Key Takeaways

• Heart health is crucial for longevity.

• Heart disease is the most common cause of death in Singapore, and is also a leading cause of disability.

• A variety of measurements can be used to understand your level of heart disease risk, including blood pressure, lipoprotein levels, and C-reactive protein levels.

• These screening tests are important, because they give you important and actionable information about your heart health. 

• For those whose results show increased risk, lifestyle changes are the first step towards improving heart health.

• In some cases, supplements and/or medications may also be used to reduce heart disease risk.

How important is heart health for longevity?

If you’re hoping to live a long life, paying attention to heart health is crucial. 

In fact, heart disease is the most common cause of death in Singapore. In people with heart disease, blood flow to the heart is reduced by narrowed or blocked arteries. By taking care of your heart, you can significantly reduce your chances of dying from this condition, making it more likely that you’ll enjoy a long lifespan.

Research has found that people with high cardiovascular health scores have a life expectancy that’s increased by 8.9 years, compared with those who have low cardiovascular health. This is partly due to a reduced risk of dying from heart disease. However, the risk of death from other causes is also reduced in people who have good heart health. This is likely because improved blood circulation ensures that tissues throughout the body have enough oxygen and nutrients to maintain and repair themselves, leading to improved overall health.

Besides improving your lifespan, caring for your heart is also a powerful way to improve your healthspan – the number of years that you live in good health. This is because heart disease can greatly reduce the quality of life. In fact, among Singaporeans over the age of 60, heart disease is one of the leading factors limiting people’s ability to live their daily lives independently.

When blood flow to the heart is reduced, the heart muscle becomes weaker, and the heart is less able to pump extra blood when needed. This makes it difficult to be physically active, causing symptoms like shortness of breath and chest pain. In addition, people with heart disease often experience swelling of the legs, which causes leg pain and also makes exercise more difficult. These factors can make it difficult or impossible for a person with heart disease to complete regular daily activities, like climbing stairs or even simply walking into a shop.

If you want to live as many years as possible in good health, it’s important to take steps to keep your heart healthy.

What metrics can you test to understand your heart health?

Heart health is complex, and understanding your risk of heart disease involves taking into account multiple different measurements. These include blood tests as well as other types of measurements. By considering all of these different factors, you and your doctor can gain a comprehensive understanding of your heart health.

Blood Pressure

One very important measurement, which should be taken consistently, is your blood pressure. People who have high blood pressure – medically known as hypertension – are at a significantly increased risk for a variety of serious health issues, including heart disease and strokes. 

It’s normal for blood pressure to vary throughout the day, based on factors like your activity level, stress level, and even how hydrated you are. If blood pressure is greater than 140/90 mmHg when you’re resting and calm, then hypertension can be diagnosed. However, an optimal blood pressure level is lower, at around 120/80.

High blood pressure is relatively common, with a little more than 20% of adults in Singapore experiencing this. However, even though it’s common, this doesn’t mean it’s normal. In fact, studies have shown that people with high blood pressure have a lifespan about 5 years shorter than those with normal blood pressure. In addition, they spend 2 more years in a state of poor health – meaning that high blood pressure shortens a person’s healthspan as well as their lifespan.

HDL and LDL

Measuring your cholesterol levels is also important for understanding your heart health. HDL and LDL are two forms of cholesterol. They’re measured as part of a blood test known as a lipid panel.

Cholesterol is a fatty substance that’s used by the body to build cell membranes as well as several different hormones. Although it’s an essential substance, when there’s too much cholesterol in the bloodstream, it can deposit into the walls of arteries. This makes the arteries stiffer, making it much harder for them to increase blood flow when needed. In addition, deposits of cholesterol make it more likely that a blood clot will form inside the artery.

Because cholesterol is a type of fat, it doesn’t dissolve well in blood, which is primarily made up of water. To allow cholesterol to move through the bloodstream, the body makes carriers known as lipoproteins. 

There are a few different types of lipoproteins. Low-density lipoproteins (LDL) carry cholesterol to tissues throughout the body, where it can be used as needed. High-density lipoproteins (HDL) carry excess cholesterol from the tissues back towards the liver, so it can be eliminated from the body.

When LDL levels are high, this keeps excess cholesterol in the bloodstream, where it’s likely to deposit in the walls of blood vessels. By contrast, when HDL levels are high, this helps to eliminate excess cholesterol. This is believed to be why high HDL levels are associated with a decreased risk for heart disease, while high LDL levels are associated with an increased risk.

Research has found that higher HDL levels are associated with a lower risk of mortality and a longer lifespan. However, higher LDL levels have not consistently shown an association with longevity. It’s not yet clear why this is the case, but it could be because other measurements are more strongly linked to the risk of heart disease.

Lipoproteins

While measurements of HDL and LDL are commonly performed as part of a standard medical check-up, there are other measurements that can provide a more complete picture of a person’s heart health and level of risk. These tests can be performed for those who are at a higher risk for heart disease based on their family history or other risk factors, or for those who wish to gain a more complete understanding of their level of risk for heart disease.

