Dr Aaron Wong (left) who treated Mr Sivarajoo R Kalian said the lifestyle changes he made, most likely reduced the severity of his condition.
SILENT, stealthy hardening of the arteries can, without warning, cause a heart attack.
Thirty years ago, Mr Sivarajoo R Kalian was a heavy smoker who often stayed out late with his friends, eating and drinking. But in 1990, when he was 39, he made a life-changing decision out of love for his family – he gave up smoking and started taking care of his diet.
“I was motivated to change my life when I realised how unhealthy my habits were and that my family was worried about me,” the 62-year-old said. His lifestyle was worrying his wife and preventing him from spending quality time with his young daughter.
Little did he know that the move possibly saved his life. His general health improved steadily with the change, but three years after giving up smoking, he still suffered a heart attack – his first.
An angioplasty was done to clear blockages in his arteries. Since then, he has suffered two more heart attacks – in 1996 and 2013 – and undergone multiple angioplasties and a heart bypass.
The build-up in the arteries
Mr Sivarajoo suffers from atherosclerosis, a disease where the inside of the arteries are blocked by plaque. When the plaque breaks away, it can form blood clots that cause heart attacks.
Dr Aaron Wong, Head and Senior Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS), who treated Mr Sivarajoo, said the lifestyle changes Mr Sivarajoo made most likely reduced the severity of his condition, but unfortunately did not prevent the heart attacks.
“There are many unknown factors which increase the risk of a heart attack. What we don’t know, we cannot prevent or treat. But what we do know is that if he had not changed his lifestyle, his risk of a heart attack would have been higher, and one may have occurred much earlier.”
Atherosclerosis – commonly known as the hardening of the arteries – is still something of a mystery. Exact causes are unknown but doctors say that unhealthy habits, such as heavy smoking and a fatty diet, greatly increase a person’s risk of developing it.
“When plaque builds up in an artery, it narrows the artery and reduces blood flow,” said Dr Wong.
Plaque builds up when cholesterol, white blood cells, calcium and other substances accumulate on an artery wall. In time, the plaque could break off, causing a blood clot. If the clot is large enough, it can block blood flow through a coronary artery and cause a heart attack.
Those with high cholesterol, high blood pressure, or a family history of heart disease run a high risk of suffering from atherosclerosis, which typically affects men over 50 and women over 60. Smokers, diabetics and people with unhealthy eating habits run the highest risk of developing it.
There is no cure for atherosclerosis, but there is hope. A patient who takes appropriate medical guidance and is willing to modify his lifestyle can live a relatively normal life.
“Coronary atherosclerosis is a degenerative disease which progresses with age even with a healthy lifestyle. But its progression is slower than in those who don’t look after themselves. If someone changes his lifestyle, it will definitely reduce his risk of a heart attack, compared to someone else who continues to live unhealthily,” said Dr Wong.
According to the Ministry of Health, coronary artery disease is the second most common cause of death in Singapore, after cancer. In 2011, it was responsible for 16.4 per cent of total deaths, slightly down from 18.7 per cent in 2010.
Dr Wong said that the narrowing of the arteries can affect the body in a spectrum of ways. For a start, the narrowing can be so gradual that the body’s natural compensation mechanism causes small capillaries to form, bridging the blockage before the artery is completely blocked. This “natural bypass” prevents patients from having a heart attack even though an artery may be 100 per cent blocked. However, the patient may have angina – the feeling of pain or tightness in his chest during physical exertion – with the pain typically going away when he stops to rest.
When the plaque build-up in the artery suddenly ruptures, platelets in the blood will rapidly cover up the rupture, leading to a clot forming, which narrows the artery further.
If blood flow is completely blocked, the affected muscle loses its oxygen supply and a heart attack occurs. If the blockage is not opened within 12 hours, the muscle supplied by that artery will be irreversibly damaged. Depending on its severity, a heart attack could lead to death. Patients with atherosclerosis may show no symptoms for decades, until a sudden heart attack occurs.
Treatment options
Once atherosclerosis is diagnosed, there are three main forms of treatment.
• Medicine, such as aspirin or statins, can be prescribed to reduce the risk of a heart attack and to treat the risk factors the patient has.
• A stent – a metal mesh tube – can be inserted into the blocked artery to keep it open so that blood can flow through. This method is typically used in patients with less severe or complex blockages.
• The patient can undergo a heart bypass, in which a vein or artery is taken from another part of the body and used to create a bridge around the blockage.
Heart bypasses are done in severe conditions when all three arteries to the heart are blocked, and will usually last for about 10 years or more. Those with high cholesterol levels, high blood pressure and diabetes are advised to keep these conditions in check through proper medication, as they are risk factors for heart disease.
In addition, Dr Wong advises patients who have been treated for heart disease to be particularly vigilant with their lifestyle habits and to continue with their medication, even if their symptoms go away.
The most effective way to reduce the risk of atherosclerosis becoming fatal is to have frequent health check-ups, as early detection is the best way to counter the degenerative effects of the disease.
The best way to keep heart disease at bay is to adopt a healthy lifestyle, which includes regular exercise, a healthy diet, not smoking, and maintaining a normal weight. This will not only protect against heart disease, but also stave off a host of other health problems.
Mr Sivarajoo, who is now also a diabetic, is off cigarettes, remains conscious of his diet, and stays active by taking weekly hour-long walks for exercise.
He is glad that he made that life-changing decision three decades ago. He said that if he had not, he might not have been alive to see his only daughter get married in 2013.
• This story was first published in Singapore Health, May/Jun 2014.