March 2018 - May 2018

MCI (P) 069/11/2017 fb.com/heartfoundationmyheart.org.sg twitter.com/heartSG

Official Publication of the Singapore Heart Foundation

03

下定决心找回健康

13

20

Be the Queen of Your Heart

@singaporeheartfoundation

Cardiology for the Layman #6What You Need to Know

About Anti-coagulants

PATRONESM Goh Chok Tong

CHAIRMAN EMERITUSDr Low Lip Ping

SHF 47TH

BOARD OF DIRECTORS

CHAIRMANProf Terrance Chua

VICE-CHAIRMENDr Tan Yong SengMs Tan Lee Chew

HONORARY SECRETARYProf Tan Huay Cheem

ASSISTANT HONORARYSECRETARYMr Goh Chiew Seng

HONORARY TREASURERMrs Elsie Foh

MEMBERSDr Chee Tek SiongMr Chong Chou YuenDr Goh Ping PingMdm Koh Teck SiewDr Bernard KwokMrs Regina LeeProf May LwinDr Mak Koon HouMr Peter SimDr C SivathasanAdj Asst Prof Jack Tan

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: A&D Printhub Pte. Ltd.

DEAR READERS,

Recently, I experienced writer’s block and I felt upset. Was there nothing worth writing about? Did I lose my inspiration? Where was my creativity?

Finally, it hit me. My colleague Sally W., who is living in a metropolis along the US East Coast, shared about her volunteer work in a small local non-profit organisation. She collects vegetables from the nearby farms, checks them, packs them in boxes and donates them to primary school children from the poor neighbourhood schools. The uptake is great because the children love carrots, corn and parsnip. They bring the vegetables home and ask their caregivers to prepare them. This way, the families get to consume healthy meals, as they do away with the omnipresent hamburger, fried chicken and salty snacks. It is a win-win for both sides.

On the other hand, my sister Colette, who works in a school of higher education associated with the University of Brussels, showed me the wall posters and pamphlets on healthy eating around the school campus. These caught the attention of the teenagers and the recipes in particular, encouraged the students to prepare heart healthy meals in their dormitories.

From these two examples, we can see that both very young children and teenagers want heart healthy food and enjoy making their own choices. The well educated as well as the economically disadvantaged, also prefer heart healthy food and if given a choice, will make the right decisions.

Knowledge is power and the role of public education is so important. Our messages need to always be appropriate, constant and consistent. Recently, we have introduced some new features in heartline, in the hope of remaining relevant to our readers. These include the Cardiology for Laymen series and the comics. Do you enjoy reading them? Let us know.

On behalf of our beneficiaries and the Foundation, I wish you and your loved ones much joy, prosperity and good health in this Year of the Dog.

狗年旺旺!

Patrick Deroose

3Feature

ANTI-COAGULANTSWhat You Need to Know About

Article contributed by Mr Chai Zheng Hao

What are anti-coagulants?

Anti-coagulants are medications that prevent the formation of clots in an artery, a vein or the heart, and prevent existing clots from enlarging.

What are anti-coagulants used for?

There are various conditions or reasons why anti-coagulant therapy may be prescribed and they include:

1. Atrial fibrillation – an abnormal rapid heart rhythm condition2. To reduce the increased risk of a stroke or heart attack

after certain surgeries3. To prevent unwanted blood clots after insertion of

mechanical valves or stents

There is an increased tendency for blood to clot excessively or too easily in the above conditions. The resultant clots

formed may cause poor blood circulation or block a blood vessel, which may lead to a heart attack, stroke, tissue damage or death. Thus, anti-coagulants are prescribed for prevention.

Types of anti-coagulants

1. Warfarin2. Novel Oral Anti-Coagulants (NOAC)3. Low-Molecular Weight Heparins and Unfractionated

Heparin

How does it work?

Warfarin prevents the activation of vitamin K, an essential step in the blood clotting process.

How is the dosage determined?

The warfarin dosage is based on a blood test called the International Normalised Ratio (INR). The INR test measures how easily blood clots. Your doctor will decide the INR target range for your condition. If the INR result is above your target (too high), it means that the blood takes a longer time to form clots, increasing the risk of bleeding. Conversely, if the INR result is below your target (too low), blood may take a shorter time to form clots, and hence tend to clot more easily. Your doctor may require you to take frequent blood tests at the beginning of the treatment to determine your body’s reaction to warfarin and the suitable dosage for you. Based on your INR results, your doctor will tell you if you need to change your dose and when you will need the next blood test. Once you are on a regular dosage, you do not need to do the blood test as often, unless you get sick, change your medication regimen or change your diet.

Small changes in doses may lead to significant changes in INR and other undesirable side effects. Hence, it is important to take your dosage as prescribed by your doctor to prevent fluctuations in your INR level. Different warfarin manufacturers may have minute differences in their tablet content and there may also be differences in the way the warfarin is absorbed by the body. Hence, it is a good practice to keep to the same brand of warfarin that you are on. The two brands of warfarin that are sold in Singapore are Marevan and Apo-Warfarin. Make it a point to recognise the colours of the warfarin tablets which you are taking.

Warfarin

Cardiology for the Layman #6

4 Feature

Below is a chart of the warfarin tablets, showing the different colours and strengths for each brand.

2. Many drug interactions

Many medications can change the way warfarin works, so inform your doctor and/or pharmacist about all the medications which you are taking. That includes prescription or over-the-counter medicines, herbs and vitamins e.g. aspirin, ginseng, gingko biloba and evening primrose oil.

