Cardiovascular disease (CVD) encompasses a range of disorders affecting the heart and blood vessels, including coronary artery disease, stroke, and peripheral vascular disease.

By Dr Michelle Chan, Associate Consultant, Department of Cardiology

The World Health Organisation reports that CVD is the leading cause of death globally, accounting for approximately 17.9 million deaths per year – a staggering 31% of all global deaths. Singapore mirrors this trend, with one-third of the 26,885 deaths in 2023 attributed to cardiovascular causes¹. While CVD remains a significant cause of death, a concerning trend is emerging - younger people are increasingly developing heart attack or stroke. This paradigm shift is driven by a  ombination of influences such as physical inactivity, poor dietary choices, and alcohol abuse. It highlights the importance of early health screenings to identify risk factors and early signs of CVD, enabling timely intervention and prevention.

Why Early Heart-Related Health Screening Matters

Health screening is a proactive approach that enables the detection of potential health issues before they develop into serious problems. This involves a thorough evaluation of seemingly healthy individuals to uncover any early signs of disease before symptoms become apparent. Such screening is particularly important as many cardiovascular risk factors and associated conditions - including high blood pressure, high cholesterol, and diabetes - often develop silently, without obvious early warning signs.

Early screening can unveil these hidden health concerns at a stage when they are more manageable and potentially reversible. Taking blood pressure as an example: during a routine check-up, your doctor might record a blood pressure (BP) reading of 130/90 – a potential early indicator of hypertension. Following this, your doctor would likely recommend home BP monitoring over several weeks to confirm whether your blood pressure exceeds the normal range. With this knowledge, you can make informed decisions about your dietary and lifestyle choices, potentially restoring your blood pressure to a healthy range without resorting to medications. Conversely, without such health screening, you might remain unaware of your blood pressure condition until more serious symptoms occur, such as headaches, giddiness, breathing difficulties and chest discomfort. By then, you may already be at risk of life-threatening complications like stroke or heart attack.

In Singapore, the Screening Test Review Committee appointed by the Ministry of Health recommends regular health screening, including checks for CVD-related conditions²:

There are several risk factors contributing to the increasing burden of CVD (see table below). Once identified to having any modifiable risk factor, it is imperative to try to optimise its control before CVD develops.

As we accumulate more risk factors, the likelihood of developing CVD increases. To assess this risk, doctors use specialised tools called risk prediction models. These models consider various factors to estimate a person’s overall risk and identify individuals who might benefit from early intervention or more intensive prevention strategies. One such tool that doctors sometimes use is the Coronary Calcium Score. This test detects early signs of heart disease by measuring calcium deposits in the heart's arteries. But why is calcium significant in this context?

Understanding Atherosclerosis and Calcium Scoring

Heart disease often begins with atherosclerosis – the gradual build-up of fatty deposits in arteries. This process occurs naturally as we age, but can be accelerated by factors such as:

• Smoking: Tobacco chemicals inflame vessel walls

• Hypertension: Increased pressure on vessel wall
  

• Diabetes: Causes inflammation of the vessel wall

• Hypercholesterolemia: increases concentration of harmful cholesterol
  

Over time, these fatty deposits harden and accumulate calcium, forming plaques. As plaques grow, they narrow blood vessels, reducing blood flow. In severe cases, this can cause chest pain, breathlessness or reduced exercise capacity.

The calcium in these plaques serves as a crucial indicator of heart disease risk. The Coronary Calcium Score test can detect calcium deposits in the heart’s arteries before symptoms appear. Using a specialised computerised tomography (CT) scan, it creates 3D images of the heart, allowing doctors to quantify calcium within the coronary arteries. 

A score of zero suggests no calcium is present, indicating a low risk of heart problems. Higher scores indicate more calcium and a greater cardiac risk (see table below^3,4). This early detection allows for timely interventions, potentially preventing more serious heart issues.

This test is most useful for adults between 40-75 years old, without symptoms or known heart disease, at intermediate risk based on other assessments, and not already taking cholesterol-lowering medications (statins).

Steps to a Healthier Heart

While the Coronary Calcium Score can provide valuable information, it is just one of many tools doctors use to assess heart health. Your doctor will consider this alongside other factors to provide the best advice for your condition. Regardless of your Coronary Calcium Score, maintaining a heart-healthy lifestyle is crucial. This includes:

• Eating a balanced diet low in saturated fats and high in fruits and vegetables

• Regular physical activity

• Maintaining a healthy weight

• Not smoking

• Limiting alcohol consumption

• Managing conditions like high blood pressure, diabetes, and high cholesterol