September 2016 - November 2016

MCI (P) 084/10/2015 fb.com/heartfoundationmyheart.org.sg twitter.com/heartSG Heart4Life

Official Publication of the Singapore Heart Foundation

Cardiology for the Layman #2Coronary Artery Bypass Surgery

03

什么是升糖指数?

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20

National Heart Week/World Heart Day 2016

PATRONESM Goh Chok Tong

NATIONAL HEART COUNCIL

PRESIDENTDr Richard Hu

VICE PRESIDENTSMr Sat Pal KhattarMr Shaw Vee Meng

CHAIRMAN EMERITUSDr Low Lip Ping

SHF 45TH

BOARD OF DIRECTORS

CHAIRMANAdj Prof Terrance Chua

VICE-CHAIRMENDr Tan Yong SengMs Tan Lee-Chew

HONORARY SECRETARYProf Tan Huay Cheem

ASSISTANT HONORARYSECRETARYMr Goh Chiew Seng

HONORARY TREASURERMr Chong Chou Yuen

MEMBERSDr Chee Tek SiongMrs Elsie FohDr Goh Ping PingMdm Koh Teck SiewDr Bernard KwokMrs Regina LeeA/Prof May LwinDr Mak Koon HouMr Peter SimDr C SivathasanMrs Tan-Wee Beng Yan

SPECIAL ADVISORMr Tan Boon Chiang

HONORARY ADVISORSProf Koh Tian HaiMr Liak Teng LitMr Lim Soon HockA/Prof Lim Yean TengDr Lily NeoMr Tan Kin LianMr Wong Yew Meng

EDITORIAL COMMITTEE

EDITORMr Patrick Deroose

MEMBERSAdj Prof Terrance ChuaDr Chee Tek SiongDr C Sivathasan

SECRETARIATMr Vernon KangMs Stephanie HoMs Mabel Tang

2 Editor’s Note

heartline is a quarterly publication of the Singapore Heart Foundation.9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837Tel: 6354 9340 • Fax: 6258 5240 • Email: info@heart.org.sg

The information provided in heartline is for educational purposes only. It should not be used for diagnosingor treating a heart problem or a disease, and should not be substituted for professional health care. Opinions expressed by contributors and advertisers do not necessarily reflect those of the SHF.The SHF does not endorse any products or services in heartline advertisements.

All rights reserved. Copyright is held by SHF.No portion of this publication can be reproduced without the permission of SHF.To advertise in heartline, please email info@heart.org.sg or call 6354 9340.Terms and conditions apply.

Want a copy of heartline delivered to your doorstep?Call 6354 9340 for a copy of the subscription form.Designed by: Vacain Design Pte Ltd • Printed by: Print & Print Pte Ltd

Patrick Deroose

DEAR READERS,

On the dust jacket of Siddhartha Mukherjee’s book “The Emperor of all Maladies”, Bert Vogelstein of Johns Hopkins University writes: “The Emperor of all Maladies beautifully describes the nature of cancer from a patient’s perspective, and how basic research has opened the door to understanding of the disease”.

But who will write the history of heart diseases in Singapore? Did we not progress beyond basic research? Are our doctors and nurses not specialising in cardiothoracic medicine and nursing, interventional cardiology, preventive cardiology, just to name a few? Why are we making so little impact on the cardiovascular disease epidemic in our country? No, this is not a story about the lack of political will. The Singapore government through various ministries, has spent a substantial amount of money and resources on public education and research funding. This is not a story about the Singapore Heart Foundation and similar organisations, not trying to educate the young and old alike on heart healthy living through educational events such as National Heart Week/World Heart Day.

This then brings me to you, the Singapore citizen. Do you take good care of your health? Do you make a conscious choice when deciding where and what to have lunch? Do you make a conscious choice when lighting up that first morning cigarette? Do you make a conscious choice to sit down in front of your computer to play a game, instead of going for a brisk walk? Do you make a conscious choice when you ignore the advice from your doctor to go for regular check-ups for your blood pressure and blood sugar levels? Do you make a conscious choice when you decide not to attend a symposium on the prevention of heart diseases? Because this is the real issue - taking personal responsibility for your own health. As the saying goes, you can lead a horse to the water, but you cannot make it drink.

Let there be no doubt however, that the Singapore Heart Foundation will continue its mission of transforming our nation into a heart healthy country, through its

educational activities, cardiac rehabilitation services and patient support group for those who are ready and committed to

positive lifestyle changes. So let us write the history of heart diseases from Singapore, let us write the book “The Empress of all Maladies”.

3Feature

CORONARY ARTERYBYPASS SURGERYArticle contributed by Dr Tan Yong Seng

Coronary heart disease is the most common type of heart disease affecting adult Singaporeans. It results from a condition known as atherosclerosis, a process where a waxy material is formed inside the wall of the arteries. This material, known as plaque, is made up of a mixture of cholesterol, fatty compounds, calcium and a blood-clotting material called fibrin.

Below are three established modalities of treatment for coronary heart disease. For this article, we will explain more about coronary artery bypass surgery.

Coronary Artery Bypass SurgeryBypass surgery is the most common type of heart surgery performed by a heart surgeon. This surgery aims to improve the blood flow to the heart with a new route or "bypass" a section of clogged or diseased artery, by using a section of blood vessel from the leg, chest, or another part of the body to graft onto the affected coronary artery.

During the surgery, the breastbone (sternum) is divided and the heart is stopped, while blood is sent through a heart-lung machine. Unlike other heart surgeries, the chambers of the heart are not opened during the operation. Some bypass procedures can also be done as a limited-access surgery, described as a minimally invasive bypass.

