Did you know that heart disease is the leading cause of death globally? On 11 November 2023, Asian Heart & Vascular Centre held Heart to Heart Talk 2023, organized by MediaCorp, official media partner, CNA, at Suntec Convention Centre. We hope to bring awareness and get everyone to recognize the symptoms of common heart and related diseases, and understand the treatments available. Here's the presentation shared by Dr Goh Ping Ping. Dr Goh Ping Ping is an echocardiologist trained in imaging of the heart. She is a strong advocate of preventive cardiology and awareness for women's heart health. She manages a broad spectrum of cardiovascular disease including heart attack patients. For more info, visit www.ahvc.com.sg

1. Women and Heart Disease:
Are You at Risk
Dr Goh Ping Ping
Asian Heart & Vascular Centre

2. 2020 2021 2022
Total no of
death
22054 24292 26891
% of total death 28.6 26.4 23.9
1. Cancer 18.8 20.1 20.0
2. Pneumonia
3. Ischaemic
heart disease
20.5 18.4 19.7
4.
Cerebrovascular
disease
6.0 6.1 5.8
5. Hypertensive
disease
2.9 2.7 3.7
Mortality Statistics, MOH, 2020 - 2022
2020 Total Male Female
Total number of deaths 22054
% of total death from
Cardiovascular Disease
29.4%
No. of AMI (Heart Attacks) 11887 7783 3848
Median Age of AMI 66.5 77.6
1 in 3 Singaporean women
dies of heart disease or stroke

3. Sudden Cardiac Death
■ 1000 cases of sudden cardiac death occur
annually
■ Half are below age of 60
■ Average age of 47
■ 80% are due to Acute Myocardial Infarction
(Heart attack due to blocked artery)

4. Dr, I want to check my
heart
What to screen for?
1. Screening for Risk Factors
2. Screening for Presence of heart disease

5. Atherosclerosis is Multifactorial:
Traditional Risk Factors
•Hypertension
•Hyperlipidemia
•Diabetes
•Smoking
•Obesity
•Inactivity
•Family history

6. Study on young Asian women < 50 yrs old
■ Asians - diabetes mellitus, hypertension and hyperlipidemia are
most important risk factors
■ Present in > 50% of young women with heart attack
■ Hyperlipidemia most prevalent among Indians, Diabetes among
Malays
■ Western populations – smoking and family history are most
prevalent
■ only 4% for diabetes and 13% hyperlipidemia
Acute myocardial infarction in young Asian women:
a comparative study on Chinese, Malay and Indian ethnic groups
Xie et al. SMJ, 2011.

7. Risk Calculator to check
10-year risk and
Lifetime risk
Risk 10 year risk of
heart disease
Low < 10%
Intermediate 10-20%
High > 20%

8. Ideal Cardiovascular Health
■ Total cholesterol <200 mg/dl
■ BP <120/80
■ Fasting blood glucose <100 mg/dl
■ BMI <25 kg/m2
■ Abstinence from smoking
■ Physical activity at goal: ≥150 min per
week moderate intensity , ≥75 min/wk
vigorous intensity, or combination
■ Healthy DASH-like diet
Guidelines for the Prevention of CVD in Women
JACC Vol 57, No 12, 2011:1404-23
Emotional Health ??

9. When to Screen for Heart Disease?
Screening for Risk Factors:
• Physical activity status for all > 18 yrs
• Ht, wt, waist circumference, BMI for all >18 yrs
• Blood pressure for all > 18 yrs
• Lipid disorders for all > 40 yrs
• Diabetes Mellitus for all > 40 yrs
MOH CPG 2011: Screening for Cardiovascular Disease and Risk Factors

10. What is strong family history?
Family history of Premature Heart Disease
• heart attacks at a young age
• sibling, parents or grandparents
• male relative < 55 years old
• female relatives < 65 years old
2 times risk 5 times
risk
Parents
children

11. ■ Body mass Index (BMI)
■ Weight (kg) / Height (metre) 2
27.5 and above High Risk
23 – 27.4 Moderate Risk
19-23 Low Risk (healthy range)
below 18.5 Too low
Waist circumference
< 85 cm for male
< 80 cm for female
rectangle
pear
apple inverted
triangle
What is Ideal Weight？

12. Kidney and Heart
■ Chronic kidney disease (stage 3 and stage 4) is
associated with 2-3 times higher cardiovascular
mortality
■ Measured by Glomerular Filtration Rate (GFR)
■ Microalbuminuria (leakage of protein in urine) is also
an independent risk factor

14. PUBLIC RELEASE: 11-JAN-2017
The Lancet: Study unveils how stress may
increase risk of heart disease and stroke
Study on the Amygdala - a region of the brain involved in stress
293 patients had PET/CT scan to record their brain activity and test
for inflammation of their arteries
They were tracked for an average of 3.7 years to see if they
developed cardiovascular disease
Study found that those with higher amygdala activity had greater
risk of subsequent cardiovascular disease and developed problems
sooner than those with lower activity
They also have increased bone marrow activity and inflammation in
the arteries

15. Women more prone to heart ischaemia during
Emotional Stress
■ Past research has found that compared with their male counterparts,
women with heart disease are more likely to suffer "myocardial
ischaemia " in response to mental stress
■ Recent study of 678 pts with heart disease showed that under
psychological stress, women are more prone than men to having their
blood vessels constrict
■ women are more likely than men to have "microvascular dysfunction”
These very small arteries are not clogged up with plaques, but they do
not relax and thus can impair blood flow
(published online Dec. 21 in Arteriosclerosis, Thrombosis and Vascular Biology)

16. Treadmill ECG test
Detects blockage that reduce
blood flow
marker of ischemia: ECG
Accuracy: 65-70%

17. Problem with stress testing in Women
■ False positive test:
■ Women have “non – diagnostic” ECG during exercise
■ False negative stress ECG:
■ Women may not exercise hard enough for the
abnormality to show

18. Stress Echocardiography
• Examines the function of heart muscles to detect abnormal function due
to lack of blood flow
• More accurate than ECG: 85%
• Also feasible for patients who cannot perform exercise
NON-INVASIVE
NO RADIATION

19. Sestamibi perfusion scan (has radiation)
exercise
Persantin/
adenosine
Gated SPECT (single photon emission tomography)
using 99mTc-labelled sestamibi isotope

20. Coronary calcium score
Early detection of plaque (cholesterol deposit)

21. Coronary CT-angiography
■ high temporal and spatial resolution
■ detects narrowing in vessels down to 1.5 mm
■ sensitivity 92-95%, specificity 86-93%
■ additional information about cardiac and extracardiac anatomy

26. Thank You