Risk Factors for Coronary Artery Disease – What’s New?

90% of coronary heart disease occur in those with at least one of the five leading modifiable risk factors: Hypercholesterolaemia, Hypertension, Diabetes, Obesity or Smoking.

At the recent National Life Saving Day 2020 Symposium, organised by the Singapore Heart Foundation, Dr Nithin Iyer from the National Heart Centre Singapore, shared about the new guidelines for Hypertension and Dyslipidemia, as well as ways to reduce your cardiac risk factors.

Definition of Hypertension

In recent years, the American College of Cardiology/American Heart Association (ACC/AHA) has redefined hypertension to being above 130/80, while both the European Society of Cardiology (ESC) and the Singapore’s Ministry of Health still retains the traditional definition of above 140/90.

ACC also recommends that hypertension patients on medication, as well as those aged 65 and above, to maintain blood pressure level below 130/80. The ESC, on the other hand, recommends lowering blood pressure to below 140/80.

“Failure to adhere to a low salt diet that’s less than 6g of salt per day is known to be a significant cause of resistant hypertension. That’s high blood pressure that doesn’t respond to medication. It’s known that low salt diet can lower your blood pressure by as much as 5/3.”

Besides reducing use of salt and preserved soup, you can also enhance food taste with natural herbs like onion, ginger, garlic, chilli, parsley etc. Also, avoid drinking up soup stocks and sauces.

High blood cholesterol

ESC/European Atherosclerosis Society (EAS) also released new guidelines for Dyslipidemia in 2019, recommending people to target their LDL “bad cholesterol” according to the following tiers below:

• Very high risk (patients diagnosed with cardiovascular disease who previously had heart attack, stroke, stenting, bypass surgery): <1.4mmol/L
• High risk: <1.8mmol/L
• Moderate risk: <2.6mmol/L
• Low risk: <3.0mmol/L

Dietary changes

Dr Lyer recommended two simple changes to make for a heart healthier lifestyle. First, adopt better eating habits and portion control by using the Health Promotion Board’s My Healthy Plate (or SHF’s Heart Smart Eating Plate).

He also highlighted the Mediterranean diet as an example of beneficial diet that has been proven in literature to improve cardiac outcome.

“The Mediterranean diet tend to have high levels of monounsaturated fats mainly in the form of olive oil, which is one of the healthier types of fat. Moderate consumption of alcohol mainly in the form of red wine; vegetables, fruits like legumes, grains; a moderate consumption of milk and dairy, mainly in the form of cheese; and low intake of red meat. This diet has been associated with improved cardiovascular mortality, and improve blood sugar control in patient with diabetes.”

The DASH (Dietary Approaches to Stop Hypertension) diet, which includes four to five servings of fruits and vegetables, and two to three servings of low-fat dairy, “has been shown to reduce blood pressure by up to 11/5 in hypertensive patients”.

“This has been associated with weight loss and benefits to your cholesterol as well.”

A study quoted by Dr Iyer also shows plant-based diets are associated with a lower risk of cardiac disease compared to animal-based diets.

Exercise regularly

Guidelines recommend 150 minutes per week of moderate-intensity exercise (e.g. brisk walking, water aerobics, dancing (ballroom or social), gardening or biking) or 75 minutes per week of vigorous-intensity exercise (e.g. hiking uphill, running, swimming laps, aerobic dancing or jumping rope).

“It’s known, however, that benefits start with minimum activity. You don’t even need to achieve 150 minutes a week to achieve health benefits. The simplest thing you can do is standing. Standing over 2 hours a day is known to reduce your cardiac risk and cardiac mortality by about 10 per cent.”

Watch his presentation here:

His presentation slides are also available for download.