TYPES OF PLAQUEHard Soft/Vulnerable

• Builds up in the arteriesthat supply blood to our heart, resulting in reduced blood flow to the heart.

• An inflamed part of anartery that can burst, causing the formation of a blood clot, which can lead to a heart attack.

• If the blood flow stopsdue to 100% blockage of the blood vessel, this will lead to a heart attack.

• Most heart attacks arecaused by soft/vulnerable plaque.

Progression of Atherosclerosis

Endothelial Disfunction

Fatty Streak Formation Stable (Fibrous) Plaque Formation

Unstable Plaque Formation

Heart Muscle Damage

Normal Artery

Cardiology for the Layman #2

Things to Note

1. Prior to your operation, it is important to inform your surgeon and cardiologist of any changes in your health, including symptoms of a cold or flu, as a chest infection may affect your post-operative recovery.

2 Next, you will be asked to stop all your anti-platelet medications, such as Aspirin or Plavix, usually 7-10 days prior to the date of surgery. This is to minimise bleeding and blood loss during surgery.

3. Before surgery, baseline screening tests which include an electrocardiogram (ECG), blood tests, urine tests and a chest x-ray, will be conducted to provide your surgeon with the latest information about your health.

4. If you smoke, it is best to stop smoking at least 2 weeks prior to the surgery, because it can lead to blood clotting and breathing problems.

5. You will be asked to bathe the night before the surgery, to reduce the amount of germs on your skin.

6. Lastly, the surgery is usually done under general anesthesia and you will need to have an empty stomach. Thus, you are required to fast from food and drink overnight. Should you need to eat or drink after midnight, it is important that you inform your anesthesiologist and surgeon.

4 Feature

Dr Tan Yong Seng is the Vice Chairman of the Singapore Heart Foundation’s Board of Directors.He is also a Cardiothoracic Surgeon in private practice.

On the Day of Surgery

Most patients are admitted to the hospital the day before surgery, or in some cases, on the morning of the surgery.

Small plastic disks called electrodes will be attached to your chest to monitor your heart's rhythm and electrical activity via an electrocardiogram machine. After which, you will receive a local anesthetic to numb the area where a plastic tube (called a line) will be inserted into an artery in your wrist. An intravenous (IV) line, which will provide anesthesia during the operation, will be inserted into your vein. To help you relax, a mild tranquiliser will be administered, before entering the operating room.

Once inside the operating room and when you are completely asleep, a tube will be inserted down your windpipe and connected to a respirator, to take over your breathing. A blood-thinning medicine called an anticoagulant, will also be administered to prevent your blood from clotting. You will then be connected to the heart-lung machine (a machine that performs the same functions of your heart and lungs temporarily), where your heart is stopped and your body is cooled.

The surgery may begin by grafting a long piece of vein from your leg (the saphenous vein). One end of the graft will be attached to the ascending aorta, the large artery that carries oxygen-rich blood from the heart to the body, while the other end will be attached to the affected coronary artery below the blocked area. However, the surgeon may choose to use an artery from the inside of your chest wall (the internal mammary artery) or he may use both for grafts. The procedure can take between 2 to 6 hours, depending on the number of bypasses needed.

Recovery Time

You can expect to stay in the hospital for about a week, including at least 1 to 2 days in the Intensive Care Unit (ICU).

Life after Bypass Surgery

After a bypass surgery, your doctor will recommend that you join a cardiac rehabilitation programme. These programmes can help to motivate you to make informed lifestyle changes, such as modifying your diet, exercising to get your strength back, quit smoking, maintaining a healthy weight and dealing with stress. You and your spouse may discuss freely with your doctor regarding resumption of sexual activity and the effects of some medications that can affect your sexual life (e.g. beta-blocker, erectile dysfunction medication and nitrates, etc). Generally, sexual activity can be slowly resumed 6-8 weeks after your surgery, when your breast bone has healed. In addition, you should also be free from heart failure or certain abnormal heart rhythm before you can safely resume your normal sexual activity. If in doubt, please discuss with your doctor.

As bypass surgery does not cure the underlying heart disease (atherosclerosis or coronary artery disease), medicines will be an important part of your treatment after the surgery. It is likely that you will need to take a statin or blood lipid lowering agent and begin an antiplatelet therapy.

About 20% to 30% of bypass patients will require a second procedure within 10 years. These late events, which are often associated with recurrence of symptoms, usually require a second revascularization procedure, most often done with angioplasty or stent placement and less often with a repeat surgical bypass.

SummaryThe benefits of a coronary artery bypass surgery include:

✦ Prolonged survival✦ Relief of symptoms, such as chest pain or shortness

of breath✦ Improved exercise tolerance✦ Reduction of the need for angina medications✦ Prevention of potential fatal heart attacks

Coronary artery bypass surgery is usually carried out for/when:

• Patients with debilitating angina that has failed to becontrolled by medication.

• Patients withmultiple diseased coronary arteries wherethe heart's main pump (left ventricle) is functioning poorly.

• Theleftmaincoronaryarteryisseverelynarrowedorblocked.• Patientswhoarenotsuitableforballoonangioplasty.• Patients whose coronary arteries have re-narrowed

after angioplasty.

Coronary artery bypass surgery

Glycaemic Index6 Feature

Glycaemic Index (GI) measures how a carbohydrate-containing food increases blood glucose,

using a scale of 0 to 100. Hence, foods higher in GI would suggest a higher blood glucose raising potential as compared to medium or low GI foods.

According to the American Diabetes Association (2014), carbohydrate-containing foods can be classified as high GI (≥70), medium GI (56-69) or low GI (≤55).

