The World Heart Federation says heart disease is the world's leading cause of death. It's responsible for one in every three deaths, and 80 per cent of these deaths occur in low-and middle-income countries.

Despite these discouraging figures, with medical science making rapid and continued progress with new diagnostic and treatment methods, it is heartening to know that heart disease is preventable and treatable.      Recognising the health risks early is important as preventive measures can be taken. The presence of risk factors increase your likelihood for heart disease. Some of these factors, such as age, cannot be changed while others may be modified.      By understanding and managing these factors, you can lower your risk for heart disease. The factors you cannot change are age, gender, ethnicity and family history. THE RISK FACTORS YOU CAN MODIFY High blood cholesterol Low-density lipoproteins (LDL) or "bad "cholesterol increase the build-up of plaque in the arteries, while high density lipoproteins (HDL) or "good" cholesterol removes cholesterol from the cells before they are deposited as plaque in the arteries. This build-up causes the arteries to harden, such that they become narrowed and blood flow to the heart is reduced or blocked. Modify: Keep your total cholesterol level as low as possible - do check your cholesterol levels regularly. The desirable level depends on your pre-existing risk for coronary heart disease. High Blood Pressure High blood pressure (hypertension) is one of the major risk factors for coronary heart disease and cerebrovascular disease, such as stroke. Left untreated, hypertension can also cause heart failure or lead to rupture of blood vessels in the brain. You may not experience any symptoms but in the long-term, it can lead to the damage of various body organs, including the heart, kidney and blood vessels. Modify: Check your blood pressure at least once a year. Marginally elevated blood pressure may normalise when you lose weight, exercise more and reduce salt intake. If these measures are not successful, drug treatment may be needed. Once medicine has started, you must continue with the treatment, complemented by a healthy lifestyle. Diabetes Mellitus and Abnormal Blood Glucose (Sugar) Levels Diabetes mellitus is a chronic illness, and people with it are two to four times more likely to develop coronary artery disease and stroke. lt is often associated with other cardiovascular risk factors, like high blood pressure and obesity. Modify: Maintain control over the amount of glucose in your blood. While maintaining a healthy weight, a balanced diet and regular exercise can prevent the onset of the disease. Menopause Natural oestrogen may help protect women against heart disease, but as oestrogen declines (as in menopause), it may contribute to a higher risk of heart disease and stroke. After menopause as well, women tend to have higher LDL  cholesterol levels, increasing the risk of developing coronary heart disease. Modify: Management of these risk factors becomes more important. However, hormone replacement for women who have undergone natural menopause does not prevent heart disease, and is not indicated for prevention of heart disease. Obesity and excessive weight People who have excess body fat, especially around the waist, are more prone to developing heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart. It also raises blood pressure and LDL and lowers HDL. Modify: Weight loss leads to a decrease in blood pressure, blood glucose and blood cholesterol levels. Lack of physical activity Those who are inactive put themselves at risk of heart disease. Modify: If you want to be active, start at a slow pace to avoid muscle injury. People with known coronary artery disease or those above 40 years old who have been inactive should seek medical advice first. Smoking Smokers have two to three times the risk of non-smokers for heart disease. Smoking leads to stroke, heart attack, high blood pressure, blood vessel disease, cancer and lung disease.      The carbon monoxide in the smoke lowers the amount of oxygen carried in the blood to the rest of the person's body; the cancer-causing substances are deposited in his airways and lungs. Modify: Don't start.or if you are already a smoker, stop. Stress Blood pressure goes up momentarily when you get angry, excited, scared or are under physical or emotional stress. This makes the heart pump faster and harder, causing palpitation, insomnia, headache and digestive problems. Modify: Learn to manage your stress. If you are constantly stressed over long periods of time, you may be at a higher risk of developing high blood pressure and even heart disease.

are you in the high-risk group for heart disease? AGE: Age increases a person's susceptibility to heart disease. GENDER: Men are three to five times more likely to have coronary heart disease than women. However, the risk for women increases after menopause. By about five to 10 years following it, their risk increases to the same rate as men. ETHNICITY: Compared with Chinese, South Asians (Indians, Sri Lankans, Pakistanis etc) are three times, and Malays are two times more likely to suffer from coronary heart disease. OBESITY: People who have excess body fat, especially located around the waist, are more prone to developing heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart. It also raises blood pressure and "bad" cholesterol, and lowers "good" cholesterol. It is also associated with the development of Diabetes Mellitus. FAMILY HISTORY: You can be at a higher risk of having heart disease if your immediate family members (parents, siblings) have a history of premature heart disease. If there is a family history of heart disease, control your other risk factors too.

TIPS ON PREVENTING HEART DISEASE Eat a healthy diet Avoid foods high in cholesterol and saturated fats such as animal fats, whole milk products, eggs, red meat such as beef and lamb and coconut milk. Instead, choose lean meat, fish and low-fat dairy products and increase your intake of fruit and vegetables. Exercise regularly Exercise at least three times a week to prevent heart and blood vessel disease. Although there are many kinds of physical activities, brisk walking is one of the best. Check with your doctor to see what's suitable for you. Stop smoking Heart disease is found to be more common in smokers than in non-smokers. Smoking is a big contributor to heart disease risk and in addition high-risk group also causes heart disease to occur earlier, approximately seven years on average. To reduce your risk of getting heart disease, stop smoking. Watch your weight Maintaining a healthy body weight reduces the risks of heart disease. To give you a good idea of whether you are keeping a healthy weight, your Body Mass Index [BMI = weight (kg) / Height (m) x Height (m)] should not be more than 23. The waist to hip ratio is another useful indicator. Take it easy To manage stress, engage in regular exercises. Adopt a balanced approach to work and family life. In addition, relax whenever possible to ease the tension whenever feelings of stress arise since stress may aggravate heart disease.

are you in the high-risk group for stroke? It's not surprising to learn that those who smoke are likely candidates for stroke. Also at risk are those who are obese and, disturbingly, those who are on oral contraceptives, as new studies show. Of course, the combination of these factors increases your chances even more.      The most vulnerable age group for women, mainly due to oral contraceptives as well, is between 35 to 44 years of age.      But does that mean that if you're slim, healthy and below 35, do not smoke and are not on the Pill, you will not get a stroke?      The reality is that just about anyone can get a stroke. Rupture of aneurysm (weakening in the wall of blood vessels) resulting in brain haemorrhage (bleeding in the brain) may occur at any age.There is cause for alarm if you experience the sudden onset of one or more of these symptoms: • unilateral (one-sided) weakness, • difficulty with speech • severe headache (especially if it's different from any you've had) and • loss of vision. If you do suffer a stroke, which is not likely for most of us, the truth is that life continues, albeit at a new baseline, as stroke is a leading cause of disability and handicap in adults.      To lessen your chances of a stroke, practise good lifestyle habits, say doctors. Many patients fear disability and value quality of life, yet they often fail to heed the doctor's simple advice; such as to stop smoking, to watch what they eat, and to exercise regularly.

Contributed by Dr K Gunnsegaran, National Heart Centre Singapore
and Dr Lee Kim En, National Neuroscience Institute