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Official Publication of the Singapore Heart Foundation March 2020 - May 2020
03
Do you understand
the Symptoms of
Myocardial Infarction?
14
Wear Red for Women
18
您对胆固醇和他汀类
药物了解多少?
MCI (P) 092/09/2019 myheart.org.sg heartfoundation heartSG @singaporeheartfoundation
2 Editor’s Note
PATRON
ESM Goh Chok Tong DEAR READERS,
CHAIRMAN EMERITUS As we move into the year 2020, it may be a good time to take a look at what the
Dr Low Lip Ping
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
SHF 49TH emotional support services to the elderly, people living alone; electrical bicycles will
BOARD OF DIRECTORS 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
CHAIRMAN
exist anymore).
Prof Tan Huay Cheem
VICE-CHAIRMEN One of the trends in cardiovascular health is the drive to customise the prevention,
Dr Tan Yong Seng diagnosis and treatment of coronary heart disease taking into consideration gender (male,
Ms Tan Lee Chew female and transgender) and ethnicity (Chinese, Malay, Indian and Eurasian). This requires
HONORARY SECRETARY the recognition and acceptance that there are differences in the various non-modifiable
Mr Goh Chiew Seng 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
ASSISTANT HONORARY
SECRETARY
to achieve. This intellectual rigor differentiates the “google” research from peer reviewed
Dr Mak Koon Hou research. Some of the articles in this issue tackle these difficult matters.
HONORARY TREASURER The Singapore Heart Foundation (SHF) is ideally positioned to participate in this
Mrs Elsie Foh
serious research. Over the years, we have gathered a wealth of information to create
MEMBERS preventive health education programmes that cover every stratum of Singapore
Prof Terrance Chua society, which may offer us insights in the future. Didn’t the great Greek poet of
Dr Chee Tek Siong antiquity Sophocles, through one of his characters Antigone
Mr Chong Chou Yuen proclaim: “For these things are not of today or yesterday, but
Dr Goh Ping Ping
for all times”. Let’s harness our rich heritage and
Mdm Koh Teck Siew
Dr Bernard Kwok contribute to our future.
Mrs Regina Lee
Prof May Lwin I would also like to take the opportunity
Mr Peter Sim to thank our readers for walking with us
Dr C Sivathasan through our last 50 years. May we continue
Adj Asst Prof Jack Tan to fight against Cardiovascular Disease and
HONORARY ADVISORS towards more 50 years together.
Prof Koh Tian Hai
Mr Liak Teng Lit
Mr Lim Soon Hock
A/Prof Lim Yean Teng
Dr Lily Neo
Mr Tan Kin Lian Patrick Deroose
Mr Wong Yew Meng
EDITORIAL COMMITTEE heartline is a quarterly publication of the Singapore Heart Foundation.
9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837
EDITOR Tel: 6354 9340 • Fax: 6258 5240 • Email: info@heart.org.sg
Mr Patrick Deroose The information provided in heartline is for educational purposes only. It should not be used for diagnosing
or treating a heart problem or a disease, and should not be substituted for professional health care. Opinions
MEMBERS expressed by contributors and advertisers do not necessarily reflect those of the SHF.
Prof Terrance Chua The SHF does not endorse any products or services in heartline advertisements.
Dr Chee Tek Siong
All rights reserved. Copyright is held by SHF.
Dr C Sivathasan
No portion of this publication can be reproduced without the permission of SHF.
SECRETARIAT To advertise in heartline, please email info@heart.org.sg or call 6354 9340.
Terms and conditions apply.
Mr Vernon Kang
Mr Teng Chiun How Want a copy of heartline delivered to your doorstep or emailed to you?
Ms Chng Kheng Leng Register on myheart.org.sg, via the QR code or call 6354 9360.
Ms Samantha Chan Designed by: VaCAIN LLP • Printed by: A&D Printhub Pte. Ltd.
Feature 3
Do you understand the Symptoms of
Myocardial Infarction?
Article adapted from American Heart Association.
A n evaluation of clinical symptoms is a major part of the
risk stratification of patients presenting to the emergency
department with suspected acute coronary syndrome.