Table 1: Example of foods categorised based on their GI

Aside from considering the GI, it is important to note that there are also various factors that would affect the raising potential of blood glucose.

In general, eating bigger portions of carbohydrate-containing foods will cause your blood glucose to rise more than eating smaller portions. Though GI acts as a good reference to make food choices, GL provides a better reference for diabetic individuals to evaluate the portion size that is likely to be suitable for maintaining a good blood glucose level.

What is ?Article contributed by Mr Lim Kiat, Nutritionist at SHF

Low GI Medium GI High GI•Rolledoats/Steel-cutoats •Quickoats •Instantoats

•Corn •Wholemealbread •Whitebread

•Barley •Brownrice •Shortgrainwhiterice

•Mostfruits/Non-starchyvegetables

•Couscous •Melons

Example:

GI of 1 whole watermelon

= 72

GL of a wedge of watermelon

(130 g) = 6

GL of 3 wedges of watermelon

(130 g x 3) = 17

Factors Affecting Blood Glucose

1The portion size of a carbohydrate-containing food consumed would affect how quickly it raises the blood glucose level. This is attributable to the difference in glycaemic load (GL). Contrary to GI, GL is a measurement that considers the amount of carbohydrates consumed per serving, along with how rapid it raises the blood glucose levels. Hence, a food may have a high GI but low GL.

GL is calculated by:GL = GI x carbohydrate of food (g) / 100

PORTION SIZE

7Feature

Table 2: GI of some commonly consumed food

Blood glucose levels can also be affected differently - depending on whether you consume foods containing mainly carbohydrates or a mixture of carbohydrates, fats and protein. In general, meals with a mixture of carbohydrates, fats and protein (e.g. a serving of white rice, a serving of salmon and a serving of vegetables) would have a lower blood glucose raising potential than consuming a serving of white rice. This is because fat, protein and fibre help to slow down the rate of digestion, hence causing a more gradual and lower rise in blood sugar.

GI: A reference for healthier food options?

GI only suggests how rapid the carbohydrate-containing food would raise the blood glucose, but does not necessarily suggest a healthier food option. For instance, many higher GI foods can have more nutritional value than lower GI food.

Example:

Chicken rice (rice only), GI = 67

Short grain brown rice, GI = 76

2 FOOD COMPOSITIONFood

•Shortgrainbrownrice•Nasilemak(riceonly)•Longgrainbrownrice•Chickenrice(riceonly)•Sodadrink

GI7669656763

The SHF Heart Smart Eating Plate is a dining plate that aims to promote healthy eating habits through visualisation of the recommended food portions by:

• TheHealthPromotionBoard,Singapore• SHF’s3-5-7healthyheartdietprinciple• TheAmericanHeartAssociation’srecommendationofeatingamixtureoffoods

to maximise nutrient intake.

This will also discourage "super-sized" portions, which can lead to excess weight gain and obesity – two modifiable risk factors for most chronic diseases.

The SHF Heart Smart Eating Plate is available for $8 at SHF’s office @ Bishan Junction 8 (Monday to Friday, 9am to 5.30pm only). For more information, visit www.myheart.org.sg or call 6354 9340.

Though short grain brown rice has a higher GI, it contains fibre and phytochemicals that constitute a healthy diet. The lower GI of chicken rice (rice only) is attributable to its fat content, which delays digestion. Studies have suggested that excessive intake of saturated fats may increase the risk of cardiovascular disease.

The use of GI should be balanced with variety and moderation. To combat against chronic diseases, eat a balanced & healthy diet and lead an active lifestyle!

Remarks:

9Health Bites

According to a study of 26,000 people worldwide, ten modifiable risk factors are responsible for 9 out of 10 strokes worldwide, but the ranking of those factors vary regionally. Researchers found that the number of strokes would be practically halved (48%) if hypertension was eliminated; trimmed by more than a third (36%) if people were physically active; and shaved by almost one fifth (19%) if they ate more healthily. In addition, there was a 12% reduction if smoking was eliminated; 9% for cardiac (heart) causes, 4% for diabetes, 6% for alcohol intake, 6% for stress, and 27% for lipids. The study confirms that hypertension is the most important modifiable risk factor and the key target in reducing the burden of stroke globally.

Do you wish to receive heart health related news on a regular basis? Subscribe to our e-newsletter Heart Mattersby emailing mabel@heart.org.sg with your name, email address and contact number.

HEALTHWomen with migraines have higher risk of cardiovascular disease and mortality

Beneficial effects ofexercise change with age

Global study shows thatstroke is largely preventable

A large study has found that women diagnosed with migraines, have a slightly increased risk of developing cardiovascular disease (CVD), such as heart attacks and strokes, and are somewhat more likely to die from these conditions than women who do not have migraines. A total of 115,541 women aged between 25-42 years, were assessed for over 20 years, of which 1,329 total CVD events occurred and 223 women died due to CVD. Given the high prevalence of migraine in the general population, migraine should be considered an important risk marker for CVD, but more research is needed to determine the possible causes, and whether treatments to prevent migraines could help to reduce these associated risks.

In a linked editorial, Rebecca Burch from the Harvard Medical School and Melissa Rayhill from The State University of New York at Buffalo, cautioned that "the magnitude of the risk

should not be over-emphasised" as "it is small at the level of the individual patient, but still important at a population level because migraine is so prevalent.”

