More younger people in Singapore developing heart conditions; heart attacks remain on the rise
SINGAPORE: At the age of 37, Mr Alvin Mercado suffered his first heart attack while accompanying his young daughter at their family clinic.
'I would describe it as something like a crushing, heavy pain. And then I had this numbness running from my neck through my left hand, and I was wearing a mask - and I recall that I couldn't breathe at all,' he recounted.
When he sought help from the doctor, he was immediately taken to the hospital where he was told he needed an emergency stent procedure.
But that was not the end of the bad news.
Nine months later in mid-2024, he suffered a second heart attack despite having already made healthier changes to his lifestyle. The IT engineer is now undergoing a cardiac rehabilitation programme.
Mr Mercado is among a growing number of younger Singaporeans experiencing heart problems that could lead to more serious conditions later in life, according to doctors and cardiologists.
The National Heart Centre Singapore (NHCS) now handles more than 120,000 patient consultations every year – up from 80,000 in 2006.
This also comes as the number of heart attack cases in Singapore continue to go up. Data from the Singapore Myocardial Infarction Registry showed the number went up from about 8,000 in 2011 to over 12,000 a decade later.
The number of heart attacks in Singapore is projected to rise almost three-fold from about 480 cases per 100,000 people this year, to around 1,400 by 2050, according to forecasts by medical researchers from the National University Health System cluster.
Cardiovascular disease – or heart disease – is the top cause of death in Singapore, accounting for almost a third of deaths in 2023.
WHAT ARE THE MAJOR RISK FACTORS?
Dr Ching Chi Keong, senior consultant cardiologist at NHCS, told CNA that the number of people aged above 50 with hypertension, high cholesterol and diabetes has risen over the years.
These are major risk factors for heart disease, the most common of which is coronary artery disease.
'Fortunately, not all patients with coronary artery disease have the severe form leading to heart attacks or sudden death, but it's prudent to control these risk factors,' Dr Ching added.
For those like Mr Mercado who suffered heart attacks below the age of 40, doctors pointed to two main risk factors – a history of smoking and a family history of heart disease.
Mr Mercado said he had ignored the warning signs in the weeks leading up to his first heart attack, including his family history. He had felt the same sort of 'heavy crushing pain' in his chest, numbness in his hands and cold sweat.
'These are the classic traits, but I brushed it off because it went away after 15 minutes. I brushed it off as something like a transient kind of fatigue,' he said.
Dr Ching warned that these are the exact symptoms – chest pain or difficulty breathing – that could point to an undiagnosed heart condition.
Pressing on with activities could lead to sudden fainting spells, he further cautioned.
Meanwhile, extreme cases of arrhythmia – or an abnormal heart rhythm – affect about 2 per cent of the population or more than 100,000 people in Singapore, according to available statistics.
Dr Ching said those suffering from this may feel light-headed and experience palpitations. It could lead to a stroke or heart failure.
Risk factors include age, existing heart disease and other diseases like thyroid disorders, lung disease, poorly controlled hypertension, and obesity.
Dr Ching advised that patients go for an electrocardiogram (ECG) when they experience an abnormal heart rate or rhythm, as this can come and go.
'For those without any symptoms, it may be appropriate or reasonable to see your doctor for a physical checkup, maybe an ECG before one goes on strenuous physical activity or training. The family physician is usually able to assess symptoms,' he said.
He added that he recommends patients to wear gadgets, like smartwatches, that can record a heartbeat. This helps provide an additional point of reference for doctors.
MARATHON DEATHS
Dr Ching also noted recent media reports of sudden deaths of young people dying after marathons, including a 23-year-old man who died at the 2XU Compression Run last month. The case is still under police investigation.
In 2011 and 2016, a 22-year-old and a 28-year-old died respectively after taking part in the Standard Chartered Singapore Marathon. Both were found to have succumbed to heart conditions.
'In these individuals who are at risk of sudden death events from physical exertion, we have (found that) coronary artery disease remains one of the major causes,' said Dr Ching.
'But there are other uncommon heart conditions that may lead to sudden cardiac death from heavy physical exertion, such as abnormal thickened heart muscles – a condition called hypertrophic cardiomyopathy.'
Inadequate hydration while running a marathon can also 'cause a perfect storm' with other medical or heart conditions, leading to sudden cardiac death, added Dr Ching.
MORE CPR, AED TRAINING
At the Singapore Heart Foundation, more than 3,000 clients passed through its heart wellness centres in the past year – 15 per cent more than in 2021.
The foundation runs rehabilitation programmes which include supervised exercise, dietary planning, and even mental health support.
It is also boosting its training efforts to ensure people know how to react if they come across someone suffering a heart attack. A patient's chance of survival drops by 10 per cent for every minute that nothing is done to resuscitate them.
According to the foundation, about 70 to 80 per cent of cardiac arrests happen outside of healthcare facilities – specifically at home or in public places.
In 2021, nearly 6 in 10 cardiac arrest victims received bystander cardiopulmonary resuscitation (CPR) - up from 20 per cent from a decade before. But among these cases, only less than 10 per cent used an automated external defibrillator (AED).
To plug this gap, the foundation conducted more outreach efforts.
This led to more than 15,000 people attending CPR and AED courses from April last year to March this year. This was a nearly 80 per cent increase from the same period the previous year, said the foundation's chairman Tan Huay Cheem.
"To use a defibrillator and to administer shock sounds really daunting to most people, but actually the machine can self-scan … it's kind of an idiot-proof sort of device where you can learn very quickly as long as you follow the instructions,' Professor Tan added.
'We want to encourage people to learn both CPR as well as AED, because (with this) combination, you can reduce the chance of mortality by more than 50 per cent in some of these patients.'
MORE AEDS ISLANDWIDE
Beyond training, the foundation is pushing for more AEDs to be installed islandwide, including in private buildings. One AED is installed in the lift lobby of every two Housing Board blocks.
Each unit costs about S$2,000, with about 12,000 units currently accessible across the country.
Prof Tan noted that the foundation also emphasises prevention through education – not just with adults but also at the school level with young children.
'While the disease affects mainly the elderly population, it is not to say that heart attack cannot occur in a younger person,' he said.
Mr Mercado said that after suffering two heart attacks, he now wants to correct such misconceptions and remind people to be vigilant.
"I thought heart attacks will only happen to people in their 50s or 60s and to old people, not me, right? And so that is something that I know I only have two choices about. One is - I don't do anything. I just cry about it. Or, I pick myself up,' he added.
'And with that grit and determination, and looking at my family, I know I have to do something about it, and so that is a turning point in my life to carry forward.'
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