On World Heart Day, we want to know, after a heart attack, what happens next?

Lance Alexander (0:01)

Best of Live Well with Michelle.

Yes, indeed, we want to talk about heart attacks because today is World Heart Day. Now, surviving a heart attack does not mean the danger is over. Every time we talk about heart attacks, I think about my father, he was in his late 50s when he had his first heart attack. But did he change his diet? No. Did he continue smoking his lucky strikes? Yes, he did. And that didn't help. Even after a quadruple bypass, he didn't stay with us very long. He passed on just a few years later. Now, the reason we're talking about heart attacks and how you can continue to do well is important. We look at the first year because it's an important period for patients who are at risk. They could be very well facing another heart attack or stroke.

A new Singapore expert consensus paper is calling for closer attention to LDL cholesterol, often called bad cholesterol after a heart attack. It recommends checking LDL levels again within four to six weeks, rather than waiting until that 12 week mark and broader local lipid guidance. The paper also recommends lower LDL targets for patients who have had acute coronary syndrome. And this includes heart attacks and certain forms of severe chest pains caused by sudden reduction in blood flow to the heart. With today being World Heart Day, like I said earlier, we look at the critical weeks after a heart attack and what patients can do to reduce the risk of yet another heart attack. Joining us is Dr. Tan Ru San, Senior Consultant, Department of Cardiology, National Heart Centre Singapore. He's also a lead author of the Consensus Paper. Dr. Tan, thank you for joining us on Money FM. Let's imagine someone has had a heart attack. This individual has made a recovery, a good recovery and has been discharged from hospital. He's gone home.

Tell us why the next few weeks and months are so critical.

Dr Tan Ru San (2:11)

It's very important because the underlying cause of a heart attack is the blockage of the artery and it occurs at the site of an arteriosclerotic plug. By arteriosclerosis, we mean that there's fatty buildup due to prior injury to the inner lining of the heart blood vessel. And that also in combination with inflammation causes a progressive narrowing and hardening of the plug. At the time of heart attack, because the plug will rupture because of the fatty content and that will incite the formation of a clot over the site of the plug. So in many patients with heart attack, we actually, one of the most common methods is to treat with a stent. We open the artery and put the stent over it. However, the underlying risk is actually there.

For instance, the fatty blood may extend beyond the site of stent implantation. So the risk is always there of another heart attack occurring at other sites.

Further, in the first year after heart attack, it's actually raised levels of inflammation and hence, and also thrombogenicity, which is a propensity of the blood to clot up, especially at the site of stent. So patients should continue to take medications, including blood thinning medications, to make sure the clot is less likely to be formed and cause acute blockage again. And also to contain the control cholesterol very aggressively, so that we can prevent the... we can actually make sure that the blood do not build up at other sites, and also to induce another heart attack.

Lance Alexander (3:36)

Dr Tan, does your body send you signals after your first heart attack, and you're back home, you're relaxing, maybe you're doing some exercises, you're watching your diet, but if you're still at risk, does your body actually say there's something wrong with you? Do you feel pain? Do you feel there's some stress on your heart when you do some activities? Does it send you signals, like if you have a laptop, when it's running out of power, it tells you you're running out of power.

How does the body actually send you a signal to say, you need to look after yourself better?

Dr Tan Ru San (4:09)

It depends on the individual patients. Some patients may have a relatively simple disease in the sense that there is maybe one artery involved, and the stent is opened up and you're taking your medications, then they can, and there's not much, the extent of damage is not too large, the heart function is maintained, they can actually appear pretty well.

So for those patients, you may not have a signal to warn you of the risk of another event. In other patients, they may have suffered extensive damage to the heart muscle, or they may have not received the opening of the arteries early enough, so the damage may be more permanent, and they may suffer symptoms like recurrent chest pain or heart failure.