Two groups of men ages 18 to 30 and those above 55 years old cycled for 30 minutes, with blood being drawn six different times measuring cell function and antioxidant response. Exercise intensity was relative to the individual's age and maximal aerobic capacity was determined during a screening. The results indicated that a single session of submaximal aerobic exercise is sufficient to activate an important group of antioxidant genes at the whole cell level in both young and older adults. However, younger adults will experience greater antioxidant benefits from one exercise session. This is because, nuclear import is required for Nrf2 (regulator for the group of antioxidant genes) to access the antioxidant gene targets and nuclear import is impaired with aging.

2016

10 Event Reviews

Only 10% of respondents were aware that cardiovascular disease is the leading cause of death for Singaporean women

and 51% of respondents aged 21-34 years old believed they are not at risk for heart diseases.

56% and 43% of respondents were aware that chest pain and shortness of breath are the warning symptoms of a heart attack.

Healthy awareness (96%) that exercise prevents or reduces the risk of heart diseases with 8 out of 10 women engaged in at least some form

of moderate exercise weekly.

PLEDGE YOUR

GRFW 2016 SURVEY FINDINGS

HEART WALKIn conjunction with the annual Go Red for Woman (GRFW)

campaign, Pledge Your Heart Walk 2016 aimed to motivate and increase the awareness for physical activity to help curb the

development of cardiovascular disease in women. Held on 26th June 2016 at the scenic Marina Bay Waterfront Promenade, the 3.5km family-friendly walk focused on encouraging women both young and old, to take charge of their heart health.

Ms Low Yen Ling (Parliamentary Secretary, Ministry of Education & Ministry of Trade and Industry, Mayor of the South West District) was our Guest of Honour and Mr Bryan Wong (Celebrity ambassador for the Nestlé Omega Plus Acticol) made a special guest appearance.

More than 1,600 participants turned up in their event pledge tees and there were basic health screenings and a Zumba for Heart dance workout as well.

One key highlight was the announcement of the 2016 GRFW survey findings.

11

Atrial Fibrillation (AF) is one of the most common heart rhythm disorder affecting millions around the world and statistics have suggested that the prevalence of AF

in Singapore is about 1.5% , which is expected to increase with an aging Asian population. Affected individuals will experience rapid and irregular heartbeats and the condition deteriorates with age. In recognition of the expected epidemic of AF in Asia, the Asia Pacific Heart Rhythm Society collaborated with SHF and the Singapore Cardiac Society, to host a public forum in efforts to raise awareness of the condition in Singapore.

Held at The Joyden Hall @ Bugis+ on 2nd July 2016, the public forum was titled “Irregular Heartbeat Matters”. Sessions were held in English and Mandarin, where experts weighed in on the condition, risk factors, symptoms, related complications and prevention measures. We were honoured to have Dr Lam Pin Min, Minister of State, Ministry of Health as the Guest of Honour, alongside a total of 500 participants.

The highlight of the event was the ‘Ask the Expert’ session, where the panel of guest speakers addressed questions from the floor. At the end of the event, all participants were treated to light refreshments and went home with a CPR 3A Kit (worth $65) each.

With an increased focus on prevention and the understanding of risk factors of heart diseases, SHF spearheaded the inaugural Fitness and Nutrition

Seminar 2016 at The Fullerton Hotel, Ballroom 2 on July 9th 2016.

Centered on the theme, ‘Heart Smart Truth for a Healthier You’, professionals shed light on the truth about heart diseases and how one can make informed fitness and nutrition changes to prevent the onset of cardiovascular disease (CVD).

Guest of Honour, Ms Low Yen Ling, Parliamentary Secretary, Ministry of Education & Ministry of Trade and Industry, Mayor of South West District launched SHF’s new Heart Smart Eating Plate, together with a heart-friendly recipe book titled ‘Cook Right, Eat Right’, published in collaboration with the AllSpice Culinary Institute.

The Train-to-Trim (T3) Challenge 2016 also culminated at the Fitness & Nutrition Seminar, where the biggest ‘loser’ winner was announced. Ms Sunitha lost 7.6% of her body fat and 12.2kg of her body weight. A job well done to Ms Sunitha and the other participants!

Event Reviews

Every Matters

Fitness & NutritionSeminar 2016

12 National Heart Week/World Heart Day 2016

That is why it is so important to look after your heart, otherwise you are putting yourself at risk of cardiovascular disease (CVD), which includes heart

diseases and stroke. CVD is the world’s number one killer. Each year, it is responsible for 17.5 million premature deaths, and this is expected to rise to 23 million by 2030.

But the good news is that much of CVD can be prevented by making just a few simple daily changes, such as eating and drinking more healthily, getting more exercise and stop smoking.

So this World Heart Day on 29th September 2016, come andfuel your heart, move your heart, love your heart and power your life!

KNOW YOUR RISKLooking after your heart starts with understanding your risk, so make sure you know all your health number such as body mass index and blood pressure measurements. Visit your healthcare professional for a health screening. Remember, knowledge is power.

Take a Healthy Heart selfie forWorld Heart Day!

#poweryourlife #worldheartday #singaporeheartfoundation

It lets you love, laugh and live your life to the fullest!

Your heartyourwhole body

Join us on 1st October

2016 @ Hard Court

next to Yishun MRT

to celebrate World

Heart Day!

Refer to back cover for more information!

13National Heart Week/World Heart Day 2016

Fuel Your HeartEating and drinking well, gives your heart the fuel it needs for you to live your life healthily

• Reduce intakeofprocessedandprepackaged foods,whichareoftenhigh insalt,sugar and fat.

• Cutdownonsugarybeveragesandfruitjuices-choosewaterorunsweetenedjuicesinstead.• Substitutesweetandsugarytreatsforfreshfruitsasahealthyalternative.• Trytoeat5portions(aboutahandfuleach)offruitandvegetablesaday–theycan

be fresh, frozen, tinned or dried.• Limityouralcoholintakewithinrecommendedguidelines.• Makeyourownlunchforworkorschool.