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
The accurate interpretation of clinical symptoms has with men with myocardial infarction. International guidelines
implications for patient triage, treatment, and subsequent reinforce the view that women are more likely to present
management. with atypical symptoms, such as epigastric pain, dyspepsia, or
breathlessness. It is unknown how identification of these newly
The last 2 revisions of the universal definition of myocardial identified patients will impact the symptom profile of patients
infarction recommend the use of sex-specific troponin with myocardial infarction.
thresholds for the diagnosis of myocardial infarction. Use of sex-
specific thresholds has identified a population of patients with Clinical Perspective
previously unrecognised myocardial infarction. These patients
would not have been included in previous study populations 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
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.
Commentary by Prof Tan Huay Cheem
Chairman, Singapore Heart Foundation
Senior Consultant, Department of Cardiology,
National University Heart Centre, Singapore
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.
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.
Feature 5
What do you know about
Cholesterol and Statins?
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.
H yperlipidaemia, 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 88% of respondents identified unhealthy food or poor diet as
long-term use of statins with damage to the liver and kidney, the top cause of high cholesterol, while 10% attributed it to lack
while a third associated chronic statin use with the development of exercise or hereditary causes. 64% of them see heart disease
of cancer. and stroke to be closely related to high cholesterol level.
The study, conducted in 2010, involved 365 respondents The result of the study also revealed several misconceptions
aged between 30 to 69, consisting of both Singaporeans which could potentially impair effective management or
and Permanent Residents. They were sampled across all five treatment compliance.
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.
6 Feature
Myths & Facts 2 64% think that people
3
with high cholesterol
1 87.8% of respondents
usually have symptoms
such as breathlessness or
58% believe that patients
cannot stop taking cholesterol
believe diet and exercise chest pain.
medication once they have started.
are as effective as medication
in lowering cholesterol level. FACT:
FACT:
For most people, high
Statins are typically very successful
FACT: cholesterol has no
at lowering cholesterol, but they
Medication is usually more symptoms. However, when
only work when you are taking
effective in lowering cholesterol it causes plaque to build
them. If you would like to stop, you
as compared to lifestyle up in the larger arteries in
should do so with guidance from
changes like diet and exercise. your heart, coronary artery
your doctor, as the statin may be
However, for best result, it is disease will result, along
protecting you and lowering your
recommended to combine with angina, chest pain,
risk of heart attack.
diet change and exercise arrhythmia (an irregular
with medication, if a person’s heart beat), and shortness However, if you would like to stop,
cholesterol level cannot be of breath. you can do so with guidance from
controlled by lifestyle changes your doctor, as it can be very
alone. dangerous and can cause serious
health risks.
5
4 Slightly more than half
One-third of the respondents perceive
herbal medicine to be more effective than
Western medication.
believe that long-term use of
statin can cause damage to their
liver or kidney or even increase risk FACT:
of cancer. Although many people opt for traditional or
herbal medication to lower their cholesterol
levels, the long-term effects of these medications
FACT:
have not been extensively studied.
Based on several trials and studies,
there is no evidence that statins are Moreover, any possible side-effects from these
a significant cause of liver/kidney traditional or herbal medications (either mild or
failure or cancer. serious) are not known.
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!
Health Bites 7
Health Bites
Which is the healthier bread choice?
Based on a Talking Point episode contain high amounts of sugar, salt and saturated fat, which help
shown on Channel 5, it is to make the bread texture “a bit softer”, according to Senior
interesting to find out that the Principal Dietician Gladys Wong of Khoo Teck Puat Hospital.
nutritional facts about your
bread might not appear like But fear not, here are 2 simple shopping tips to help you select
what you thought it might be. the healthier bread option:
Increased whole-grain intake 1. Look out for the Healthier Choice Symbol on the packaging,
has been associated with a as items with the logo contains at least 25% more whole-grains.
reduced risk of type 2 diabetes and
cardiovascular disease, including stroke. 2. Check the ingredients list
However, mass-produced bread is defined as to ensure that wholemeal
is one of the first few For more
ultra-processed food, and this belongs in the same category as
sausages and instant noodles. ingredients, as ingredients information, you
are usually listed in order of can find out on
The term “ultra-processed food” refers to foods that have the quantity used. CNA insider.
gone through substantial industrial processing and typically
Ensuring our “superwomen” are in the pink of health
It is often viewed that women are At the Singapore Heart Foundation, we have been working
generally good at multitasking, hard to educate women that heart disease does not only afflict
managing various responsibilities males. In fact, the disease is the #1 killer in the world, with 1
including family, motherhood in 3 Singaporean women dying from heart disease and stroke
and career. yearly.
