FAQ - Dr Yee Kok Meng

Cholesterol is a waxy substance that builds in the arteries. It is not completely harmful, despite its reputation for being bad for you. In fact, some of it can even improve your health when consumed in the right amounts.

There are two types: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). As a general rule, HDL is considered “good” cholesterol, while LDL is considered “bad.” This is because HDL carries cholesterol to your liver, where it can be removed from your bloodstream before it builds up in your arteries. LDL, on the other hand, takes cholesterol directly to your arteries. This can result in atherosclerosis, a plaque buildup that can even cause heart attack and stroke.

Triglycerides make up the third component of cholesterol and act as unused calories that are stored as fat in the blood. Eating more calories than you burn can cause triglycerides to build up in the bloodstream, increasing your risk for heart attacks.

About 30% of deaths from heart disease in the U.S. are directly related to cigarette smoking. Smoking is a major cause of atherosclerosis. Among other things, the nicotine in smoke causes:
● Less oxygen to the heart
● Higher blood pressure and heart rate
● More blood clotting
● Damage to cells that line coronary arteries and other blood vessels

Heart disease is the leading cause of death in women over 40 years old, especially after menopause. Once a woman reaches the age of 50 (about the age of natural menopause), the risk for heart disease increases dramatically. In young women who have undergone early or surgical menopause, the risk for heart disease is also higher, especially when combined with other risk factors such as:

• Diabetes
• Smoking
• High blood pressure
• High blood cholesterol, especially high LDL or “bad” cholesterol
• Obesity
• Lack of exercise
• Family history of heart disease
• Problems during pregnancy, such as preeclampsia, high blood pressure, gestational diabetes, or elevated sugars
• Rheumatologic and inflammatory diseases

Whilst some CV risk factors are non-modifiable such as age, sex and family history of heart disease, many risk factors can be modified or controlled to limit the progression of atherosclerosis, and hence reduce the risk of developing heart disease. These include:

• Smoking
• High cholesterol
• High blood pressure
• Lack of exercise
• Obesity
• Diabetes
• Unhealthy diet
• Stress

By addressing these risk factors, and by taking simple steps to modify your diet and lifestyle, you can reduce your future risk of a heart attack.

Heart disease may manifest as chest pain, tightness, or discomfort. Shortness of breath or a reduction in effort tolerance (ie. fatigue or tire easily) are also symptoms associated with heart disease. Dizziness or a fast or irregular heartbeat are other possible symptoms.

The process of atherosclerosis is irreversible, but heart disease may potentially be prevented by addressing the risk factors such as cholesterol, blood pressure, and smoking. Several studies have shown, for example, that aggressive lowering of blood LDL cholesterol (bad cholesterol) is associated with reduced risk of a heart attack.

Your risk of a heart attack is increased if a first-degree relative (parent or sibling) has previously suffered a heart attack or stroke. That is especially so when the heart attack occurred at a young age (male before the age of 45yrs, female 55yrs). Obviously, you cannot change your family history, but if you do have a strong family history, it`s important to make heart-healthy choices in terms of your diet and lifestyle to reduce your future heart attack risk.

There are many things you can do to reduce your chances of getting a heart attack. Making heart-healthy choices in terms of diet and lifestyle will reduce your future heart attack risk – this may mean choosing a healthier diet, exercising regularly, stop smoking (if you are a smoker), and by reducing the stress levels at the workplace.

If you are at risk, it would also be advisable to see your family doctor or physician for medical checkups on a regular basis. If you have a family history of heart disease, it is wise to have your blood cholesterol checked after the age of 18 and annually thereafter. The patient should also have their weight, blood pressure and fasting blood sugar tested on a regular basis. Perhaps more importantly, one should maintain a healthy lifestyle. In fact, it is never too young to start – what you do now will affect the heart later in life.