KNOW YOUR BLOOD GLUCOSE LEVELSHigh blood glucose (blood sugar) can be indicative of diabetes. CVD accounts for 60% of all deaths in people with diabetes. If left undiagnosed and untreated, it can put you at an increased risk of heart diseases and stroke.

Move Your HeartStaying active can help you reduce your risk of heart diseases and feel great

• Aimforatleast30minutesofmoderateintensityactivity,5timesaweek.• Playing,walking,dancingandevendoinghousechores–theyallcount!• Climbthestairs,walkorcycleinsteadofdrivingtoyourdestination.• Motivateandencourageyourfriendsandfamilytoexercisewithyoutoo.• Shouldyouhaveanymedicalhistory,checkwithyourhealthcareprofessionalbefore

embarking on an exercise plan.• Downloadanexercisemobileapplicationoruseapedometertokeeptrackofyourprogress.

KNOW YOUR BLOOD PRESSUREHigh blood pressure is the number one risk factor for CVD. It is called the ‘silent killer’ because it usually has no warning signs or symptoms, so many people do not realise that they have it.

Love Your HeartQuitting smoking is one of the best things you can do to improve your heart health

•Within2yearsofquitting,theriskofcoronaryheartdiseaseissubstantiallyreduced.•Within15years,theriskofCVDreturnstothatofanon-smoker.• Exposuretosecondhandsmokeisalsoacauseofheartdiseasesinnon-smokers.• Stopsmokingwillnotonlyimproveyourhealthbutalsothatofthosearoundyou.• Seekprofessionalhelpifyouareunabletoquitonyourown.• Youcanalsoaskyouremployeriftheyprovidesmokingcessationservices.

KNOW YOUR CHOLESTEROL & BMICholesterol is associated with around 4 million deaths per year worldwide, so visit your healthcare professional and ask them to measure your levels, as well as your weight and body mass index (BMI). They will then be able to advise you on your CVD risk, so you can plan how to improve your heart health.

The DIRECT DONOR DEBIT PROGRAMME (DDDP) is designed toencourage individuals to give small donations to SHF on a regular basis, for our life-

saving programmes. SHF would like to thank the following DDDP Event Site Sponsors, who have generously provided their venues for our various roadshows.

TOGETHER, WE CAN WORK TOWARDS A HEART HEALTHIER NATION!

Congratulations to all winners* and thank you for your participation! *Winners have been notified via phone or email.

14 Nutrition

Debunking

D i e tMyths

ANSWERS FOR CROSSWORD PUZZLEJun 2016 - Aug 2016

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Across:4. A healthy diet comprises a variety of different whole food, balanced meals and everything in _____ .5. Skipping meals can result in overeating at the next meal. (True/false)6. Eating a balanced breakfast increases one's energy and _____ levels.9. A diet high in protein and low in carbohydrate is not an _____ long-term weight loss plan.10. Sweet/potatoes are an _____ source of staple carbohydrate.

Down:1. Fad diets are the fastest and safest way to lose weight. (True/false)2. _____ lifestyle changes often result in unsuccessful weight loss.3. _____ is the body's primary fuel for energy.7. Making small changes and setting a _____ goal are important in a weight loss journey.8. The calorie quality does not matter, as long as I eat within my recommended daily calorie intake.

15Nutrition

Simply email/fax this page to heartline@heart.org.sg / 6258 5240 by 30 November 2016.

Name: ______________________________________________ NRIC: ______________________________________________

Email: ______________________________________________ Mobile: ______________________________________________

All winners will be notified via phone or email. Good luck!Look out for the answers in the next issue of heartline or visit www.myheart.org.sg after 1 December 2016.

GET THEFATS riGHT!

• 1X750mlbottleofNaturelExtraVirginOliveOil• 1X500gpacketofNaturelOrganicHomMaliMixedBrownRice+RedRice• 1kgpacketofCaptainOats• 1XbottleofSalbaChiaSeeds• 2XKoreanrealnanodualbristletoothbrushes• 1Ximportedpillboxwith3functionalusages

We wish to thank the following prize sponsors:

Lam Soon Singapore Pte Ltd, Captain Oats, Salba Singapore,

HAP Nutrition Pte Ltd and iTrade Marketing.

Categorise the food according to the types of fat. (i.e. monounsaturated fat, polyunsaturated fat).

GOOD FATS(Monounsaturated fats, polyunsaturated fats)

BAD FATS(Saturated fats, trans fats)

Submit your correct answers and stand a chance to win1 of 5 hampers (worth more than $50) in our lucky draw!

Black & white sesame seeds

French fries

Ice cream

Avocado

Cake

Cashew Nut

Almond

Cookie

Walnut

Fried Chicken

Chocolate

Salmon

Donut

Olive Oil

17Editorial

Heart healthy eating is having whole grains, lean protein, vegetables and fruits in a well-balanced meal. With the latest concern of glycaemic index (GI) and glycaemia load (GL), whole grains (WG) have a lower GI and GL as compared to refined grains, which means they have a more gentle effect on the blood sugar level. This can serve as a prevention towards obesity, type II diabetes, as well as CVD. Some examples of WG include brown rice, oats, quinoa, millet and barley.

