Lip Low

Atherothrombosis is the leading cause of cardiovascular mortality. The Reduction of Atherothrombosis for Continued Health (REACH) Registry provided information on atherosclerosis risk factors and treatment. Singapore was one of the 44 participating countries in the REACH Registry. The objective of this study was to determine the atherosclerosis risk factor profile and treatment patterns in Singapore patients enrolled in the REACH Registry. The REACH Registry is an international prospective observational registry of subjects with or at risk for atherothrombosis. Patients aged 45 years or older with established vascular disease [coronary artery disease (CAD), cerebrovascular disease (CVD), peripheral arterial disease (PAD)] or 3 or more atherosclerosis risk factors were recruited between 2003 and 2004. A total of 881 patients (64.4% male) were recruited in Singapore by 63 physicians. The mean age was 64 +/- 9.8 years (range, 45 to 95). Seven hundred and one (79.6%) patients were sympt...

The prevalence of the metabolic syndrome among a number of Asian populations as defined by several current criteria has been increasing rapidly and appears to resemble that among Western populations. We review 25 surveys of the metabolic syndrome in Asian populations (PR China, Hong Kong, Taiwan, Japan, Philippines, Singapore) that report adequate information published during the last 5 years. Using Asian-adapted definitions of obesity (BMI > or = 25 kg/m(2)) and increased waist circumference (for male > or = 90 cm; for female > or =80 cm) prevalence appears to be between 10 to 30%. Those with the syndrome are more likely to have a history of diabetes and cardiovascular disease. The risk of developing Type 2 diabetes is 10 times higher among middle-aged Japanese men with the metabolic syndrome compared to healthy subjects. In Chinese and Japanese populations, people who have the metabolic syndrome are 3 to 10 times more likely to develop cardiovascular disease. Variance in ...

Acebutolol is a relatively "cardioselective" beta-adrenergic blocking agent with an antihypertensive action. The aims of this investigation were to establish the effective dosage range, to study the effect on supine, standing and exercise blood pressure (BP) and heart rate (HR), and to compare the efficacy of once daily (OM) with twice daily (BD) dosing of acebutolol. This was a within patient, double-blind, randomised study. This study shows that the optimum dosage of acebutolol for control of BP and heart rate is 400mg or more daily, and that OM dosing seems to be as effective as BD dosing for supine, standing and post exercise BP control, but is less so for heart rate control.

... University of Singapore: LP Low and G. Ku; Research Statistics Unit, Ministry of Health, Singapore: EH Goh and WY ... Bee et al ... in different TABLE 4. PREVALENCE OF HYPERTENSION IN SELECTED COMMUNITY SURVEYS Author(s) Community Prevalence rate(a ai Criteria (1 ...

Rosuvastatin is more efficacious than other statins in lowering low-density lipoprotein cholesterol (LDL-C). Studies showing higher blood levels in Asians have resulted in concerns regarding increased adverse drug reactions. This study aimed to evaluate the efficacy and safety of rosuvastatin in hypercholesterolemic Asian patients. This retrospective observational study was conducted on statin-naive patients and statin-switch patients. Patients were treated with rosuvastatin for > or =8 weeks. Primary outcomes were changes in LDL-C levels and proportions of patients achieving their goals (primary prevention, LDL-C < or =130 mg/dL; secondary prevention, LDL-C< or =100 mg/dL). Of 1007 hypercholesterolemic patients, 483 were statin-naive (LDL-C 161+/-40.8 mg/dL) and 524 were statin-switch patients (LDL-C 132.7+/-36.9 mg/dL). In statin-naive patients, rosuvastatin significantly reduced LDL-C, total cholesterol, and triglycerides by 39.9%, 28.8%, and 9.2%, respectively (p<0.001). Eighty-one percent of these patients achieved LDL-C goals. In the statin-switch cohort, LDL-C, total cholesterol, and triglycerides levels were significantly reduced by 24.5%, 16.6%, and 3.8%, respectively (p<0.001). Achievement of target LDL-C levels increased from 29% to 72.9%. There was no significant adverse drug reaction. Rosuvastatin was well tolerated and effective in lowering LDL-C in hypercholesterolemic Asian patients. Patients whose LDL-C levels were suboptimal on other statins improved their levels and more achieved LDL-C goals after switching to rosuvastatin.

