More than one-third of Singaporeans may be unaware of CVD risk factors

A significant proportion of Singaporeans without cardiovascular disease (CVD) may not be aware of their CVD risk factors, findings from the SEED* study showed.

“[I]t is concerning that in spite of the relative ease of access to information and health care in Singapore … over a third of patients with any of the three major CVD risk factors [diabetes, hypertension, hypercholesterolemia], alone or in combination, are still unaware of their condition(s),” said the researchers.

Participants were 6,904 adults (mean age 58.2 years, 52.6 percent female) enrolled in the SEED study. Participants did not have CVD (self-reported) but had one or more of the following conditions: hypertension (78.0 percent, n=5,386), hypercholesterolemia (52.2 percent, n=3,607), and diabetes (34.5 percent, n=2,380). Unawareness of the conditions was determined by the answer “no” to the question “Did your medical practitioner ever tell you that you have diabetes/hypertension/high cholesterol?”

About 43 percent of patients with hypertension were unaware of their condition, as were 40.9 percent of those with hypercholesterolemia and 30.7 percent of those with diabetes. [Popul Health Metr 2019;17:17]

Overall, unawareness of all conditions was highest among individuals aged 40–49 years and lowest in those aged ≥70 years (p<0.001) and highest in Malays compared with Chinese and Indians (p<0.001).

Compared with Chinese, Malays were more likely unaware of their diabetes (OR, 1.33; p=0.046) or hypercholesterolemia (OR, 2.68; p<0.001), while Indians and Malays were more likely unaware of their hypertension status (OR, 1.24; p=0.010 and OR, 1.44; p<0.001, respectively). Indians were more likely aware of their diabetes status (OR, 0.58; p<0.001).

Compared with non-smokers or former smokers, current smokers were more likely unaware of their hypertension (OR, 1.29; p=0.012) or hypercholesterolemia (OR, 1.35; p=0.018). A lack of education (≤6 years) was tied to unawareness of hypercholesterolemia (OR, 1.29; p=0.013).

Obesity was associated with unawareness of diabetes (OR, 1.50; p=0.005) and awareness of hypertension or hypercholesterolemia (OR, 0.52; p<0.001 and OR, 0.75; p=0.011, respectively), while being married was associated with awareness of hypercholesterolemia (OR, 0.58; p=0.002). Compared with professionals or office workers, those in blue collar jobs were more likely unaware of hypercholesterolemia (OR, 1.32; p=0.033), while homemakers, retirees, or unemployed participants were more likely unaware of hypercholesterolemia (OR, 1.54; p=0.003) and aware of diabetes (OR, 0.65; p=0.017). Notably, self-reporting of any of the three comorbidities was associated with increased awareness of the others.

Gender, alcohol consumption, income level, and housing type were not associated with unawareness of the conditions.

Unawareness of hypertension and hypercholesteremia was tied to a seven- and 14-fold increased likelihood of poor control of these conditions, respectively (OR, 7.65 and OR, 14.58; p<0.001 for both). In contrast, unawareness of diabetes was tied to better control of this condition (OR, 0.51; p<0.001).

The higher awareness of diabetes compared with hypertension or hypercholesterolemia may be partly due to extensive screening and education campaigns in Singapore, noted the researchers.

In addition, a proportion of patients lacked awareness of the conditions despite taking medications for them. This occurrence was attributed to a lack of education (>50 percent with primary or below education in this subgroup) or advanced age (>65 percent aged ≥60 years) and suggested that conversations about health status may be between doctors and caregivers and not between doctors and the patients. “[This] indicate[s] a need for awareness campaigns to utilize simplified language and descriptions about these three CVD risk factors in order to improve awareness in [these] individuals,” the researchers added.

“[The results] suggest that public education campaigns to increase awareness of CVD risk factors and promote the importance of annual health checks are needed to reduce high levels of unawareness of the three major CVD risk factors in adults aged ≥40 years in Singapore, particularly amongst Malay individuals and smokers,” the researchers said.