Oats can be a quick fix meal as it requires lesser preparation and cooking time, yet is nutritious for breakfast. Oats are versatile and can be prepared as a sweet or savoury dish, based on your preference. For sweet oats, it can be paired with low-fat plain milk or plain yoghurt with fresh/dried fruits like berries, bananas, raisins, cranberries and apricots. You may even add in spices such as cinnamon, for a tinge of sweetness. However, you need

to be mindful on the amount of dried fruits added, as it can contribute to sugar intake, e.g. no more than 1 tablespoon of raisins. For savoury oats, turmeric can be added together with lentils, to give you an extra source of protein.

Apart from having a low GI and GL, oats have a component known as soluble fibre, which can be found in barley as well. Studies have shown that the intake of soluble fibre helps in lowering low density lipoprotein (LDL) cholesterol; which causes fatty deposit build up in the artery walls. The reduction of LDL cholesterol will also lower your risk of CVD.

Eating well not only improves one’s heart health, but also improves one’s wellbeing such as having quality sleep, more energy and better concentration. These all add up to a healthier and happier you!

OOTD: Oats Of The Day

Every day, 15 people die from cardiovascular disease (CVD) - which includes heart disease and stroke, in Singapore. Last year, CVD accounted for 29.6% of all deaths locally, which means that

nearly 1 out of 3 deaths was caused by heart disease or stroke. Fortunately, CVD can be mostly prevented or managed by making modifications to one’s lifestyle; one of which is heart healthy eating.

冠状动脉心脏病是影响新加坡成年人最常见的心脏疾病类型。它是由被称为动脉粥样硬化的疾病引起，这是一种在

动脉的管壁内部形成蜡状物质的过程。这种物质，被称为斑块，是由胆固醇、脂肪族化合物、钙和称为血纤维蛋白

的凝血材料的混合物组成。

动脉粥样硬化的形成

下面是三种已建立的治疗冠状动脉心脏病的模式。在本文中，我们将更多地介绍关于冠状动脉搭桥手术。

搭桥手术是由心脏外科医生执行的最常

见的心脏手术类型。这种手术目的是用

一条新的路线或者“绕过”一段堵塞或

患病的动脉(通过使用一段取自腿部、胸

部、或身体其它部分的血管移植到受影

响的冠状动脉上)来改善流入心脏的血流

情况。

在手术过程中，必须开胸并停止心脏的一

切活动，而血液通过心肺机传送。这不像

其它的心脏手术，在手术过程中不打开心

脏各腔室。有些搭桥手术也可以作为小切

口手术进行，被描述成微创搭桥。

斑块的类型

硬的 软的/易损的•在提供血液到心脏的动 脉中积聚，导致流入心 脏的血流量减少。

•动脉的发炎部分，该部 分可能破裂，从而引发 血块形成，这样会导致 心脏病发作。

•如果由于100%血管堵 塞而血流停止，这将导 致心脏病发作。

•软的/易损斑块引发大 多数心脏病发作

稳定(纤维)斑块的形成

不稳定斑块的形成

心肌损害

正常动脉

内皮功能失调

脂肪斑纹的形成

陈言森医生的文章

18 特写

外行人的心脏病学(二)