Very often, they get tired from The tricky bit is that when a heart attack strikes, women –
juggling so many things that they more often than men – may have subtler, less recognisable
are left with little energy to pay symptoms. They include upper abdominal discomfort, light-
attention to their own health. This headedness, nausea and unusual fatigue. Women can improve
can be detrimental to their physical and their chances of recovery if they recognise these symptoms
mental health in the long run. and get medical attention in a timely manner.
It is important that these “superwomen” realise that they Join us to Go Red for Women as we empower women with the
should be in tip top condition before they attend to the right knowledge and tools to take better care of their hearts
multiple priorities in their lives. and their families.
Are Statins the right choice for you?
A common fact that we know is new analysis of decades of scientific research published in
that statins lower your blood Arteriosclerosis, Thrombosis and Vascular Biology.
cholesterol level, especially the
bad cholesterol (LDL). A high For patients with proven coronary artery disease, such
level of LDL can increase your as those with heart attacks, bypass surgery or stents for
risk for heart attack and stroke. narrowed arteries, moderate to high dose statins are strongly
Your risk is even higher if you recommended to reduce re-narrowing of arteries and the risk
have high cholesterol together of heart attack, in addition to diet and exercise. For patients
with other risk factors such as without proven heart disease, the decision whether to take a
advanced age, high blood pressure, high statin will be based on the overall assessment of cardiac risk,
blood sugar, obesity, family history of heart attack, smoking, such as whether the patient has diabetes, high blood pressure
heavy alcohol consumption. and high cholesterol.
Unfortunately, there has been much “fake news” in recent years As with any other medication, statins should be taken after
suggesting that statins should not be taken due to side effects. consultation with your doctor. Side effects such as muscle
ache and higher blood sugar have been reported but are
The benefits of statins far outweigh the risks, especially for rarely serious and will resolve on stopping the medication.
patients with proven heart disease, according to a scientific For patients at increased risk of heart attack, the benefits
statement from the American Heart Association based on substantially outweigh the risks.
Do you wish to receive heart health related news on a regular basis? Subscribe to our newsletter heartline
by emailing samantha@heart.org.sg with your name, mailing address and contact number or scan the QR code.
Event Reviews 9
rk
WofoHeart
T he 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 Scan the QR code
Wellness Programme and members of the public, Mr to purchase a copy
of Work of Heart.
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.
2nd AED on Wheels Programme
O n 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
AEDs, each of these taxis were also
equipped with first aid kits and
fire extinguishers.
Programme at the Kampung Admiralty Community Plaza.
The first AED on Wheels
The Guest of Honour for the launch was Mr Amrin Amin, Senior Programme was in partnership with
Parliamentary Secretary, Ministry of Home Affairs & Ministry of SMRT Taxis in 2015, where SHF installed 100
Health and MP for Sembawang GRC. AEDs in SMRT taxis.
At the event, SHF launched the The AED on Wheels Programme equips taxi drivers with AEDs
installation of 50 AEDs in the HDT and dispatches them in the event of a cardiac emergency.These
Singapore Taxi. 50 taxi drivers drivers are equipped with the skills of CPR+AED and also the
from HDT Singapore Taxi joined myResponder app, which will notify users of any cardiac arrest
the family of community first incident within a 1.5km radius of their taxi location. Upon
responders, where they were arrival, these participating drivers will administer CPR+AED
trained in CPR+AED and until the paramedics take over, thus improving survival rates.
first aid. On top of the 50
Event Reviews 11
SHF went (Go)
W hile we remind ladies to
take care of their hearts
Red for Men
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, To kick start the challenge, male colleagues
let’s work together to pump hard for your heart. at SHF came together to challenge each
other.Watch this video to see how they did!