Novel Oral Anti-Coagulations (NOACs)

NOACs are the newest class of anti-coagulation agents. They work by inhibiting a clotting factor directly. The 3 NOACs in Singapore are:

1. Apixaban (Brand name: Eliquis) 2. Dabigatran (Brand name: Pradaxa) 3. Rivaroxaban (Brand name: Xarelto)

NOACs are easier to use, as they do not have a small safety window like warfarin and they do not require extensive blood tests. They are easily available as oral tablets.

With the exception of dabigatran, there are no agents for rapid reversal of their effects, in the event of an overdose.

Low-Molecular Weight Heparins and Unfractionated Heparin

These are molecules that inhibit a clotting factor required to commence the clotting mechanism, to stop clots from forming.

This is a popular choice for the in-patient setting, as they take a short time to act. Their effects are easily reversible in the event of an over anti-coagulation and they do not last for a long period of time in our body, making it easy for physicians to control the anti-coagulation effect needed in a short time.

However, they are only available in injectable form. Hence, they are not widely used in the out-patient setting, due to the inconvenience.

Low-molecular weight heparins are available as:

1. Enoxaparin (Brand name: Clexane)2. Nadroparin (Brand name: Fraxiparine)3. Tinzaparin (Brand name: Innohep)

Unfractionated heparin (UFH) was the first anti-coagulant discovered in 1916. The discovery of low molecular weight heparin (LMWH) was based on unfractionated heparin and both heparins are similar in terms of its uses and benefits. However, UFH can only be given intravenously (through a vein directly into the bloodstream) whereas LMWH can be given subcutaneously (under the skin) or in out-of-hospital situations. UFH may require extensive blood tests and closer monitoring of its effects. UFH also tends to be affected by other protein-binding drugs to a greater extent and hence has more drug interactions. However, UFH has been studied more widely and is usually more affordable than LMWH.

Additional things to note of when taking warfarin

1. Many food interactions

The efficacy of warfarin can be affected by the amount of vitamin K in our diet. This does not mean that we have to avoid vitamin K in our diet. The initial INR levels measured would have factored in the amount of vitamin K in your usual diet. It is advisable to keep to a consistent level of vitamin K in your diet and not make drastic changes. Examples of foods rich in Vitamin K are shown in the table below.

Marevan

Apo-Warfarin

Brown1 mg

Blue3 mg

Pink5 mg

Food Amount of Vitamin K Content

Low Moderate High

Beverages CoffeeMilkSoybean milk

Green teaHerbal tea

Cereals & Grain

Bread CerealPastaRice

Dairy & Egg Butter Cheese Egg

Margarine

Meat BeefChickenPorkSeafood

Liver

Vegetables CarrotCauliflowerCeleryCucumberGarlicMushroomOnionPotatoTomato

BroccoliBrussels sproutCabbageColeslawLettuceParsleySeaweedSpinachSpring onion

Fruits AppleBananaGrapesOrange

Avocado

Pink 1 mg Grey 2 mg Orange 5 mg

5Feature

Mr Chai Zheng Hao is a pharmacist and practises at Parkway East Hospital Pharmacy.

What to take note of when taking anti-coagulants?

The most common side effect is bleeding from any part of your body. The bleeding can be minor or sometimes serious and dangerous. Hence, it is important to recognise any signs of bleeding in your body. A visit to the doctor to readjust your dosage may be required.

To avoid the risk of bleeding and bruising:

• Useasoft-bristledtoothbrushwhenbrushing.• Reducefallriskbyclearingwalkwaysoffurnitureandother

obstacles within your home, to create a clear walking path.• Prevent falls by installing handrails in places where you

need the extra support, or use a walking cane if necessary.• Usesalinenasalspraysorhumidifiersathometohelpkeep

your nostrils moist and prevent your nose from drying out, to reduce the risk of nosebleeds.

If your anti-coagulation medication is not adequate, clots will form easily in your body and you may experience signs and symptoms of clotting. This is also dangerous as the blood clots may break off and travel to your lungs, legs and brain, blocking off circulation in the affected areas. A visit to the doctor to readjust your dosage may be required.

Other things to note

• Informyourdoctorifyouarepregnant,intendtogetpregnantorarebreastfeeding.Achangetoamoresuitableanti-coagulantmay be required.

• Informyourdoctorordentistthatyouaretakinganti-coagulantsbeforeanyoperationordentalprocedure.Thisistopreventany excessive bleeding due to the procedure.

• Asyourriskofbleedingisgreater,becarefulifyouareengagedinactivitieswithahighriskofinjury.• Informyourdoctorifyouaretakinganyothermedicationsorsupplements.Thisistoensurethattheywillnotinteractwith

the anti-coagulants in your body and cause the effect to become greater or weaker than intended.

What if I miss a dose?

Keep to your regular timing for medications when taking anti-coagulants. Your body may not have adequate anti-coagulants to prevent blood clots from forming, if you miss a dose. Taking doses too near each other or double dosing, will thin your blood and bleeding may occur. The various anti-coagulants have specific instructions on how to manage a missed dose. Make sure to consult your pharmacist or doctor, if you are unsure.