需注意的事项

1. 在手术之前，告知你的外科医生和心脏病专家关于你健康的任何

变化是很重要的，这包括感冒或流感的症状，因为胸部感染可能

会影响你的术后恢复。

2. 接下来，要求你停止所有抗血小板药物，如阿司匹林或波立维，一

般在手术日期前7-10天。这是为了在手术过程中减少出血和失血。

3. 手术前，将进行基线筛查试验，这包括心电图(ECG)、验血、验

尿和胸部X光，以提供给外科医生有关你健康的最新信息。

4. 如果你抽烟，最好在手术前至少两周停止吸烟，因为这会导致血

凝和呼吸问题。

5. 要求你在手术前一夜洗澡，以减少皮肤上的细菌量。

6. 最后，手术通常在全身麻醉下进行，你将需要进行清肠胃。因此，

要求你过夜禁食。如果你需要午夜后进食，告知你的麻醉师和外科

医生是很重要的。

在手术当日

大多数患者在手术前一天入院，或在某些情况下，在

手术日的早晨。

将称为电极的小塑料盘连接到你的胸部通过心电图机

器来监视你的心脏节奏和电活动。在这之后，你会被

注射局部麻醉剂以麻木某个区域，在该区域中将一根

塑料管(称为导管)插入到你的手腕中的动脉里。将静

脉内导管，该导管会在手术过程中提供麻醉作用，插

入到你的静脉里。为了帮助你放松，在进入手术室前

会给你服用温和的镇静剂。

一旦当你在手术室里完全睡着了，会将一根管子插入

你的气管下，并连接到人工呼吸器，取代你的呼吸功

能。还会给你服用称为抗凝血剂的稀释血液药物，以

防止血液凝固。然后，将你连接到心肺机(暂时地执行

与心脏和肺一样功能的机器)，这种情况下你的心脏停

止，并且身体变冷。

该手术可以通过从你的腿部(大隐静脉)移植一根长静

脉开始。将移植物的一端连接到升主动脉上，即携带

从心脏到身体的富氧血液的大动脉，而将另一端连接

到阻塞区下方的受影响的冠状动脉上。不过，外科医

生可以选择使用来自胸壁内部的动脉(内乳动脉)或者

他可以将两者都用于移植。该过程可能耗时2至6小时

之间，取决于所需的搭桥的数目。

恢复时间

你可以期望留在医院一个星期左右，包括在重症监护

室(ICU)中至少1至2天。

搭桥手术后的生活

在搭桥手术后，医生会建议你参加心脏康复项目。这

些项目可以帮助激发你做出明智的生活方式改变，如

改善你的饮食，力量恢复性运动，戒烟，保持健康的

体重和应对压力。你和你的配偶还应该自由地与医生

讨论有关性活动的恢复以及一些药物的影响(如β受体

阻滞剂，勃起功能障碍的药物和硝酸盐等)。通常地，

当胸骨完全愈合并且患者没有心脏衰竭或某些心律异

常时,6-8周后可以缓慢地恢复性活动。

由于搭桥手术不能治愈潜在的心脏疾病(动脉粥样硬化

或冠状动脉病)，在手术后用药物治疗是重要的部分。

你有可能需要服用他汀类药物或降血脂剂，并开始抗

血小板治疗。

20%至30%的搭桥患者将需要在10年之内进行第二次手

术。这些后期事件往往与症状复发有关，通常需要进

行第二次血管重建术，经常与血管成形术或支架置入

术一起进行，而不常与重复手术搭桥一起。

冠状动脉搭桥手术的益处包括:

✦生存期延长

✦缓解症状，如胸痛或气短

✦提高运动耐受力

✦减少对心绞痛药物的需求

✦预防潜在的致命性心脏病发作

通常何种患者/何时进行冠状动脉搭桥手术:

• 患者患有已经无法用药物进行控制的心绞痛。

• 患者患有多发性冠状动脉病变，这种情况下心脏的

主泵(左心室)功能不良。

• 左侧主冠状动脉严重狭窄或阻塞。

• 不适合进行气囊血管成形术的患者。

• 血管成形术后冠状动脉已再次狭窄的患者。

陈言森医生是新加坡心脏基金的董事会的副主席。他也是私人诊所的心胸外科医生。

19特写

冠状动脉搭桥手术

之前 之后

旁路移植

升糖指数(GI)使用0到100的范围来衡量含碳水化合物的食物所能提高血糖的潜力。因此，与中等或低GI的食物相比，较高GI的食物将表明较高的升血糖潜力。

根据美国糖尿病协会(2014)，含碳水化合物的食物可被分类为高GI(≥70)，中等GI(56-69)或低GI(≤55)。

表1:低GI，中等GI，高GI的食物例子

除了考虑GI之外，血糖的上升潜力也会因不同的因素而影响。

一般情况下，吃较大份量的碳水化合物会将血糖升得较高。尽管GI可以反映此食物对血糖的影响，GL则为糖尿病患

者提供更良好的参考，从而评估对于保持良好血糖水平所该摄取的份量。

?

低GI 中等GI 高GI

•燕麦片/刀切燕麦 •快速燕麦 •即溶燕麦

•玉米 •全麦面包 •白面包

•大麦 •糙米 •短粒白米饭

•大多数水果/非淀

粉类蔬菜

•粗麦粉 •甜瓜

例子:

一个西瓜的

GI = 72一片西瓜

(130 g) 的GL = 6三片西瓜

(130 g x 3) 的GL = 17

影响血糖的因素

1碳水化合物的摄取量会影响血糖升高的迅速。这

可归因于升糖負荷(GL)的差异。与GI相反，GL是一种运用食物里所含的碳水化合物以及升糖指數

(GI)的测量法。因此，一种食物可能具有高的GI但低的GL。

计算GL:GL = GI x 食物的碳水化合物(g) / 100

份量大小

升糖指数什么是文章由新加坡心脏基金的营养师林杰先生提供

20 特写

表2:一些日常食品的GI

血糖水平还可以受到不同程度地影响—这取决于你是

否食用含碳水化合物为主的食物或含有碳水化合物、

脂肪和蛋白质的一餐。在一般情况下，碳水化合物、

脂肪和蛋白质的一餐(例如一份白米饭、一份鲑鱼和一

份蔬菜)将比食用一份白米饭具有较低的血糖升高潜

力。这是因为，脂肪、蛋白质和纤维有助于减缓消化

速率，从而使血糖的上升较缓慢。

GI:一种较健康的食物选择的参考？

GI仅表明食物所能升血糖的潜力，但不一定表明是

较健康的食物选择。例如，许多较高GI的食物可能

比较低GI的食物具有更多营养价值。

例子:

鸡饭(仅饭)，GI = 67 短粒糙米，GI = 76

2 食物成分食物

•短粒糙米

•椰浆饭(仅饭)

•长粒糙米

•鸡饭(仅饭)

•苏打饮料

GI

76

69

65

67

63

该SHF心智餐盘是一种餐盘，旨在通过将建议的食物份量形象化从而促进

健康的饮食习惯。餐盘的建议来自于：

•新加坡保健促进局

•SHF的3-5-7健康心脏饮食原则

•美国心脏协会的吃混合食物的建议，以最大限度地摄入营养素。

此外SHF心智餐盘还能劝阻“特大”的饮食份量,避免体重增加和肥胖—

对于大多数慢性疾病而言的两种危险因素。

在SHF办公室@碧山 Junction 8 花费8元可购得SHF心智餐盘(仅周一到周五，

上午九点到下午五点半)。欲知更多详情，请浏览www.myheart.org.sg或拨打

6354 9340。

尽管短粒糙米具有较高的GI，它含有构成健康饮食的纤维和植物化学物质。鸡饭(仅饭)的GI较低是因为

所含的脂肪有延缓消化的作用。研究已表明，摄入过多的饱和脂肪可能会提升心血管疾病的风险。

应该多样、适度和平衡地使用GI。为了对抗慢性疾病，应该吃平衡和健康的膳食，并提倡一种积极的生活方式！

备注:

