When Dr Michael Lim, a medical director and senior cardiologist at Royal Healthcare, conducted medical reviews for his patients last year, he noticed that they had put on weight and recorded poorer sugar, blood pressure and cholesterol readings.

These results were not entirely surprising to him.

When Singapore entered its circuit breaker period in April 2020, people were urged to stay home as much as possible to break the chain of community infections. This pandemic-induced inactivity naturally led to a more sedentary lifestyle over time. For many, ordering takeout or consuming processed food while working from home also became a default, leading to the development of unhealthy diet habits.

Thankfully, Dr Lim notes, his patients later grew more aware of their health, and even scheduled more frequent appointments with him.

He adds: "In fact, they started embarking on exercise programmes and had hired personal trainers; some even found that Covid-19 provided the pause they needed in their hectic lives to focus on their families and personal goals."

As for its medical effects, Dr Lim, who is also chairman of the Chapter of Cardiologists of the College of Physicians, Academy of Medicine, Singapore, says that the current evidence suggests that the risk of Covid-19 causing direct heart muscle damage is very small. "Rather, the virus causes inflammation, and puts stress on the lungs, which can impair heart function," he says.

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In view of this, being updated about cardiovascular trends in Singapore may help patients take better care of their heart health in the future.

Where heart health is headed

According to the World Health Organization, the leading cause of death worldwide is cardiovascular disease, which is responsible for 32 per cent of global deaths. About 19 people die from cardiovascular disease (heart disease and stroke) in Singapore every day, and in 2020, it accounted for 31.7 per cent of all deaths - cancer was a close second at 28.4 per cent according to 2019 statistics from the Ministry of Health.

However, thanks to advancements in medicine and technology, increasingly accurate tests are able to assist doctors with early and effective diagnosis and treatment for their patients.

According to Dr Lim, the number of deaths from ischaemic heart disease per 100, 000 population in Singapore has decreased from about 179 in 1970 to about 63 in 2019.

He says: "If you look at the guidelines recommended by the main cardiology organisations in the US or Europe, there's a trend towards more accurate tests being conducted. For those with chest pain, a coronary computed tomography (CT) angiogram - a scan of the arteries that supply blood to the heart - has an accuracy of almost 100 per cent in ruling out significant heart artery disease."

Other tests, such as the traditional treadmill test, stress echocardiogram or nuclear scan, have lower accuracy rates, he adds. However, these still have their place in situations where CT scans are not available, if the patient is unsuitable for CT scans, or the aim is to determine the adequacy of blood flow to the heart muscle.

At Royal Healthcare's Siemens Healthineers Asia Reference Centre in Novena, a new generation CT machine delivers sharper, high-quality images in colour and 3D, which allow doctors to provide more accurate diagnoses. In optimal scanning situations, the radiation dose for a heart scan is also low, just being slightly more than a mammogram.

Dr Lim explains: "When we see a blockage, we can use the machine to help us better understand why the artery is blocked, and by what kind of plaque. It will also help the doctor to assess what is the likelihood that this blockage will result in a heart attack.

"From there, we can tailor patient treatment, or rule out the need to have a procedure or a stent done, and just have the condition managed with medication."

Dr Lim hopes that his patients' increased awareness of their lifestyles, and their desire to start taking charge of their health by going for more regular checks, will complement advancements in medtech and dramatically reduce instances of sudden heart attacks and related procedures.

He shares that in the last decade, the number of people undergoing heart bypass surgery has been decreasing. For example, one study in the US showed that the number of heart bypass surgeries performed in 2008 was one-third less than that performed in 2001.

At the same time, treatment methods are also evolving. Dealing with a partial blockage could be as simple as controlling one's cholesterol, sugar and blood pressure levels through diet, exercise and lifestyle tweaks. Awareness of the warning signs, or treatment via medicine instead of surgery, could also be mitigating factors.

Shares Dr Lim: "Apart from conventional pills, new treatments to lower cholesterol include receiving fortnightly or monthly injections. Since September last year, we have newer options with new-generation drugs that can be injected once every six months."

Prevention is better than cure

Among diabetes, high cholesterol, smoking and blood pressure, the first poses the greatest challenge as managing it requires iron discipline, says Dr Lim. For example, an Asian diabetic male, aged 40, could have his lifespan shortened by as much as eight to nine years, as high blood sugar levels damage blood vessels and could contribute to the narrowing of the arteries.

He cautions: "Just because you have no symptoms doesn't mean you don't have heart problems. If you look at the statistics from the American Heart Association, you will see that about half of the men and two-thirds of the women who died of sudden cardiac arrest did not experience any warning signs."

A strong proponent of preventive healthcare, Dr Lim has made it his life's mission to work closely with every patient to "get them to 100 years".

He says: "My personal belief is that a large part of the future of heart medicine will be prevention. For example, if you experience chest discomfort or chest pain, new generation scanners will quickly provide a diagnosis. You can then decide whether you need medicine or not, and be able to make an informed decision on the options available.

"That makes it quite difficult for you to develop a life threatening blockage, and you may never need to have your heart fixed throughout your life."