• Unexpectedorseverebruising• Pinkorredurine• Blacktarrystoolsorbloodinyourstools• Gumbleeding• Nosebleeding• Coughingupblood• Bleedingthattakesalongtimetostop• Suddensevereandpersistentheadache,dizziness

or weakness• Afallorinjurytoyourheadorface• Menstrualbleedthatisheavierthannormal

Major signs of bleeding

• Clotsinthelegs(deepveinthrombosis)maycauseswelling, warmth, redness, pain and numbness in your legs.

• Clots in your heart (heart attack) and lungs(pulmonary embolism) may cause unexplainable shortness of breath, sharp chest pains, upper body discomfort or numbness in the arms, back, neck or jaw.

• Clotsinyourbrain(stroke)maycauseweaknesson one side of the body, headaches, blackouts, dizziness, unexplained loss of sensation, slurred speech or visual disturbances.

Major signs of blood clots

7Feature

Former Minister of State, Mr Teo Ser Luck, shares with us his weight loss journey.

fitCommit To BeQ1. When did your weight become an issue? When I was living overseas and working on

my businesses, I weighed more than 85kg and my waist measurement was over 35 inches. The doctor said that with all the excessive drinking and eating, my body age was much older than my chronological age. He warned that if I did not take good care of my health, everything will give way soon.

Q2. What was your light bulb moment that pushed you to lose weight?

It got increasingly more difficult to pass my IPPT in the army and once, I nearly blacked out just after climbing one short flight of stairs. That was when I decided to get serious about living a healthier lifestyle.

Q3. What was the biggest struggle in your weight loss journey?

The biggest struggle for me was not achieving the results that I expected and I was also unsure if I was doing it right.

Q4. How much have you lost so far? How long did it take?

My weight is around 70 to 72kg now. It took me one year to lose 15kg.

Q5. What keeps you motivated, at times when you don’t feel as disciplined?

I sign up for running events and triathlons. After awhile, the good habits kick in and you begin to adopt the healthier lifestyle that forms you as a person. Today, I still wake up at 5am to workout for 2 hours.

Q6. How has your weight loss improved your life?

My weight loss has given me greater confidence, higher productivity at work and I feel energised at every moment.

Q7. What do you do to stay heart healthy? My personal formula is 70% nutrition and

30% workout.

Q8. Lastly, what are some tips you can share with our readers?

Focus on eating right. Always set a target and consistency over volume, meaning even if you have only 10 minutes, do some workout rather than none at all. It is not how much time you spend, but rather how regularly you do it. Photos courtesy of Mr Teo Ser Luck

9Health Bites

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

Studies have found that obese heart disease patients who practiced yoga and aerobic exercise together, had twice the reduction in blood pressure, body mass index and cholesterol levels, as compared to those who did either yoga or aerobics alone. They also showed significant improvement in the left ventricular ejection fraction (amount of blood pumped out of the heart with every heart beat), diastolic function and exercise capacity. Over a period of 18 months, 750 patients with coronary heart disease were divided into 3 groups who did – aerobics only, yoga only and aerobics/yoga together. Results showed that a combination of both yoga and aerobics can not only reduce mental, physical and vascular stress, but may also lead to decreased cardiovascular mortality and morbidity by lowering the risk factors.

Researchers examined data of 3,730 non-diabetic petroleum industry Chinese workers over a period of 12 years, and found that those who experienced stressful tasks on the job were 57% more likely to develop diabetes. The biggest contributors included feeling overloaded with work, unclear about expectations and responsibilities of the job, and physical labour. In addition, workers who had reduced recreational time and coping resources such as social support from family and friends, had a 68% increased risk of getting diabetes. Among coping resources that influenced the risk of diabetes, decline in self-care and rational coping skills seemed to make the most difference. Thus, it is important to maintain a healthy lifestyle and a healthy weight, even during turbulent periods at work.

A recent US study suggests that married heart patients have better long-term survival odds, as compared to divorced, widowed and single counterparts, who were up to 71% more likely to die. Those with spouses tended to have a greater purpose in life, fewer risk factors and were more likely to be responsible for their health through diet, exercise and medication adherence. However, compliance starts to slip when a significant other is gone. In separation and widowed cases, the emotional, financial stress and psychological behaviour thereafter may play a role in adverse outcomes. In conclusion, all heart patients are encouraged to find a sense of purpose, whether it be engaging in a new interest or getting more involved with family, because the role of relationships and friendships can help in managing coronary artery disease.

Increased stress at work linkedto higher risk of diabetes

Married heart patients more likely than singles to survive

Healthbites

Yoga and aerobic exercise together may improve heart disease risk factors

Healthy Mummy,

Healthy FamilySymposium 2018

Nutrition 11

DATE: 12th May 2018, Saturday

TIME: Registration and booth activities start at 10amWorkshops: 10.30am – 12.15pmCooking Demonstration & Cooking Competition Finale: 1.00pm – 2.30pm

VENUE: Keat Hong Community ClubAuditorium and Foyer2 Choa Chu Kang Loop#01-01, Singapore 689687(2 minutes’ walk from Choa Chu Kang MRT station)

TICKET PRICE:

$6/pax or $10/pair•Goodiebag(worthuptoS$50)•Activitybooths•Lightrefreshments•Luckydrawchance(Topprizeworthupto$400)

Workshops

Salt taste test: Are you Salty?

Have you ever wondered why does some food taste bland to one, yet salty to another? This may be due to the difference in the detection and recognition threshold of salt. Join us in this intriguing experiment and find out how salty you are!