21特写

22 Recipes

Recipe contributed by Mr Lim Kiat, Nutritionist at SHF. 本食谱由新加坡心脏基金的营养师林杰先生提供。

Preparation Time 准备时间: 10 minutes 分钟

Cooking Time 烹饪时间: 10 minutes 分钟

Serves 份量: 4 人份

Stir-friedBrown Rice Vermicelli

Nutrients per Serving 每份营养Energy 能量: 271 kcal 千卡

Protein 蛋白质: 10 g 克Fat (Saturated fat) 脂肪(饱和脂肪):9 g 克 (1 g 克)

Carbohydrate 碳水化合物: 56 g 克

Sodium 钠: 356 mg 毫克

Cholesterol 胆固醇: 44 mg 毫克

Dietary fibre 膳食纤维: 8 g 克

Method 做法:

1. Soak the brown rice vermicelli in hot water for 1 minute and thaw the mixed frozen vegetables.

将糙米粉浸泡在热水中1分钟，同时解冻冷冻的蔬菜，再切丝卷心菜。

2. Whisk the eggs in a small bowl. Then, heat 1/2 tablespoon of oil in a non-stick pan and fry the mixture until slightly brown. Set aside.

在一个小碗中，打匀鸡蛋。然后，在一个不粘锅里用半汤匙的油把鸡蛋煎熟。待用。

3. Drain the vermicelli and set aside. 沥干米粉，待用。4. In a bigger wok, heat 11/2 tablespoon of oil over a medium

heat and stir fry the garlic, onions, chili padi and mushrooms until fragrant.

在大的锅中，用中火加热把1½汤匙的油翻炒蒜、葱、小辣椒和蘑菇直至散出香味。

5. Stir in the carrots, beansprouts, cabbage and mixed vegetables into mixture.

将红萝卜、豆芽，卷心菜和蔬菜拌入到混合物中。6. Once the vegetables are slightly cooked, toss in the

vermicelli and mix thoroughly. Stir constantly to prevent charring at the bottom.

一旦蔬菜微熟，就将米粉倒入锅中并不断搅拌至均匀，防止锅底烧焦。

7. Mix in the condiments and stir well. 拌入调味品搅匀。8. Once the vermicelli has softened and fragrant, it now

ready to serve. 一旦米粉已经软化散出香味，即可食用。

Ingredients 材料:• Brownricevermicelli,200g 糙米粉，200 克• Garlic,6cloves 大蒜，6 片• Redonion(small),2whole 红洋葱(小)，2 只• Chilipadi,3pieces 小辣椒，3条• Shiitakemushroom,8whole 香菇，8 颗• Beansprouts,100g 豆芽，100 克• Cabbage,half 卷心菜，一半• Mixedfrozenvegetables,200g 冷冻蔬菜(玉米，青豌豆，胡萝卜)，200 克• Carrot,2sticks(julienne) 红萝卜，2 条(切丝)• Darksoysauce,1tablespoon 黑酱油，1 汤匙• Salt,1pinch 盐，一撮• Pepper,1dash 胡椒粉，少量• Egg,2whole 鸡蛋，2 粒• Cookingoil,2tablespoons 油，2 汤匙

23食谱

RecipecontributedbyAyamBrandSingapore.本食谱由新加坡雄鸡标提供。

Preparation Time 准备时间: 25 minutes 分钟

Cooking Time 烹饪时间: 10 minutes 分钟

Serves 份量: 4 人份

Sweet PotatoTuna Cakes

Nutrients per Serving 每份营养

Energy 能量: 227 kcal 千卡

Protein 蛋白质: 16 g 克

Fat (Saturated fat) 脂肪(饱和脂肪):7 g 克 (1.7 g 克)

Carbohydrate 碳水化合物: 26 g 克

Sodium 钠: 201 mg 毫克

Cholesterol 胆固醇: 134.8 mg 毫克

Dietary fibre 膳食纤维: 4 g 克

Ingredients 材料:

• AyamBrandTunaFlakesSpicyin Olive Oil, 185 g 雄鸡标橄榄油香辣金枪鱼片, 185 克• Peeledsweetpotato,400g (steamedorbaked) 去皮的红薯,400克(清蒸或烤)• Cabbage,100g(slicedthinly) 卷心菜,100 克 (切成薄片)•Brownonion,100g 棕色洋葱,100 克• Carrot,100g(gratedorjulienne) 红萝卜,100 克 (磨碎或切丝)• Springonion,2stalks(julienne) 小葱, 2 根(切丝)• Egg,3whole 鸡蛋, 3 粒• Cornflour,1tablespoon 玉米粉,1汤匙

Method 做法:

1. Mash the tuna in a medium bowl and mix in the sweet potato, cabbage, onion, carrots and spring onion.

在中碗中将金枪鱼捣碎并且拌入红薯、卷心菜、洋葱、红萝卜和小葱。

2. In a separate shallow bowl, whisk the eggs and cornflour until smooth.

在 另 外 一 个 浅 碗 中 ， 搅 拌 鸡 蛋 和 玉 米 粉 ， 直 至均 匀 。

3. Shape the tuna mixture into four flat round cakes, approximately 2cm in thickness.

将 金 枪 鱼 混 合 物 塑 成 扁 圆 形 糕 饼 样 ， 约 2 厘 米 的厚度。

4. Lightly oil a non-stick frying pan over a medium heat. 用中火在一个不粘煎锅上稍加点油。5. Dip the cakes into the egg mixture and pan-fry on

both sides, until golden brown and crispy. 将糕饼浸入蛋液中，然后在平底锅上煎至两面金黄

酥脆。

Preparation Time 准备时间: 10 minutes 分钟

Cooking Time 烹饪时间: 10 minutes 分钟

Serves 份量: 4 人份