉，让后搅拌均匀。3. In a separate bowl, mix cooking oil, brown sugar, chopped dates and vanilla essence

until the sugar dissolves. 在另一个的碗里，混合食用油、红糖、红枣和香草香精，直到糖完全溶解。4. Add the dry ingredients into bowl and mix to get a crumb-like consistency. 将干的配料倒入碗中，混合均匀，至面包屑状粘稠度。5. Mix well with a spatula or your hand to get a soft and sticky dough. 使用小铲或用手将混合物混合均匀，形成软而粘的面团。6. Create small balls with the dough and press gently to make small circles. Create an

impression using a fork and repeat with the remaining dough. 将面团做成小球状，再轻轻压成小圆饼。使用叉子进行压花，重复以上步骤。7. Arrange the flattened dough onto a lined baking tray and bake for 10 – 12 minutes at

160°C in the preheated oven. 将压扁的面团放到烤盘上，在预热过的烤箱中160°C烤制10 – 12分钟。8. Once baked, let it cool completely and store them in an airtight container. 烤好后，待其完全冷却，再存放在密封的容器中。

燕麦及红枣曲奇Oats and Dates Cookies

Nutrients per piece 每块营养Energy 能量: 105 kcal 千卡

Protein 蛋白质: 1.3 g 克

Fat (Saturated fat) 脂肪(饱和脂肪): 5.5 g 克 (0.7 g 克)

Carbohydrate 碳水化合物: 12.3 g 克

Sodium 钠: 54 mg 毫克

Dietary fibre 膳食纤维: 1.1 g 克

Scan the QR code for the tutorial video:扫描二维码获得教程视频:

Tip! 提示！Select cooking oil with lower saturated fat content. Reduce sugar amount. 您可以选择含有低量饱和脂肪的食用油。 减少糖的分量。

Makes 20 pieces制作20块

Ingredients 材料:• Captain® Instant Rolled Oats

(Oatmeal), 100g Captain® 即食原粒燕麦片，100克 • Flour, 100g 面粉，100克• Baking powder, 1 tsp 发酵粉，1茶匙 • Baking soda, ½ tsp 苏打粉，½茶匙• Cooking oil, 100g 食用油，100克 • Brown sugar, 50g 红糖，50克 • Dates, chopped, 100g 红枣 (切碎)，100克 • Vanilla essence, 2 tsp 香草香精，2茶匙

DAtE:20th June 2020,

Saturday

vENuE: Oasis Terraces

Community Plaza, Punggol

timE: 8:00am – 1:00pm

CAtEgoRiES:2.5km and 5km

Non-competitive walk

REASoNS foR pRomotiNg phySiCAl ACtivity:Exercise is an essential component of healthy living. It not only increases the level of HDL (“good”) cholesterol in the blood, but also reduces the level of LDL (“bad”) cholesterol. In addition, it helps us to maintain our weight within a healthy range, lower our blood sugar levels, and improve our overall cardiovascular fitness. A physically active person is approximately 1.5 times less likely to develop heart disease and 30-50% less likely to be hypertensive.

Registration opens in March 2020, so stay tuned @ www.pledgeyourheartwalk.sgor SHF’s Facebook page @ www.facebook.com/heartfoundation for more details!

In conjunction with the annual Go Red for Women campaign,

SHF will be organising its 3rd instalment of the fun walk, Pledge Your Heart Walk 2020 (PYHW), to encourage women to increase their participation in physical activity to reduce their risk of CVD. Consistent exercise has also been shown to improve physical and mental health.

PYHW 2020 encourages women of all ages to bring along their family members and friends (males are welcome too!) to kick-start a heart healthy lifestyle together. The cultivation of healthy behaviour is the most effective when it is started by and with the family.

Join us at this meaningful event with your loved one!