Mental health workshop: Secrets of Stress Management

Stress may affect behaviours and increase cardiovascular disease risk factors such as poor diet, physical inactivity, smoking and excessive alcohol consumption. Join us in this workshop to learn about stress management techniques, to help yourself and others.

Tickets are available at the Singapore Heart Foundation’s main office.

Address: 9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837

Opening Hours: Mondays to Fridays only, from 9.30am to 5.00pm (closed during lunch time from 12.30pm to 1.30pm)

Keen to participate in our Hearty MasterChef Challenge? Stay tuned on our website (www.myheart.org.sg) and Facebook page in March 2018 for more information!

For any enquiries, please call 6354 9350/65 or email nutrition@heart.org.sg.

Cooking Demonstration by Celebrity Chef Daniel Koh

Join Celebrity Chef Daniel Koh, as he shares tips and recipes on how a healthy meal can be easily prepared.

Hearty MasterChef Challenge (Finale)

Contestants who have been through a series of qualifying rounds and training, battle against each other in a mystery box challenge. The winner will then be crowned Hearty MasterChef 2018.

Cooking Demonstration and Cooking Competition Finale (Limited seats available)

When we come across the term glycaemic index (GI) on food packaging, we often associate low GI to healthier choices, but

do you actually know what it means? What about the term glycaemic load (GL)?

GI is defined as how fast carbohydrate (CHO) foods are being broken down into glucose and absorbed into the bloodstream.

On the other hand, GL is a measure that takes into account the amount of carbohydrate (CHO) in a portion of food, together with how quickly it raises blood glucose levels.

To calculate GL, take the GI x carbohydrate / 100.

For example, 1 serving (50g) of raw oats with a GI of 55 and 29g CHO.

Hence, the GL is (55 x 29) / 100 = 15.95.

In translation, 1 serving of raw oats with a GI of 55 and a GL of 15.95,means that it has a low rate of conversion from CHO to glucose for absorption into the bloodstream, with a medium rate of raising blood glucose.

The lower the indexes, the more gentle and constant rise of blood glucose. GI and GL can be useful in managing one’s blood sugar levels, especially for

pre-diabetic and diabetic individuals.

For the most part, foods that are lower in these indexes are high in dietary fibre too, such as oats, barley, apple etc., which can increase satiety and assist

in weight management.

So, start your day right by having a bowl of heart friendly oatmeal, as it may help to reduce the risk factors of cardiovascular disease such as obesity and diabetes!

Scan here to read more about GI on P6

The Lowdown On

GlycaemicIndex Low Medium High

GI 0 to 55 56 to 69 70 to 100

GL 0 to 10 11 to 19 20 and over

Editorial12

13Go Red for Women

Be the

Why Women?Women are often the primary caregivers to their families and their loved ones. Recognising this pivotal role that women play in their families, SHF launched the GRFW campaign in 2005 to send out a red alert to women, as many are still unaware of the dangers posed by this “silent killer”. In 2016, a heart health survey conducted by SHF revealed that only 10% of Singaporean women were aware that heart disease is their leading cause of death.

Pledge Your Heart Walk 2018Held in conjunction with the annual GRFW campaign, SHF will be organising the 2nd installment of the fun walk, to motivate and increase the awareness for physical activity to help curb the development of CVD in women. Consistent exercise has also been shown to improve physical and mental health.

Pledge Your Heart Walk 2018 encourages women of all ages to bring along their family members and friends (males are welcome too!) to kick-start a heart healthy lifestyle together. The cultivation of healthy behaviours is most effective when it is started by and with the family.

Categories:3.5km and 5kmnon-competitive walk

Date: 23rd June 2018, Saturday

Time: 8:00am to 12:30pm

Venue: Punggol Waterway Park(Event Lawn @Recreation Zone)

Guest of Honour:Ms Low Yen LingSenior Parliamentary Secretaryfor Ministry of Education& Ministry of Trade and Industry Mayor of South West District

Registration* opens inMarch 2018, so stay tuned@ www.pledgeyourheartwalk.sgor SHF’s Facebook page@ www.fb.com/heartfoundationfor more details!

* Limited slots are available and registration is based on a first come, first served basis.

Wish to participate in thiscause as an organisation orin a group? Write to us atgrfw@heart.org.sgfor more information!

Join us at this meaningful event with your loved ones!

of your

HeartWhat Is Go Red For Women?Go Red for Women (GRFW) is an international awareness campaign dedicated to the prevention, diagnosis and control of cardiovascular disease (CVD) in women. The American Heart Association initiated the GRFW movementin2004,toempowerwomen with the right knowledge and essential tools to take charge of their heart health. The World Heart Federation, together with its members, has taken the campaign globally to highlight the fact that heart disease and stroke combined, is the No. 1 killer of women.

15Event Reviews

PHSG would like to thank Bayer SEA & Actelion Pharmaceuticals for their kind sponsorship during the Blue Lips Campaign 2017.

Brought to you by:

November is the Pulmonary Arterial Hypertension Awareness month across the world. In Singapore last year, the Blue Lips Campaign was organised by the Pulmonary Hypertension Singapore (PHSG), National Heart Centre Singapore (NHCS) and the National University Hospital (NUH).

The 2-day event educated 500 members of the public on how to detect the signs and symptoms of the disease. Many were surprised to learn about PH and they showed their support to the patients by penning words of encouragement on “Blue Lips” notes.

We hope to see you at the Blue Lips Campaign event in November 2018! Stay tuned on our Facebook page (PH Singapore) for more updates.