Supported by:
National Life Saving Day 2020
O n 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.12 Event Review | SHF 50th Anniversary
g her
Student applyin
Upper Primar y m ea su rin g BP.
ills of
newly gained sk
BPContest
Photo BP through
g more about
A father learnin bo oklet.
@ Schools
our BP Initiative
B P 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.
Special Thanks to:
SHF would like to thank BOUNCE Singapore for their kind Student asking
he r
sponsorship in supporting and encouraging healthy living Upper Primar y s BP.
re hi
father to measu
through exercise.
Our Golden Jubilee
50 years of caring for your heart
F rom 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.”
Setting the future direction for SHF, Chairman Prof Tan Huay
“Initially we were also operating on something like a few thousand Cheem intends to focus on three key pillars – Advocacy,
dollars a year. Fortunately, we had well-wishers who donated to Education and Manpower Upskilling.
SHF and we had to prove to them that their donations were
well used.” On active advocacy, Prof Tan said SHF must work with various
stakeholders to generate knowledge and information for the
Indeed, with great support from the public, government bodies public to get to know about heart disease.
and generous benefactors, SHF is able to continue its increasingly
important role in saving lives and promoting heart health in “Given the flux of fake medical news over social media, it
Singapore and the region through its various programmes. is important for SHF to work with relevant authorities and
international heart associations, to educate the public with
“Since its founding, SHF has really raised awareness of heart scientifically-proven, evidence-based medical facts. We want to
disease and how to prevent it in Singapore. It also runs annual be the source of right medical information to our patients, as
events like National Heart Week, pushed for initiatives such as well as to the public.”
CPR training, public access to defibrillators, and helped to set up
programmes that exist today such as the Myocardial Infarction He also wants to build a culture of continual learning in SHF,
Directory. I’m very proud to be part of this organisation. I’m such that staff will always be mission-ready, professional and
confident the Singapore Heart Foundation will continue to competent in tasks they are carrying out.
grow to greater heights under its new chairman, Prof Tan Huay
Cheem,” former Chairman Prof Terrance Chua said. We look forward to the next 50 years of touching hearts!Volunteerism 13
Survivor with a
Heart of Gold
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.
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 Share your talent with
the wrong decision to continue with the game. Throughout
the day, I suffered three heart attacks, with symptoms like the community, nothing is
cold sweat, nauseous, weak limbs and tight chest. It felt like too small to share.
10 elephants were sitting on my chest. By the third attack,
my friends decided to send me to the University Hospital SHF: What was your memory about volunteering for
in Petaling Jaya, where I was admitted for 26 days just for the then Singapore National Heart Association?
observation and rest.
R: My recollection dated back to 1985, when SNHA used to
In January 1984, a cardiologist at Singapore General Hospital, have a small office at Pasir Panjang with just one secretary and
Prof Arthur Tan, reviewed my condition and discovered three of one assistant secretary. A fellow bypass operation friend, Mr
my arteries were about 70 – 85% blocked. I was then referred Fred Sabapathy, and I helped out often. Dr Low was the then-
to do a surgery in Sydney, Australia as the mortality rate there chairman.
was much lower than Singapore at that time.
In fact, I started voluntary work in 1947 with the Chinese
On 24 February 1984, I did my bypass operation on four YMCA (now called Metropolitan YMCA). Since then, I have
blocked arteries, with the fourth artery being identified during been a Board and Executive Committee Member for close to
the operation. 20 social service agencies.
SHF: How do you feel now after so many years? SHF: Any advice for people who may be keen to
R: I think I am very fortunate, as not many people’s bypass can volunteer?
last so long after their operations. A lot of my friends had to go R: Always remember the 3Ts.
through another bypass after 9 to 15 years.
Time – You can always make time if you want.
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. Talent – Share your talent with the community, nothing is too
small to share.
I am still part of the Rotary Club of Singapore, where I
contribute an article once a month. Other than that I try to Treasure – Treasure what you have and help those whose needs
do light exercises and reading at home to keep myself active. are greater than ours.
