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Earlier screening, cholesterol control: How heart attack prevention can start sooner
Advances in risk assessment and imaging are helping doctors stay ahead of cardiovascular disease and intervene before irreversible damage occurs, says senior consultant cardiologist Michael Lim
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Published Fri, Aug 14, 2026 · 05:50 AM
- According to Dr Michael Lim (right), understanding an individual’s risk profile is a key step towards preventing heart disease before symptoms develop. PHOTO: ROYAL HEALTHCARE
AS SINGAPOREANS live longer, preventing disease is becoming just as important as treating it. According to the Singapore Department of Statistics, life expectancy at birth reached 83.9 years in 2025, while those currently aged 65 and above can expect to live to 86.6 years
Living longer also means a greater chance of developing chronic conditions that become more common with age. Among them, cardiovascular disease – including heart disease and stroke – remains one of Singapore’s biggest health challenges, accounting for nearly one in three deaths. Ischaemic heart disease, caused by blocked heart arteries and commonly associated with heart attacks, remains the largest contributor
Medical researchers from Singapore’s National University Health System project that heart attacks could nearly triple from about 482 cases per 100,000 people in 2025 to 1,418 by 2050. This means an estimated one in 100 Singaporeans could experience a heart attack
Must we simply accept this trend as inevitable? The answer is no.
Heart attacks are the result of risk factors that accumulate silently over many years. Rather than waiting until disease develops, advances in medicine are placing increasing emphasis on preventing cardiovascular disease through earlier detection, better management of risk factors and healthier lifestyles
One example is the Healthier SG initiative, launched in July 2023, which supports a growing body of evidence that shows that early screening, effective management of risk factors and lifestyle interventions can significantly reduce the incidence of cardiovascular disease
For those who are at high risk, early detection and timely treatment not only lower the likelihood of heart attacks but also reduce hospitalisations, minimise the need for invasive procedures and improve long-term quality of life.
A healthy lifestyle, good control of risk factors and taking prescribed medication are all important steps in protecting heart health
Silent threats: high cholesterol and high blood pressure
According to theNational Population Health Survey 2024, about one in three Singapore residents have high cholesterol and/or hypertension. The challenge is that both conditions are often silent in their early stages. Many feel perfectly healthy while damage is gradually occurring within their blood vessels
One of the biggest risk factors is low-density lipoprotein cholesterol (LDL-C), or “bad cholesterol”. When too much LDL-C builds up in the artery walls, it forms plaque that gradually narrows the blood vessels and restricts blood flow. Over time, these plaques may rupture or completely block heart arteries, cutting off oxygen-rich blood the heart muscles need, resulting in a heart attack
Managing cholesterol, therefore, is not just about improving your test results but about protecting your heart and blood vessels
Blood pressure is another important risk factor. According to Ministry of Health guidelines published in December 2023, a blood pressure of 140/90 mmHg or higher is considered as hypertension, while readings of 130–139/85–89 mmHg are clinically classified as high-normal.
For patients with atherosclerotic CVD, diabetes mellitus (DM), chronic kidney disease (CKD), hypertension-mediated organ damage or Singapore-modified Framingham Risk Score (SG-FRS-2023) >20 per cent, the guideline recommends a clinic BP target of <130/80 mmHg
For patients with none of the above risk factors or comorbidities, or a risk score ≤20 per cent (SG-FRS-2023), the target BP is <140/90 mmHg. But where tolerable, a lower BP (e.g. <130/80 mmHg) can be considered
For older adults (e.g. >80 years old) who are frail, have orthostatic hypotension or limited life expectancy, the target BP is less stringent (e.g. <150/90 mmHg)
Some may require medication, but lifestyle changes also play an important role. Reducing salt intake, exercising regularly, maintaining a healthy weight, managing stress, getting enough sleep, avoiding smoking and limiting alcohol can all help lower blood pressure
3D scanning to detect clogged arteries
Traditionally, one of the most commonly used methods for evaluating coronary artery disease is treadmill stress testing
However, advances in medical imaging today have led to the increasing use of Cardiac Computed Tomography Angiography (CCTA) as a powerful diagnostic tool. This non-invasive scan uses specialised X-rays and contrast dye to produce detailed images of the heart’s arteries
Advances in computed tomography (CT) scanner technology, including photon-counting CT, have significantly improved image quality while reducing radiation exposure. The technology also allows doctors to examine the heart’s arteries and any plaque build-up in three dimensions. In suitable patients, the radiation dose is comparable to just a few chest X-rays
Performed as an outpatient procedure, CCTA is non-invasive, safe and fast, with the scan itself taking only seconds
In Singapore, the Clinical Practice Guidelines for Cardiac Computed Tomography Committee of the Academy of Medicine is currently reviewing the latest evidence and plans to release updated clinical practice guidelines on the use of CCTA next year
Precision medicine in cholesterol management
Statins, the most commonly prescribed cholesterol-lowering medicines, remain the first choice for lowering cholesterol and reducing cardiovascular risk.
For patients who cannot tolerate statins or who fail to achieve their cholesterol targets despite treatment, other options are now available.
For people with mildly elevated LDL-C, doctors may consider using cholesterol absorption inhibitors as a treatment option, which work by reducing the body’s absorption of cholesterol. However, for those with underlying coronary artery disease, these may not be enough to achieve their target LDL-C level
Doctors may then consider newer injectable cholesterol-lowering medications such as evolocumab or inclisiran. When prescribed for appropriate patients, these medications can help people with coronary artery disease achieve their target LDL-C levels.
Keeping LDL-C within the recommended range is one of the most important ways to reduce the incidence of a heart attack. With preventive care, earlier diagnosis and effective treatments, this risk can be greatly mitigated
While they may never be completely eliminated, heart attacks can be increasingly uncommon with preventive care, earlier diagnosis, effective treatments and personal responsibility.
Ultimately, the goal of medicine is not simply to save lives after a heart attack, but to prevent one from happening in the first place
VisitRoyal Healthcare Heart, Stroke and Cancer Centreor contact the clinic at these numbers: (Royal Healthcare Tel) +65 6565 6868, (Royal Healthcare Concierge WhatsApp) +65 6881 8000
This article was contributed by Dr Michael Lim Chun Leng, senior consultant cardiologist and chief medical officer of Royal Healthcare Heart, Stroke and Cancer Centre. He serves on the Council of the College of Physicians at the Academy of Medicine, Singapore, and chairs the Academy of Medicine, Singapore’s Clinical Practice Guidelines on Management of Lipids and Cardiac Computed Tomography
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