Sealed with A BLUE KISS Pulmonary hypertension (PH) is a rare condition where

the blood pressure in the lungs is increased, leading to a lack of oxygen, breathlessness and mobility issues. One of the main symptoms is cyanosis or blue lips. Although this disease is rare, its symptoms can significantly affect a patient’s life.

Thus, the Blue Lips Campaign was initiated by the Pulmonary Hypertension Association of Canada in 2010, to raise awareness for the disease. Since then, it has been organised annually in Singapore.

On 20thJanuary2018,SHF’s14th Flag Day saw close to 1,900 volunteers, walking along the streets of Singapore to help raise funds for the Foundation, as well as to create awareness for cardiovascular disease.

The street collection exercise and donation cards from corporations and individuals raised a total of approximately $100,000. These funds will help sustain SHF’s life-saving programmes, allow us to carry on our mission of promoting heart health in Singapore, and provided timely financial aid to needy heart patients.

SHF would like to convey our sincere thanks to Tote Board and Singapore Turf Club for their outright donation. Our heartfelt gratitude and a big thank you also goes out to allwhohelpedmakethe14th Flag Day a huge success. This would not have been possible without your support!

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!

Are YoU too SweeT?

Congratulationsto all winners* and

thank you foryour participation!

*Winners have been notified via phone or email.

1 cup (250ml) ofMilo (chocolatemalt beverage)a) 1 tsp (5 g)b) 2 tsp (10 g)c)4tsp(20g)

Answer:

1 cup (250ml) of soya bean milka) 2 tsp (10 g)b)4tsp(20g)c) 6 tsp (30 g)

Answer:

1 cup (250ml) of Kopi/Teh (coffee/tea)a) 1 tsp (5 g)b) 2 tsp (10 g)c)4tsp(20g)

Answer:

1 cup (250ml)of Kopi/Teh Siu Dai (coffee/tea less sugar)a) 0 tsp (0 g)b) 1 tsp (5 g)c) 3.5 tsp (17.5 g)

Answer:

1 glass (250ml)of 100% juicewith no sugar addeda) 0 tsp (0 g)b) 5 tsp (25 g)c)8tsp(40g)

Answer:

1 can (330ml) of sweetened sodaa) 2 tsp (10 g)b)4tsp(20g)c) 7 tsp (35 g)

Answer:

ANSWERS (Dec 2017 – Feb 2018)

C

CC

B B

C

16 Nutrition

Post Festive

Simply email/fax this page to heartline@heart.org.sg/62585240by31 May 2018.

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 June 2018.

Here are 8 simple ways to reverse your holiday weight gain. Fill in the blanks with the helping words provided in the box below.

Submit your correct answersand 5 lucky winners will receive

a limited editionSHF Heart Smart Eating Plate

in our lucky draw!

1.2.3.4.5.6.7.

8.

Period Checklist

Week Saturated Balanced Frequency Sugars

Herbs and spices Portion Unsaturated Whole-grains Trans

control is a good way to manage calorie intake.

Cut back on to avoid consuming empty calories.

Reduce the of sweetened beverages and snacks.

Exercise for at least 150 minutes a .

Try to eat a healthy and diet.

Spice up your meal with instead of condiments.

Replace fat and fat with

fats.

Choose instead of refined grains.

17Nutrition

什么是抗凝血剂？

抗凝血剂是一类旨在防止动脉、静脉或心脏内血块

形成的药物，同时还能预防现有的血块扩大。

抗凝血剂是用来治疗什么病情？

采用抗凝血剂疗法的病情或原因多种多样，其中

包括：

1. 房颤–一种异常的心律加快情况

2. 旨在降低某些手术后中风或心脏病发作的风险

3. 旨在预防人工心瓣膜或支架插入后不必要的血

凝块

上述情况可能增加血液凝结过度或过易的机率。所

形成的血块可能导致血液循环不畅或阻塞血管，从

而导致心脏病发作、中风、组织损伤或死亡。因

此，抗凝血剂是用来预防这些情况。

抗凝血剂类型

1. 华法林

2. 新型口服抗凝血剂

3. 低分子量肝素和普通肝素

华法林

作用原理？

华法林抑制维他命K被激活，一个凝血过程必备

步骤。

如何决定剂量？

华 法 林 的 剂 量 根 据 一 种 被 称 为 国 际 标 准 化 比 值

(International Normalised Ratio，INR)的血液测试结

果而定。INR测试测量的是血液凝结的容易程度。医

生将根据病情来确定INR的目标范围。如果INR结果

高于目标值(过高)，就意味着血液需要更多的时间来

形成凝块，增加了出血风险。如果INR结果低于目标

值(过低)，血液形成凝块所需的时间缩短，降低了出

血风险但增加血块形成的机率。治疗初期，医生可

能会要求您频繁进行血液测试，以便了解您的身体

对华法林的反应，以及决定适合您的剂量。根据INR结果，医生将告诉您是否需要更改剂量，以及什么

时候需要进行下一次血液测试。一旦开始服用常规

剂量，则不需要频繁进行血液测试，除非您病了、

更改了用药方案或者改变了饮食。

剂量的小变化可导致INR的显著改变以及其他不良副

作用。因此，非常重要的一点是，为了防止INR值的

波动，必需根据医生开具的剂量用药。不同的华法

林生产商生产的片剂含量存在微小差异，而华法林

被身体吸收的方式也有所不同。因此，持续使用同

一品牌的华法林是一种较安全的做法。在新加坡出

售的两个华法林品牌为Marevan和Apo-Warfarin。请

您认清您正在服用的华法林片剂的颜色。

蔡正豪先生的文章

外行人的心脏病学(六)