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:14 Go Red for Women
Wear Red
Day 2020
D id 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.
We can no longer ignore heart
disease. 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.
– Karen Murray, chair of the American
Heart Association's Women and Heart
Disease Advisory Group
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.特写 15
采用男女性别特异性主要症状标准
诊断心肌梗塞
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。
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
准确解释临床症状，对患者的分流、治疗和后续管理 这一观点，即女性更有可能出现非典型症状，如上腹
均具有意义。 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。
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 临床前景展望
的使用，已经确诊了一批先前未被确诊为心肌梗塞的
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。16 特写
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。
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。DATE
SPONSORSHIP TIERS
10 JULY 2020
$50,000 Co-naming rights FRIDAY
8 invitations to dinner 1 complimentary invitation
VENUE
Logo acknowledgement on all event collaterals SICC
(Island Course)
G
GUUEES NO UR
OU R
ST HO
T-OF-H ON
E
C
$10,000 4 invitations to dinner
Logo acknowledgement on event collaterals
$5,000
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 2020.18 特写
本文改编自《新加坡医疗期刊》(Singapore Medical Journal)。
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 88%的调查对象认为，不健康的食物或不良的饮食习
害肝脏和肾脏，而三分之一的调查对象认为长期服用 惯是高胆固醇第一大导因，而10%的调查对象认为，
他汀类药物会致癌。 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 这项调查的结果还揭示出，可能损害有效治疗或治疗
抽样来自全部5个社区发展理事会区域，确保能够公允 依从性的几个误区。
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。特写 19
误区与真相 2 3 58%的调查对象认为，患者
64%的调查对象
一旦开始服用降胆固醇药物
1 认为高胆固醇患
者通常有呼吸困难或
就无法停药。
87.8%的调查对象认为
胸痛等症状。
在降低胆固醇水平方 真相：
面，饮食和运动与药物一 他汀类药物通常在降低胆固醇
样有效。 真相：
方面非常有效，但仅在服用时有
大多数高胆固醇者没
效。若要停止服用，应在医生的
有任何症状。然而，
真相： 指导下停药，因为他汀类药物可
当高胆固醇导致斑块
在降低胆固醇方面，药物通 以为您提供保护并降低您的心脏
在心脏的大动脉中逐
常比饮食和运动等生活方式 病发作风险。
渐积聚时，将诱发冠
改变更有效。然而，若一个
心病并伴有心绞痛、
人的胆固醇水平无法仅仅通 然而，若要停止服用，可以在医
胸痛、心律失常(不规
过改变生活方式得到控制， 生的指导下停药，因为停药可能
则心脏搏动)和气短等
建议将饮食改变和运动与药 会非常危险，并可能导致严重的
症状。
物相结合，以达到最佳的降 健康风险。
胆固醇效果。
5
4 略超过一半的调查对象认为长
三分之一的调查对象认为草药比西药
更有效。
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：
虽然许多人选择传统药物或草药来降低他
真相： 们的胆固醇水平，但这些药物的长期疗效
多项临床试验和研究结果表明， 尚未得到广泛研究。
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 而且，这些传统药物或草药可能产生的何
要诱因。 种副作用(轻微或严重)目前尚不清楚。
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]20 Nutrition
Eating Well
1. Use the Heart Smart Eating Plate as a guide to have a
this festive
season
ANSWERS
(Dec 2019 – Feb 2020)
7. Choose lower fat cooking methods such as _______, steam
healthy and balanced
_______ _________ diet. grill
braising, and _____ instead of deep-frying.
2. Control your portion by using a ________smaller plate and leaner meat cuts to reduce your saturated fat
8. Go for _______
skipping second servings. intake.
Share items such as side dishes and desserts instead of
3. ______ 9. Season your food with herbs and spices, in replacement of
consuming the full portion. sodium intake.
salt and sauces, to reduce your ________
sweetened drinks and
4. Liquid calories count too. Enjoy ___________ snacks
10. Minimise _______ like chips and cookies in between meals.
alcoholic
_________ drinks in moderation.
two standard
5. The daily limit for alcohol is no more than _____
one
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 content
fibre from wholegrains, fruits and vegetables
6. Include _____
to help you feel full and prevent overeating.
