Saturday, September 04, 2004

Fewer deaths from cancer, heart disease and stroke 

The Straits Times reported today that the death rates for cancer, heart disease and stroke have declined over the last seven years.

In 1997, 150 in every 100,000 Singaporeans aged between 35 and 64 died of cancer. Last year, 119 in every 100,000 did.

Heart disease claimed the lives of 59 in every 100,000 last year, compared to 85 in 1997.

And 21 in every 100,000 died of stroke last year, down from 37 in 1997.
To collect data for improving disease-control programmes, the Ministry of Health will be conducting its third National Health Survey between 10 September and 4 December (I first mentioned this in an earlier post).

Another article in The Straits Times today highlighted the nine risk factors that account for nine out of ten of all cardiac arrests. The risk factors, as identified in the study called the Interheart study and published in The Lancet, are:

  • High blood cholesterol
  • Smoking
  • Stress
  • Diabetes
  • Family history of high blood pressure
  • Abdominal obesity
  • Level of consumption of fruit and vegetables
  • Frequency of physical exercise
  • Level of consumption of alcohol

  • There were several interesting points in this list.

    The first is that stress rates rather highly. More than ten years ago, I remember that stress was highly stressed as a factor in heart attacks. More recently, it had given way to diet and exercise as top risk factors. The Interheart study re-emphasises the important role of stress as a risk factor.

    The second interesting point is the mention of consumption of fruit and vegetables, but not the more-commonly mentioned avoidance of red meat and dairy products. Personally, I think that both are important and mentioning one factor without mentioning the other makes it unbalanced.

    Which leads me to the third point. Many of the factors mentioned above actually have overlapping root causes. High blood cholesterol, diabetes, high blood pressure and abdominal obesity are actually symptoms of other factors. By treating them as independent factors, some of the actual controllable factors, like diet and exercise, get subsumed under them. Some uncontrollable factors also get subsumed, namely genetic factors. This is almost certainly why diet and exercise appear relatively far down the list, and consumption of red meat doesn’t even get a mention. Genes were not analysed as an independent factor.

    Finally, I think it is worth mentioning that an important risk factor for heart attacks is actually age. The study apparently controlled for age, and so did not study it as an independent factor. In any case, it would have been one of the factors that get subsumed in some of the other risk factors that are mentioned, and it is an uncontrollable factor as far as laymen are concerned.

    Nevertheless, it is an important factor to keep in mind because control of age-related factors may be the next avenue through which researchers can attack not only heart disease but other diseases like stroke and cancer. It is also useful to remind laymen that with increasing age comes increasing risk of many age-related diseases, and the rise in risk is something that must be taken into account in their lifestyle choices.


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