18 特写

抗凝血剂必知二三事

以下为有色片剂图表，列出每种品牌不同的颜色及剂量。

Marevan

Apo-Warfarin

棕色

1 毫克

蓝色

3 毫克

粉色

5 毫克

粉色 1 毫克 灰色 2 毫克 橙色 5 毫克

2. 众多药物相互作用

许多药物都会改变华法林在人体内的功能，因此将您

正在服用的所有药物都告知医生和/或药剂师。其中

包括处方药物或非处方药物、草药及维生素片，比如

阿司匹林、人参、银杏叶和月见草油。

新型口服抗凝血剂

这类最新研发的口服抗凝血剂通过直接抑制凝血因

子而发挥作用。新加坡使用的三种新型口服抗凝血

剂为：

1. 阿哌沙班(品牌名称：Eliquis) 2. 达比加群(品牌名称：Pradaxa) 3. 利伐沙班(品牌名称：Xarelto)

新型口服抗凝血剂更容易使用，因为它们不像华法林

有窄小的安全窗，而且不需要频繁的血液测试。它们

可以作为口服片剂轻松服用。

除了达比加群外，在过量的情况下，没有任何药剂可

以快速逆转其作用。

低分子量肝素和普通肝素

这些分子能够抑制启动凝血机制所需的凝血因子，从

而阻止凝块形成。

由于起效快，这是住院治疗很常用的一种治疗选项。

过抗凝情况下，它们的疗效可以轻易被逆转，而且这

些药物不会长时间停留在我们体内，有利于协助医师

在短时间内控制所需的抗凝效果。

由于这种药物只有注射剂型，不够便利，因而无法被

广泛使用于门诊环境。

可用低分子量肝素为：

1. 依诺肝素(品牌名称：Clexane)

2. 那屈肝素钙(品牌名称：Fraxiparine)

3. 亭扎肝素钠(品牌名称：Innohep)