Congratulations to all winners* and
thank you for your participation!
*Winners have been notified via phone or email.Nutrition 21
Are you
too salty?
E xcessive 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!
Per tablespoon:
1. Light soy sauce 5. Chili sauce
a. 530mg a. 220mg
b. 690mg b. 230mg
c. 860mg c. 240mg
2. Oyster sauce 6. Sambal
a. 580mg Belachan
b. 740mg a. 590ng
c. 910mg b. 690mg
c. 790mg
3. Kecap Manis
(Sweet Soy Sauce) 7. Tomato sauce
a. 157mg a. 200mg
b. 227mg b. 210mg
c. 367mg c. 220mg Submit your correct
answers and 5 lucky
4. Fish sauce 8. Mayonnaise winners will receive
a. 632mg a. 95mg a Your Heart Matters
b. 872mg b. 105mg book by Dr Mak Koon
Hou and Louisa Zhang
c. 1012mg c. 115mg in our lucky draw.
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 2020.22 Editorial
T
Oat So Good!
he 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
Bran
Endosperm
including the endosperm, germ and bran.This makes the product higher in fibre, vitamins, and minerals.
Germ
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!Recipe 23
O ats and Dates Cookies
燕麦及红枣曲奇
Scan the QR
code for the
tutorial video:
扫描二维码获
得教程视频:
Makes 20 pieces Method 做法: Nutrients per piece 每块营养
制作20块 1. Preheat oven to 170°C.
Grind the instant rolled Energy 能量: 105 kcal 千卡
Ingredients 材料: oats, roughly, in blender Protein 蛋白质: 1.3 g 克
• Captain® Instant Rolled Oats and add to mixing bowl.
(Oatmeal), 100g 将烤箱预热至170°C。将即 Fat (Saturated fat) 脂肪(饱和脂肪): 5.5 g 克 (0.7 g 克)
Captain® 即食原粒燕麦片，100克 食原粒燕麦片放入搅拌机中
Carbohydrate 碳水化合物: 12.3 g 克
• Flour, 100g 进行粗磨，然后倒入碗中。
面粉，100克 2. Add wheat flour, baking Sodium 钠: 54 mg 毫克
• Baking powder, 1 tsp powder and baking soda
Dietary fibre 膳食纤维: 1.1 g 克
发酵粉，1茶匙 to oats in the mixing bowl
• Baking soda, ½ tsp and mix well.
苏打粉，½茶匙 在碗中加入面粉、发酵粉和苏打粉，让后搅拌均匀。
• Cooking oil, 100g 3. In a separate bowl, mix cooking oil, brown sugar, chopped dates and vanilla essence
食用油，100克 until the sugar dissolves.
• Brown sugar, 50g 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。
红糖，50克 4. Add the dry ingredients into bowl and mix to get a crumb-like consistency.
• Dates, chopped, 100g 将干的配料倒入碗中，混合均匀，至面包屑状粘稠度。
红枣 (切碎)，100克 5. Mix well with a spatula or your hand to get a soft and sticky dough.
• Vanilla essence, 2 tsp 使用小铲或用手将混合物混合均匀，形成软而粘的面团。
香草香精，2茶匙 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。
Tip! 提示！ 7. Arrange the flattened dough onto a lined baking tray and bake for 10 – 12 minutes at
Select cooking oil with lower saturated 160°C in the preheated oven.
fat content. Reduce sugar amount. 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。
您可以选择含有低量饱和脂肪的食用 8. Once baked, let it cool completely and store them in an airtight container.
油。 减少糖的分量。 烤好后，待其完全冷却，再存放在密封的容器中。I n 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!
Registration opens in March 2020, so stay tuned @ www.pledgeyourheartwalk.sg
or SHF’s Facebook page @ www.facebook.com/heartfoundation for more details!
Categories: Date: Time: Venue:
2.5km and 5km 20 June 2020,
th
8:00am – 1:00pm Oasis Terraces
Non-competitive walk Saturday Community Plaza, Punggol
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.You can also read