Apolipoprotein B (apo B) is a component of LDL and other similar lipoproteins, so higher levels are associated with an increased risk of heart disease. By contrast, apolipoprotein A1 (apo A1) is a component of HDL, so higher levels are associated with a decreased heart disease risk. The ratio of these two substances, known as the apo B/apo A1 ratio, has been found to be a strong predictor of a person’s risk of dying from heart disease. People with a high ratio have about double the risk of heart disease compared to those with a low ratio, and their overall risk of death is increased by about 60%.

Lipoprotein (a) is a specific type of LDL. A person’s levels of lipoprotein (a) are primarily determined by genetics. People with high levels of lipoprotein (a) have been shown to have a lifespan that’s about 1.5 years shorter than those with low levels. While it’s difficult to alter your levels of lipoprotein (a), knowing your levels can allow you to take other steps to decrease your heart disease risk if your levels are high.

hs-CRP

In addition to lipoprotein levels, chronic inflammation is also associated with an increased risk for heart disease. In people with chronic inflammation, the immune system is slightly activated at all times, even when there’s no infection to fight. This causes damage to tissues throughout the body, including to the insides of blood vessels. Blood clots are more likely to form inside damaged blood vessels.

Levels of a protein known as C-reactive protein, or CRP, can be used to measure chronic inflammation. This protein is made by the liver, and is associated with inflammation. A variation of this test known as high-sensitivity CRP, or hs-CRP, is able to detect the protein at lower levels than the usual test can detect. This allows for a more accurate determination of the risk of conditions like heart disease.

Studies have found that increased hs-CRP is associated with an increased risk of death and a reduced lifespan.

What is the difference between “normal” and “suboptimal” results?

It’s important to recognize the distinction between “normal” and “optimal” results on any type of medical test. When results are reported as “normal” or “within the normal range,” this simply means that these results don’t clearly indicate a disease.

However, “optimal” results are those which indicate a low risk for serious diseases and mortality, and a high likelihood of living a long life. By contrast, “suboptimal” results indicate an elevated risk. In some cases, results that are considered normal may not necessarily be optimal. 

For example, a blood pressure of 135/88 could be considered “normal,” because this blood pressure isn’t quite high enough to diagnose hypertension. However, this is clearly higher than the optimal level, which is 120/80 or lower. This person could be said to have “suboptimal” blood pressure. Although it’s technically still within the normal range, this person does have an increased risk for experiencing a serious event like a heart attack or stroke.

Heart health and longevity

Heart health is crucial for both the quality and the length of your life. It’s important to understand your level of risk, so you can take steps to improve or maintain your heart health.

The first step is to consistently get screening tests to understand your heart health. The exact tests needed can vary somewhat, depending on factors like your age, lifestyle, and family history. 

Usually, your primary care physician will order basic screening tests, such as measuring your LDL and HDL cholesterol levels. However, to get a truly comprehensive sense of your heart health, it’s often helpful to have additional tests, such as apo B and hs-CRP. These are not generally included as part of a standard checkup with your regular doctor. Instead, you’ll need to visit a physician who offers these tests.

In general, if your test results are not optimal, ensuring that you’re living a heart-healthy lifestyle is the first step. This includes getting plenty of physical activity, as well as eating a healthy diet that’s low in saturated fat and high in fiber and unsaturated fat. A health coach can help you to develop a personalized lifestyle plan and stick to it.

Making these lifestyle changes may not always bring your results into the optimal range. However, these are healthy choices and are very likely to improve your longevity even if your lab values don’t change.

Some people use supplements to help address suboptimal results on heart health tests. For example, compounds known as plant sterols have been found to lower LDL cholesterol by about 8 to 12%. Always talk with your doctor before you start taking any new supplement, to ensure that it’s safe for you and won’t interact with any of your other supplements or medications.

In some cases, medications are used to address findings on heart health tests. For example, if LDL levels are high, medications like statins might be used to help lower it. Medications are most often used when test results are significantly outside the normal range. For those whose results are suboptimal by a smaller amount, the potential risk of side effects from the medication may outweigh the potential benefits.

For those who wish to gain a more complete understanding of their heart health in order to improve their longevity, we offer comprehensive biomarker testing with NOVI Assessment Max. If testing shows that you have an elevated risk of heart disease, our health coaches and physicians will recommend a holistic and personalized health plan to increase your chances of living a long and healthy life. 

Take charge of your health and your future with NOVI Assessment Max

NOVI Assessment Max is designed for individuals of all backgrounds and health profiles who want to invest in understanding and tracking their health over time. This proactive approach to long-term health benefits everyone. Establishing your baseline with a single set of test results helps you monitor your body’s trends and take control of your health. 

Our comprehensive testing panel includes 80 biomarkers, giving you a holistic understanding of your health. Through your user-friendly dashboard, you’ll receive clear insights into your screening results, prioritizing key areas for action. With a full team of health professionals including coaches, you’ll have all the support you need to develop and implement your personalized holistic lifestyle plan.