普通肝素是于1916年发现的第一种抗凝血剂。低分子

量肝素是基于普通肝素发现的。这两种肝素在用途

和作用方面都是相似的。不过，普通肝素只能通过静

脉输入给药(通过静脉直接进入血液)，而低分子量肝

素则可以于皮下给药(在皮肤之下)或者在院外环境给

药。普通肝素可能需要频繁的血液测试，并密切地监

查其效果。普通肝素也会因受到其他蛋白结合药物影

响而产生药物与药物间相互影响情况。然而，相较于

低分子量肝素，普通肝素在研究方面则更为广泛也更

加经济实惠。

服用华法林时需要注意的其他事项

1. 众多食物相互作用

华法林的疗效会受到饮食中维生素K摄入量的影响。这并不

是说我们在饮食中应避免摄入维生素K。建议保持均衡的饮

食并维持相同水平的维他命K摄取量，不要出现剧烈变化。

富含维生素K的食物示例如下表。

食物 维生素K含量

低 中等 高

饮料 咖啡牛奶豆浆

绿茶花草茶

谷物粮食 面包 谷物意面大米

奶制品和鸡蛋

奶油 奶酪 鸡蛋

人造奶油

肉类 牛肉鸡肉猪肉海鲜

肝

蔬菜 胡萝卜白花椰菜芹菜黄瓜大蒜菇类洋葱马铃薯番茄

花椰菜抱子甘蓝高丽菜凉拌高丽菜生菜欧芹海藻菠菜大葱

水果 苹果香蕉葡萄柑橘

酪梨

19特写

蔡正豪先生是一名药剂师，在百汇东岸医院(Parkway East Hospital)药房執業。

服用抗凝血剂时要注意什么？

最常见的副作用是身体任何部位出现出血症状。出

血可以表现为轻微出血或严重出血且危急。因此，

很重要的一点是辨别身体出血迹象。您可能需要回

诊以调整用药剂量。

如何避免出血和淤伤：

• 刷牙时使用软毛牙刷。

• 清理家中走道上的家具及其他障碍物，形成通常

无阻的过道，从而降低跌倒风险。

• 在您需要额外支撑的地方安装扶手来防止跌倒，

如有必要可使用拐杖。

• 在家中使用盐水鼻腔喷雾剂或加湿器来保持鼻孔

湿润，防止鼻子变干，减低流鼻血的风险。

如果您的抗凝血药物不足，血块将很容易在您体内

形成，您将出现凝血迹象和症状。这也是非常危险

的，因为血凝块可能会破碎并进入您的肺部、腿部

和大脑，阻断患病区域的血液循环。您可能需要回

诊以调整用药剂量。

其他需要注意的事项

• 如果您已怀孕、计划生育或正处于哺乳期，请告知您的医生。您可能需要更换成更合适您的抗凝血剂。

• 接受任何手术或牙科治疗程序前，请告诉您的医生或牙医您正在服用抗凝血剂。这是为了预防手术过程

中过量出血。

• 由于您的出血风险高于常人，请在参加任何有可能导致受伤的活动时，多加小心。

• 如果您正在服用任何其他药物或补充剂，请告诉您的医生。这是为了确保这些药物或补充剂不和您体内

的抗凝血剂相互作用，以免增进或弱化预期疗效。

如 果 我 忘 记 服 药 怎 么办？

服用抗凝血剂时，必须记得按时服药。如果您忘

记服药，您的体内可能没有足够的抗凝血剂来防

止血凝块形成。服药时间间隔过短或者服用双倍

剂量，将稀释您的血液并可能导致出血。关于

忘记服药的补救方法，不同的抗凝血剂有特定

的指导说明。如您不确定，请务必咨询药剂师

或医生。

• 无故淤青或严重淤伤

• 粉色或红色尿 • 黑色柏油样便或血便

• 牙龈出血 • 流鼻血

• 咳血

• 流血不止

• 突发、严重且持续性头疼、晕眩或虚弱

• 跌倒，或头部或脸部受伤

• 月经血量大于正常情况

主要出血迹象

• 腿部凝块(深静脉血栓)可导致腿部肿

胀、发热、红肿、疼痛和麻痹。

• 心脏内(心脏病发作)和肺部(肺血栓)中

的血块可导致呼吸急促、尖锐胸痛、

上身不适、或手臂、背部、颈部或下

巴麻痹。

• 大脑血块(中风)可导致身体一侧虚弱无

力、头痛、短暂性昏迷、晕眩、知觉

丧失、口齿不清或视力模糊。

血凝块的主要体征

20 特写

前政务部长张思乐先生分享了

他的减重塑身心得

找回健康下定决心

问1. 您从何时开始被体重问题困扰？

大概是从我在海外生活和工作的时候开始。那时候，我的体重超过85kg，腰围也超过35英寸。医生告诉我因为过量的饮酒和进食，使我的身体衰老程度远超过我实际年龄应有的水平，如果继续放任后果会不堪设想。

问2. 您的减重契机为何？

我感觉在军队中要通过IPPT考核明显变难了，有一次仅爬完一小段楼梯就让我差点晕倒。这次意外使我下定决心要改变现状，选择更健康的生活方式。

问3. 在减重过程中您遇到最大的心理危机是什么？

对我来说比较大的困扰是效果总是不如预期，而且我也没办法确定我的减重方式究竟是否正确。

问4. 最近您成功减重了多少？花了多久时间？

现在我的体重控制在70-72kg左右，我用了一年的时间减重15kg。

问5. 当您想要偷懒或者放纵一下的时候，是怎么让您最终能坚持下去？

我报名参加了长跑和三项全能活动。坚持一段时间后我的身体适应了更健康的生活作息，这种作息也让人感觉越来越好；如今每天早晨5点起床锻炼两小时已经成为我的习惯。

问6. 减重让您的生活有了哪些改变？

成功减重让我信心倍增，在工作上更有活力，人也更有精神。

问7. 您如何保持心脏健康？

对我来说，是70%的营养+30%的锻炼。

问8. 最后，您是否有些小建议想与读者们分享？

一定要注意正确饮食。要不断给自己确定目标。就算只有10分钟的空闲也不要浪费，做点锻炼。记住频率比强度重要；关键不在于一次投入多少时间，而是你会不会坚持。

照片由张思乐先生提供

21特写

Preparation Time 准备时间:30 minutes 分钟

Cooking Time 烹饪时间:15 minutes 分钟

Serves 份量: 4 人份

Shrimp Whole WheatPasta with Greens虾仁鲜蔬全麦意大利面

Method 做法: 1. Cook and prepare the pasta as directed on the packaging. Then, set aside. 根据包装上的指示煮熟意大利面，放置一旁备用。 2. Mix the shrimps, red pepper flakes, salt and black pepper in a medium bowl. 将虾仁、红辣椒粉、盐和黑胡椒倒入碗中拌匀。3. Use a non-stick pan and heat the oil over a medium fire. 将米糠油倒入不沾锅中，以中火加热。4. Add in the garlic and cook till fragrant or golden brown. 倒入大蒜，直至炒出蒜香或呈金黄色。5. Sir-fry the spinach for 1 minute, then add in the cherry tomatoes and stir-

fry for another minute. 菠菜倒入锅中快炒1分钟，然后加入小西红柿，再快炒1分钟。6. Add in the shrimps and cook for around 1 to 2 minutes before turning off

the heat. 加入虾仁翻炒1-2 分钟，随后关火。7. Divide the pasta into 4 portions. 将意大利面分成4份。8. Pour the shrimps mixture, basil and lemon juice onto the pasta, toss to

combine and serve. 将炒好的虾仁、罗勒叶和柠檬汁倒在意大利面上，拌好后即可上桌。

Ingredients 材料:• Wholewheatdriedpasta,340g 全麦意大利面, 340克• Peeledcookedshrimps,28whole 去壳的熟虾仁, 28只• Redpepperflakes(optional),1/2 tsp 红辣椒粉(可选), ½茶匙• Goodsalt(reducedsodiumcookingsalt),1/2 tsp Goodsalt(低钠食用盐), ½ 茶匙• Blackpepper,Fewgrinds 黑胡椒, 碾碎• Ricebranoil,4tsp 米糠油, 4 茶匙• Garlic,4cloves(crushed) 大蒜, 4 瓣(切碎)• Cherrytomatoes,250g(halved) 小西红柿, 250克(对切)• Spinach,240g(chopped) 菠菜, 240克(剁碎)• Freshbasil,1/2cup(chopped) 新鲜罗勒叶, ½ 杯(剁碎)• Lemonjuice,4tbsp 柠檬汁, 4 汤匙

