THE HEART DISEASE FACTS I

What You Need to Know

• What is Cardiovascular Diseases?

Cardiovascular diseases (CVDs) are a group of disorders of the heart and brain and blood vessels and they include :

• Coronary heart disease (also called ischemic heart disease, coronary artery disease), i.e. disease of the blood vessels (blockage) supplying the heart muscles.
• Cerebrovascular disease including strokes – disease of the blood vessels supplying the brain.
• Peripheral arterial disease (also called peripheral vascular disease – PVD) – disease of blood vessels supplying the arms and legs.

Other Heart Diseases include :

• Rheumatic heart disease – infection and resultant damage to the heart valves and heart muscles from rheumatic fever – an infection caused by a strain of bacteria call streptococcus bacteria.
• Congenital heart disease – malformations of heart structures including heart valves, major heart blood vessels, heart muscle defects existing at birth
• Deep vein thrombosis – blood clots in the leg veins
• Pulmonary embolism – blood clots in the leg veins which can dislodge and move to heart and lungs.
• Heart Failure – as a result of heart pump failure
• Abnormal rhythms of the heart — most common is atrial fibrillation. Others include heart conduction abnormalities, e.g. heart blocks and tachyarrhythmias (abnormal fast heart rhythm arising or originating from the upper or lower chambers of the heart).
• Ion channelopathies — due to rare genetic disorders in the channels that regulate sodium, potassium and calcium in and out of the heart muscle cells that result in electrolyte imbalance and malfunction leading to disturbances in the heart electrical rhythm that can results in blackouts and sudden death.

• Heart attacks and strokes are emergencies and present as acute events and are mainly due to a blockage in the blood vessels in the heart and brain which result in the prevention of blood from flowing to the heart or brain.
• The most common reason for the blockage is due to the build-up of fatty deposits on the inner walls of the blood vessels (atherosclerosis) that supply the heart and brain.
• Strokes can also be caused by bleeding from a blood vessel in the brain or from clots.
• The cause of heart attacks and strokes are usually due to a prolonged presence of a combination of risk factors which include :
  1. Tobacco use (smoking)
  2. Unhealthy diet
  3. Obesity
  4. Physical inactivity
  5. High blood pressure
  6. High cholesterol
  7. Diabetes mellitus
  8. Harmful use of alcohol

THE HEART DISEASE FACTS II

Cardiovascular Diseases (CVDs) (Facts from World Health Organisation)

Worldwide

• CVDs are the number 1 cause of death worldwide
• Globally more people die annually from CVDs than any other cause
• An estimated 17.5 million people died in 2013, representing 31% of all global deaths
• Of these deaths, an estimated
  • 4 million were due to coronary heart disease
  • 7 million were due to stroke
• Over ¾ of CVD deaths take place in low- and middle-income countries

Singapore

• In Singapore, coronary heart disease (also termed ischemic heart disease) is the number 3 killer in 2012 – 2014 (data from Ministry of Health), followed by cerebrovascular disease (including stroke) at number 4, and hypertensive diseases (including hypertensive heart disease).
• If we combine the above, in 2014 (ischemic heart disease [16.0%], stroke [8.4%], hypertensive heart disease [3.6%] of all deaths), CVDs, account for 28% of all deaths and push this as the number 2 killer in Singapore (behind cancer at 29.4% – the number 1 killer). If we include other heart disease (1.9%) — with a total of 29.9%, CVD will be the number 1 killer ahead of cancer (figure 1).

Figure 1.  Principle causes of deaths in Singapore 2014 (Data from Ministry of Health)

What Do These Statistics Mean?

• Every day, 15 people will die from cardiovascular disease (heart and stroke) in Singapore.
• Nearly 1 out of 3 deaths in Singapore is due to heart disease or stroke.
• Male has a higher prevalence of heart and hypertensive disease deaths than females (see figure 2).
• Females have higher risk /death from strokes.
• However the total combined CVD death is almost the same for males and female — a trend that in Singapore, there is equalisation of gender risk and deaths from CVD (compare to what was previously known that CVD is male predominant at a rate of 1:3).

Figure2.   Mortality of CVDs by Sex (2014) in Singapore

Other important CVD facts (hospital admission and attendance at polyclinics)

• Coronary heart disease (ischemic heart disease) is responsible for the 3rd highest hospital admission in Singapore behind accident, poisoning and violence and cancer. Combining with stroke and other heart disease, CVD is the 2nd highest reason for hospitalisation.
• Hyperlipidemia (high cholesterol and other lipids) and hypertensive illness are the top 2 conditions for attendance in polyclinics