ABSTRACT : A prospective analysis of 17 cases of paroxysmal atrial tachycardia with block was carried out over a five-year period from June 1968 to June 1973 in a medical unit in Singapore. Seventy-six percent had prior digitalis therapy, and all except one were more than 50 years old. Of the 17 cases, eight patients (46%) with chronic obstructive lung disease and cor pulmonale developed this arrhythmia after digitalis administration, five had severe chronic ischaemic heart disease, two chronic renal failure, one hypertensive heart disease and one had no apparent organic disease. Digitalis was stopped in all those patients who had received digitalis as it was assumed to be one of the contributing factors which precipitated the arrhythmia. Intravenous potassium chloride was used successfully in nine out of 10 patients. The use of potassium and its dangers are discussed. Intravenous diphenylhydantoin and propanolol were used in three and two patients respectively.Sixteen patients had their arrhythmia terminated but the mortality rate remained high (59%) reflecting the severity of the underlying disease. The incidence of this arrhythmia (1: 2,000 ECGs per annum) in our department was low compared to other series.

Hyperlipidaemia is a major risk factor for coronary artery disease (CAD). Its effective treatment has been shown to reduce the incidence of cardiovascular events, both in secondary and primary prevention. An essential component of risk factor management at the community level is public awareness and knowledge of treatment benefits. However, this data is limited in Singapore. A cross-sectional survey questionnaire of public perception and knowledge on cholesterol treatment among adult Singaporeans aged 30-69 years was commissioned by the Singapore Heart Foundation and conducted by a professional market survey company. Regional quota sampling was performed to ensure that the sample was representative of the Singapore population. This was followed by random sampling of households and respondents. Of the 365 respondents, 40.9% were male, 70.3% were Chinese, 18.8% Malay and 10.9% Indian. The mean age was 47.5 years. Although 81.9% of respondents had medical check-ups involving blood tests, only 11.0% knew their actual cholesterol levels. A third of the respondents saw herbal medicine as healthier and safer than Western medication. More than 80% of respondents believed that diet and exercise were equally effective at lowering cholesterol as medication. About half of the respondents associated long-term use of statins with damage to the liver and kidney, while a third associated chronic statin use with the development of cancer. There are gaps in the level of public awareness and understanding of cholesterol treatment in Singapore. Common misconceptions should be addressed, as they could potentially impair effective management or treatment compliance.

The Ministry of Health (MOH) has updated the clinical practice guidelines on Dementia to provide doctors and patients in Singapore with evidence-based treatment for dementia. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Dementia, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical/2013/cpgmed_dementia_revised.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

To investigate demographic and cardiovascular disease risk factors associated with awareness, treatment and control of hypertension in a multi-ethnic Asian population. Participants from four previous cross-sectional studies were invited for a repeat examination (2004--2007). Information of demographic details and cardiovascular disease risk factors was obtained using questionnaire, physical examination and blood tests. Odds ratios and 95% confidence intervals were calculated using multiple logistic regression models. The final number of respondents was 5022 (response rate 49.7%). Although hypertension treatment (84.4% of those aware of hypertension) was high, awareness (51.8% of those having hypertension) and control (27.1% of hypertension on treatment) were low. Reduced awareness and treatment were associated with being younger, never married, and working adults with a higher education level. Low socioeconomic status individuals were more likely to be treated but had poorer control. A similar relationship was found for treatment and control for individuals with coexisting cardiovascular disease risk factors. The use of multiple drug classes was not associated with better control. Diuretic use for treatment of hypertension, as recommended by local and international guidelines, was not common (15.0% of all hypertension medications used). The awareness, treatment, and control of hypertension in Singapore can be improved. There is a need to improve awareness through education and target screening and treatment in younger, working adults with higher levels of education and higher economic status, as well as Malays. Control of hypertension could be improved among older or diabetic hypertensive individuals.

Ten patients, all below 30 years of age (8 females and 2 males) developed Stokes-Adams attacks from complete heart block due to acute nonspecific myocarditis. Coexisting thyrotoxicosis was present in two patients and cardiogenic shock was seen in four. Temporary transvenous pacing was instituted in all but one patient. Except for two patients who developed permanent complete heart block, normal A-V conduction returned in between 1 to 12 hours after ventricular pacing in seven patients and after 12 hours of isoprenaline therapy in the final patient. The ECG returned to normal in six patients and all 10 patients survived their acute illness.