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Heart Health: How exercise, alcohol and food affects your ticker

Keen to keep your ticker in tip-top shape? Dr Brian Khoo, cardiologist at Pacific Heart Centre, addresses a range of issues on heart health. 

Getting to the heart of the matter (sorry, terrible pun) 

What are some of the main causes of heart disease?
There are various types of heart disease. It can be broadly classified into a disease of the heart arteries (coronary artery disease), a disease affecting the conduction system of the heart, or a disease affecting the structure of the heart (e.g., affecting the heart valves – this includes congenital heart disease and cardiomyopathy, a disease affecting the heart muscles). Most heart diseases are due to a combination of genetic and environmental (lifestyle) factors. Take coronary artery disease as an example; it’s mainly contributed to by smoking, high cholesterol, diabetes, high blood pressure, obesity and a sedentary lifestyle. Yet your risk would also be substantially higher if there’s history of cardiovascular disease in the family – the genetic factor.

What’s the key to looking after your heart?
Eat and live healthy: that’s the key to maintaining a healthy heart. It’s recommended for most adults to engage in at least 150 minutes of moderate-intensity exercise each week.

What specific types of exercise would you recommend to keep the heart healthy?
Physical activity can be divided into three types:

1. Lifestyle activity: this encompasses the physical activity involved in our daily lives, such as walking and taking the stairs.

2. Aerobic activity: this is physical activity (cardio exercise) that involves the aerobic energy-producing system, such as brisk walking, jogging, cycling and swimming.

3. Strength activity or resistance training: this is any form of resistance or weight-bearing activity that improves bone, joint and skeletal muscle strength.

Any forms of exercise are beneficial to the health. However, there is strong evidence that aerobic activity provides the most health benefits in terms of cardiovascular risk reduction.

Why do we read of seemingly healthy young people dying of heart-related issues on sports fields?
Despite the media attention, sudden cardiac death is rare among athletes. Currently, pre-participation in cardiovascular screening is poor among individuals who participate in vigorous exercise. Incidence of sudden cardiac death can be minimised through vigorous screening by way of thorough history, physical examination and cardiac tests.

Would you advocate the use of heart monitors during exercise?
The use of heart monitoring will not prevent sudden cardiac death. However, it can help individuals to gauge the intensity of their exercise, and help them to pace themselves during training.

What effect does excess alcohol intake have?
It’s recommended that men shouldn’t drink more than 21 units of alcohol a week, or two to three units a day. Women shouldn’t drink more than 14 units a week or one to two units a day. Generally, a pint of beer contains two to three units of alcohol and a medium glass of wine contains two units. There are many detrimental effects on your health with excess alcohol consumption; to name a few, it increases the risk of stroke, heart attack, gout, liver disease and nerve damage.

Which foods would you say are particularly beneficial to maintaining a healthy heart?
Diets rich in fruits, vegetables, legumes, whole grains and unsaturated fatty acids have been shown to be beneficial to the heart. The ‘Mediterranean diet’ is one of the examples of this.

And as for food that might be considered a negative, is it just high-fat foods or does it go beyond that?
Most people believe that any forms of high-fat food are bad for you. Fat can come in different forms. Foods that are rich in polyunsaturated, monounsaturated fat provide essential fatty acids that are beneficial for your heart. Conversely, foods that contain trans fat are bad for your heart since trans fat raises the bad cholesterol (LDL) and lowers the good cholesterol (HDL).

What kind of patients do you typically see?
I see a variety of patients ranging from healthy persons coming for heart screening to those with life-threatening conditions such as heart attacks requiring emergency operations to open up heart arteries – a procedure called angioplasty.

Is heart disease becoming more common because of certain lifestyle changes?
In developed countries, at least, the incidence of heart attack has remained relatively stable in recent years.

Have there been recent changes in the approach to the procedures you carry out?
Until recently in coronary angioplasty procedures, we would puncture the femoral artery in the groin in order to perform the angioplasty; now we puncture the artery through the wrist instead. This has morbidity benefits – that is, it reduces complications. It’s easier to stop the bleeding in the radial artery, for one thing.

What about technological changes?
Cardiology is an evolving field, with new technology available to help treat patients better and detect disease earlier. We now have a wide availability of facilities in Singapore to do angiography, balloon angioplasty and stent insertion (PCI) for treating heart attacks. Recent technological advances include using different scans to predict future heart attacks, for example, by measuring the thickening of the wall of the neck arteries; by measuring the amount of calcium in the walls of the coronary arteries; or by visualising the heart arteries in a non-invasive way to look for early build-up of fatty deposits.

Are there other developments on the horizon?
Studies have shown that PCI is superior to giving medication to dissolve clots to unblock the heart artery during a heart attack. Currently most stent insertions are performed using drug-eluting stents (DES), in which the metal scaffold remains in the heart arteries. A newer generation of ‘bioresorbable’ stents is becoming available; with these, the scaffold absorbs over time. They’re not widely used yet due to certain technical restrictions and price considerations, but over the course of the next few years, new generations of bioresorbable stent will most likely replace DES.

Did you know
Just over 39% of people in Singapore do not engage in sufficient physical activity each week, according to a 2010 National Health Survey.