By Tan Yihui

Businessman Teo Kong Hwee used to measure the distance he walks by lamp posts.

The 59-year-old recalls: 'Whenever I walked too far, my legs would feel very painful. At first I could still walk the length of one lamp post to another, then the distance started getting shorter and shorter.'

For a decade, he tried everything from acupuncture to Western medicine, but to no avail. Walking became arduous - he had to stop and rest every 30m or so before he could continue.

It was only this year that, on the advice of a new doctor, he went for a scan at Tan Tock Seng Hospital (TTSH) and was diagnosed with atherosclerosis in his limbs.

The condition refers to the narrowing and hardening of arteries due to a build-up of cholesterol, fatty deposits and other cells. It is a process that can begin from childhood and continue for the rest of a person's life. According to doctors, atherosclerosis is also an underlying cause - as much as 90 per cent - of cardiovascular diseases.

As the arteries become blocked, the supply of oxygen-rich blood to organs and various parts of the body is reduced, resulting in various problems from heart attacks to strokes and, in the case of limbs when untreated, gangrene.

And the startling fact is: A recent survey conducted by the Singapore Heart Foundation and healthcare group AstraZeneca revealed that almost 50 per cent of patients with atherosclerosis had not tested their cholesterol levels in the past year.

While there is no stipulated frequency for cholesterol testing, doctors say it should be done at least once a year as part of a full-body check-up.

According to TTSH's vascular surgeon, Dr Sanjay Nalachandran, how symptoms present themselves vary according to the organs the affected vessels are supplying blood to.

Atherosclerosis may even be asymptomatic. Dr Terrance Chua, chairman of the Singapore Heart Foundation, says: 'As the condition is progressive, symptoms may take years to appear, if at all.'

Experts say men are more susceptible, with Indians up to three times more likely to get the disease, even though exact reasons are yet unknown. Risk factors range from obesity, smoking and high blood pressure to cholesterol and genetic make-up. Other conditions such as diabetes and hypertension can also increase susceptibility.

Treatments include a modification in lifestyle such as exercise and a healthier diet to prescription of blood-thinning medication and, in severe cases, surgery.

Mr Teo went for a bypass operation earlier this month and is still recovering. He says he feels no pain now and expects to regain his mobility with blood-thinning and cholesterol-lowering medication.

Doctors cite a lack of awareness of the disease as the biggest issue. According to Dr Chua, life-long medication to regulate cholesterol levels is safe and effective, but there is a misconception among patients that once levels are brought down, medication should be ceased.

Adds TTSH's Dr Nalachandran on patients' ignorance: 'They come to the clinic and they complain of a leg or sole problem, and they assume the problem is only there.'

Others just were not aware of their cholesterol levels until symptoms appeared, as indicated in the survey.

Ms Teo Mee Lee, an executive trainer in her 50s, was put on medication after being diagnosed with atherosclerosis. She says: 'I never went specially to check my cholesterol levels. Now I check it once every three or four months.

'I had no idea I had atherosclerosis until I fell sick and fainted one day.'

She went for a cholesterol check only upon recommendation by her doctor.

Dr Nalachandran adds: 'I always tell my patients: Though you're feeling the symptoms now at 60, this has been going on for the last 20 years.'

Dr Chua says a reason for non-action could be that some might be aware of such conditions 'but this awareness does not translate into a change in behaviour'.

Thankfully though, some people, such as Mr Teo, are willing to make the change. Says the smoker of 30 years, who used to smoke 30 cigarettes a day: 'I think I will give up smoking.'

tanyihui@sph.com.sg

This story was first published in thesundaytimes on Sept 28, 2008.

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