SPEECH BY PROFESSOR KENNETH MAK, DIRECTOR-GENERAL OF HEALTH, MINISTRY OF HEALTH, AT THE 28TH ASEAN FEDERATION OF CARDIOLOGY CONGRESS

Dr Alex T. Junia, President of ASEAN Federation of Cardiology (AFC

Dr David Foo, President of Singapore Cardiac Society and Organising Chairman of AFC Congress 2024

Dr Yew Min Sen, Scientific Chairman of AFC Congress 2024

Distinguished Speakers and Guests

Ladies and Gentlemen

Good morning. I am happy to join you today at the 28^th ASEAN Federation of Cardiology Congress.

2.               As have been shared, the theme for this year’s Congress is “Navigating the Mace/Maze to Advance Frontiers in Cardiovascular Care”. It is apt that the theme also refers to a maze, spelt with a “z” instead, because it can often be daunting and challenging to navigate clinical trials, research, innovation and guidelines, it is really akin to entering a very complex maze.

Cardiovascular Disease Burden in ASEAN Region and Singapore

3.               ASEAN countries are seeing rising disease burden from cardiovascular diseases (CVD). Based on the Global Burden of Disease Study 2021, due to CVD, the disability-adjusted life years per 100,000 population has increased by 10.7% from 2011 to 2021 among ASEAN countries. This trend is also observed in Singapore. In 2021, an average of 34 people were diagnosed with acute myocardial infarction (AMI) every day, up from 22 people in 2011. About one third of all deaths in 2023 were attributed to CVD.

4.               CVD risk factors, such as obesity, hypertension and hyperlipidaemia, are also on the rise and the CVD burden in Singapore may continue to increase with an ageing population. Hence, it is important to ensure good preventive health to lower CVD risks, and to detect and manage CVD early.

Sharing and collaborating with ASEAN countries

5.               I will share more about various initiatives that Singapore has implemented to address our relatively high CVD burden. While each ASEAN country has its own unique health challenges, I strongly believe that we can learn from each other, and where feasible, adapt initiatives to suit our country’s context and population. In this regard, Singapore has ongoing work with ASEAN countries on the prevention and control of non-communicable diseases (NCD) as part of the ASEAN Health Cluster 1 (AHC1) platform. These include the co-development of regional frameworks, minimum standards and guidelines, advocacy campaigns, and specific intervention packages to address NCDs, including CVDs, and their risk factors. This enables ASEAN countries to learn from best practices across the region and together strive to prevent and reduce the risk and burden of CVDs.

Tackling CVD risk factors through encouraging healthier lifestyles

6.               In Singapore, the Ministry of Health (MOH) and the Health Promotion Board (HPB) have been working on upstream efforts to encourage healthier lifestyles and to lower the risk of developing CVD.

7.               The prevalence of hypertension rose from 20% to 37% between 2010 and 2022. For hyperlipidaemia, the increase was from 26% to 32% in 2022. To tackle these, we have plans to further enhance measures to reduce excessive intake of sodium and saturated fat. Building on the positive impact that Nutri-Grade labelling and advertising prohibitions for sugar sweetened beverages has had in lowering sugar intake, we will be similarly implementing a mandatory Nutri-Grade label in the retail setting to packaged salt, sauces, seasonings, instant noodles and cooking oils, as these are key contributors of sodium and saturated fat. This will facilitate more informed, healthier choices by consumers, spur industry reformulation, and reduce the influence of advertising on consumer preferences.

8.               Smoking is another major risk factor for CVD. We have put in place a suite of measures, such as raising the Minimum Legal Age for smoking to 21 years and implementing standardised packaging, to reduce access to and to discourage smoking. HPB also continues to educate residents on the harms of smoking and vaping, and provides cessation support through the I Quit Programme and QuitLine.

9.               We will also continue to encourage more Singaporeans to have an active lifestyle. HPB offers island-wide physical activity programmes to support residents to meet their recommended levels of physical activity. To expand the available offerings, HPB is also enhancing the Healthy 365 app, to list programmes by community partners, such as those by Sport Singapore, the People’s Association, and Active Ageing Centres, to provide residents with a wide selection of healthy lifestyle activities within the community.

Managing CVD under Healthier SG

10.           To strengthen preventive care, we launched Healthier SG in July 2023. This isSingapore’s multi-year national initiative to transform our healthcare system to focus on preventive care. Residents aged 40 and above are invited to enrol in a Healthier SG clinic and adopt a Health Plan. Enrollees will receive enhanced preventive care benefits as well as guidance from their family doctor to help them stay healthy and to manage their chronic conditions well, including CVD.

11.           To further support our family doctors in managing CVD, we will be expanding the range of Care Protocols to include stable ischaemic heart disease (IHD). The stable IHD Care Protocol, set to be implemented from January 2025, will provide family doctors with evidence-based guidance on the clinical approach and management of stable IHD. This will help to prevent disease progression, AMI events and complications, such as heart failure, among those with the condition.

Multi-disciplinary care for post-AMI patients

12.           For those who had an AMI episode or undergone revascularisation procedures, cardiac rehabilitation is a key follow-up programme to aid in recovery and to prevent recurrence. Cardiac rehabilitation requires multi-disciplinary care and involves healthcare professionals with different expertise, such as cardiologists, nurse clinicians, physiotherapists, pharmacists and dietitians – many of whom are present today.

13.           To improve post discharge care of AMI patients, we piloted the AMI-HOPE (Acute Myocardial Infarction – Allied Health-Oriented, Patient-centered and Digitally-Enabled) programme since October 2022. This is co-led by the cardiologist and pharmacist within these schemes. Through tele-monitoring and tele-consultations, pharmacists remotely monitor blood pressure levels and heart rate readings uploaded by patients. These guide the titration of medications and identify patients who require further clinical assistance. Patients would also be guided to make lifestyle changes through personalised nudges in the IT platform. To date, the pilot has since been rolled out across all our public healthcare clusters.

Predictive preventive care

14.           In the area of predictive preventive care, MOH is developing the Familial Hypercholesterolemia (FH) national programme. Building on the success of a Clinical Implementation Pilot conducted by public healthcare institutions and Precision Health Research, Singapore (PRECISE), MOH will launch a national FH genetic testing programme by mid-2025. Under this programme, Healthier SG clinics and polyclinics will identify patients with abnormally high cholesterol levels and refer them for FH genetic testing at a newly set-up Genomic Assessment Centre. If an individual tests positive for FH, their immediate family members will be encouraged to undergo the same genetic test as well. Patients diagnosed with FH will receive support from their Healthier SG clinics to adopt healthier lifestyles and start appropriate, subsidised cholesterol-lowering therapies.

Translating CVD research insights to improve health outcomes

15.           To further explore new frontiers in the field of cardiology, it is important to enable and support the translation of CVD research. In February 2023, Singapore set up the CArdiovascular DiseasE National Collaborative Enterprise (CADENCE), a national clinical translational programme aimed at synergising cardiovascular research and translational capabilities across Singapore. CADENCE is currently establishing R&D capabilities across data science, clinical trials, and digital health on CVD research and innovation, together with a business intelligence and development unit to attract industry collaborations or external investments. I look forward to seeing CADENCE’s progress in translating research insights to inform clinical practice, impacting cardiovascular care and health outcomes.

Closing

16.           In closing, to achieve better health outcomes for those with, and at risk of, CVD, we must continually advance our knowledge, practice, and research in cardiovascular diseases, and focus on preventive care.

17.           I wish everyone a fruitful and enriching Congress ahead. Thank you very much.