The Secret of Cardiovascular Longevity

by Dr Peter Yan
Consultant Cardiologist
Gleneagles & Mt Elizabeth Hospitals

Cardiovascular disease (CVD) is the number one cause of death worldwide.  Globally more people die annually from CVD than any other cause.  An estimate of 17.5 million people die from CVD in 2013 representing 31% of all global deaths (WHO data).

In Singapore, CVD (include coronary or ischaemic heart disease and stroke) is the number two killer accounting for one out of 3 deaths just behind cancer.  It is estimated that everyday 15 people will die from CVD in Singapore (Ministry of Health data).

The good news is until recently both in developed countries of the West (USA and UK) and in Singapore, CVD deaths have been on the decline over the past 1 to 2 decades.  The major reason for this decline is attributed to the better control and fall in prevalence of blood pressure and high cholesterol (2 of the main causal risk factors of CVD; the others being diabetes, obesity, physical inactivity, tobacco smoking, too much stress, excessive alcohol consumption).

However there are a few bad news:

1. Over the last few years, reduction in mortality from CVD has plateaued.
2. Despite the fall in the prevalence of high blood pressure and high cholesterol in the West, in Singapore, these 2 conditions accounted for the highest number of visits to Polyclinic for treatment. In addition, CVD and stroke are the 2 top conditions for hospitalisations.  These have contributed significantly (from 2004 – 2010) to a 10% increase in total disease burden, 15% increase in disability burden and 5% increase in premature mortality burden.
3. There is a rising prevalence of obesity and diabetes mellitus worldwide fuelled by an increased consumption of processed and convenience food especially refined sugar and sweeteners (an increase by 20%). A study published recently in Europe BMC Public Health Journal reported that diabetes cost Singapore more than $1 billion in 2010 and this is expected to soar beyond $2.5 billion by 2050. (42% of this cost is attributed to treatment and the remaining in the form of productivity-related losses)   The Ministry of Health has therefore declared war on diabetes describing it as one of the biggest strain on the healthcare system here.

Traditionally, the fight against CVD lies in primary prevention and treatment of CV risk factors :

• Hypertension
• Hypercholesterolemia
• Diabetes
• Obesity
• Tobacco smoking
• Physical inactivity
• Excessive alcohol consumption

Doctors and health insurance companies have always emphasised on high CV risk factors.  But recent years there is a re-think that instead, why not look at individuals with ideal low CV risks.

AHA (American Heart Association) has identified 7 ideal cardiovascular health metrics and this is shown below :

The seven ideal cardiovascular health metrics is then divided into 3 categories:

Studies have shown that individuals possessing all 4 of the ideal cardiovascular health behaviours (non-smoking, ideal body mass index, physically active and healthy diet) have very low risks of CVD.  Even if an individual has pre-existing hypertension and high cholesterol, the possession of the 4 ideal health behaviours will still put them at a lower incidence of cardiovascular disease compared to those who do not.

This pursuit of the 7 ideal cardiovascular health metrics contribute to the secret of cardiovascular longevity.  The earlier this is achieved in life and maintained henceforth, the greater the chance of preventing cardiovascular events and mortality.  Some experts say this is the way to “cure atherosclerosis” (prevent cholesterol depositions in arteries and therefore prevent heart attack and stroke in the future).

Evidence will be presented to validate this concept and also the way forward in applying this new concept of attaining and investing in the future of our cardiovascular health.

Old Thoughts – New Concepts

Currently insurance companies are assessing insurability (at least for cardiovascular diseases) of an individual by using cardiovascular risk factors (amongst others).  Calculations and permutations of CV risk is based on risk engines in computing short-medium 10 year and life-time risk of developing cardiovascular diseases (heart attack and stroke).  Insurance eligibility and premium are also pegged against an individual’s cardiovascular risk.

Perhaps there should be a mind-set change that instead of looking at an individual’s high CV risk profile, we should be identifying how many ideal cardiovascular health metrics the individual possesses (i.e. number of low CV risk factors) and accord an incentive of lower premium.  The more number of low CV risk factors, the lower the premium.