Nutrients per Serving 每份营养

Energy 能量: 398 kcal 千卡

Protein 蛋白质: 25 g 克

Fat (Saturated fat) 脂肪(饱和脂肪): 7 g 克 (1 g 克)

Carbohydrate 碳水化合物: 57 g 克

Sodium 钠: 473 mg 毫克

Cholesterol 胆固醇: 92 mg 毫克

Dietary fibre 膳食纤维: 12 g 克

22 Recipes

RecipecontributedbyMsTohYunXuan,SeniorNutritionistatSingaporeHeartFoundation.本食谱是由新加坡心脏基金(SHF)高级营养师卓芸瑄女士提供。

Preparation Time 准备时间:30 minutes 分钟

Cooking Time 烹饪时间:15 minutes 分钟

Serves 份量: 4 人份

Preparation Time 准备时间: 25-30 minutes 分钟

Cooking Time 烹饪时间: 20 minutes 分钟

Serves 份量: 4 人份

23食谱

迷迭香-柠檬鲑鱼及花椰菜

RecipecontributedbyMsTohYunXuan,SeniorNutritionistatSingaporeHeartFoundation.本食谱是由新加坡心脏基金(SHF)高级营养师卓芸瑄女士提供。

Ingredients 材料:Salmon 鲑鱼 • Salmonfillet,raw,480g 生鲑鱼片, 480克• Ricebranoil,4tsp 米糠油, 4 茶匙• Goodsalt(reducedsodiumcooking salt),1/2 tsp Goodsalt(低钠食用盐), ½茶匙• Blackpepper,1/2 tsp 黑胡椒, ½茶匙• Driedrosemary,1tsp 干燥迷迭香, 1茶匙• Lemonslices,2whole 柠檬片, 2粒• Lemonjuice,8tsp 柠檬汁, 8茶匙

Cauliflower 花椰菜• Cauliflowerflorets,4cups 切成小花球的花椰菜, 4 杯• Water,plain,1/4 cup 白开水, ¼ 杯• Ricebranoil,1/2 tbsp 米糠油, ½ 汤匙• Garlic,1clove(crushed) 大蒜, 1 瓣(切碎)• Driedcranberries,2tbsp(diced) 蔓越莓干, 2汤匙(切块)• Almonds,2tbsp(chopped) 杏仁, 2汤匙(剁碎)• Freshparsley,2tbsp(chopped) 新鲜香菜, 2 汤匙(剁碎)• Goodsalt(reducedsodiumcooking salt),1/4 tsp Goodsalt (低钠食用盐), ¼茶匙• Blackpepper,Fewgrinds 黑胡椒, 磨碎

Nutrients per Serving 每份营养Energy 能量: 345.8 kcal 千卡

Protein 蛋白质: 24.9 g 克

Fat (Saturated fat) 脂肪(饱和脂肪):21.5 g 克 (4.3 g 克)

Carbohydrate 碳水化合物: 13.8 g 克

Sodium 钠: 333.4 mg 毫克

Cholesterol 胆固醇: 34.3 mg 毫克

Dietary fibre 膳食纤维: 3.3 g 克

Cauliflower 花椰菜 6. Add the cauliflower and water into a pan, cover and cook over medium heat for about 3 minutes.

Removeandsoakinicewatertocool. 将花椰菜倒入锅中的水，盖上锅盖并用中火加热3分钟左右。关火，然后将花椰菜倒入

冰水中降温。 7. Using medium heat, add in the oil and garlic in a non-stick pan and cook till fragrant or golden brown. 使用中火，在不沾锅中放入米糠油和大蒜，持续翻炒直至炒出蒜香或呈金黄色。 8. Drain the cauliflower before adding it into the pan. 将花椰菜从冰水中捞出沥干，随后倒入锅中翻炒。9. Mix in the cranberries, almond, parsley, salt and black pepper. Stir to heat through. 加入蔓越莓、杏仁、香菜、盐和黑胡椒，继续翻炒。10.Servethecauliflowermixturealongsidewiththesalmon. 上桌前，将炒好的花椰菜和鲑鱼放在一起。

Method 做法: Salmon 鲑鱼1. Preheat a covered pan over medium heat. 用中火预热有盖的平底锅。 2. Slice the salmon equally into 4 portions and place

them on separate sheets of aluminium foil (bigenoughtowrapthesalmon).

将鲑鱼切成4份，然后分别平铺在铝箔纸上(铝箔纸要够大，以便能充分包住鲑鱼片)。

3. Brushthetopandbottomsidesofthefishwithoil, then season it with salt, black pepper and rosemary.

在鱼的上下两面刷上米糠油，然后用盐、黑胡椒和迷迭香调味鲑鱼片。

4. For each portion, drizzle2 teaspoons of lemonjuice and top with 2 lemon slices, before closing the foil into a tight package.

在每片鲑鱼上淋上2茶匙的柠檬汁，随后在上面摆上2片柠檬。最后，用铝箔纸将其包紧。

5. Place wrapped salmon pieces on the preheated panovermediumheatandcookforabout10–12minutes. Meanwhile, prepare the cauliflower.

将包好的鲑鱼片放在预热好的平底锅上，用中火加热10-12分钟。与此同时，准备花椰菜。

Rosemary-LemonSalmon With Cauliflower

TIP!Add in a medium baked potato

to make it a balanced meal!提示!

加上一粒中等火烤熟的马铃薯，可确保营养均衡！