Heart Attack & Stroke: What’s My Risk? A Further Look at Critical Illnesses

As people live longer, we fall sick with critical illnesses more and more often. In our previous post, Cancer: What’s My Risk?, we looked at the risk of being diagnosed with severe cancer. Cancer is the leading cause of death in Singapore, affecting primarily older people. A look at the statistics collated by the National Registry of Diseases Office (NRDO) shows that the risk of critical cancer, that is a diagnosis of Stage 3 or Stage 4 cancer, is around 60% of our risk of death at any point in our lives. Here, we look at the other two major critical illnesses which, together with cancer, account for 90% of all critical illness insurance claims – heart attack and stroke. Once again, we ask the question, what’s my risk?

Critical Illnesses: Heart Attack and Stroke

Heart Attacks

More scientifically, Acute Myocardial Infarction (AMI), heart attacks are the second most common critical illness. It is a form of ischaemic heart disease, often caused by the narrowing of arteries due to the build-up of cholesterol deposits. The data recorded by the NRDO on AMI shows that the occurrence of heart attacks is quite common in Singapore, at around the same frequency as cancer. However, even though the number of heart attacks recorded is rising, there has really been no trend increase or decrease in the rate of occurence over the past decade:

Heart Attack Incidence in Singapore (2010 – 2020)

Trends in Heart Attack Incidence (2010 – 2020)

Heart Attacks Incidence and Age (2010 – 2020)

Source: NRDO

From the summary information above, it is clear that the increasing number of heart attack cases today is a function both of an ageing population, as well as population increase. If anything, the fatality rates from heart attacks seem to be getting lower somewhat. At the same time, the Age Standardised Incidence Rate (ASIR) for heart attacks seem to indicate that it is at the same level as what we see for cancer (207 cases per 100,000 people for heart attacks versus 235 cases for cancer). Hence, at first glance, heart attacks is as worrying as cancer in terms of a source of critical illness diagnosis.

However, just like the case for cancer, not all heart attacks are of the same severity. The medical profession classifies heart attacks as being of the more severe STEMI cases and the less severe NSTEMI cases. NSTEMI cases are more prevalent as it could occur on its own or as a complication in very sick patients. On the other hand, STEMI cases are more severe with a higher likelihood of fatality if intervention is not provided promptly. The chart below shows that STEMI cases account for about a quarter of all heart attacks.

STEMI and NSTEMI Heart Attack Incidence

Source: NRDO

If we assume that critical heart attack risk is associated with STEMI cases only, how does the risk of critical heart attacks compare with other health risks like cancer? Previously in Cancer: What’s My Risk? we see that critical cancer risks (defined as a Stage 3 or Stage 4 cancer diagnosis) are somewhat lower than the risk of death, for both men and women, at every stage of life. In fact, critical cancer risks are only about 60% of the risk of death from any cause. How does it look for critical heart attack risk?

When we plot the risk of critical heart attack risk next to the risk of death from any cause (as a benchmark), we see that for both genders, it is only about 20% of the risk of death.

Critical Heart Attack Risk for Men, compared to Risk of Death from Any Cause (2020)

Critical Heart Attack Risk for Women, compared to Risk of Death from Any Cause (2020)

Overall across all ages and both genders, the risk of critical a heart attack is low, compared to the risk of death. Compared to the risk of critical cancer, critical heart attack risk is even lower, at about half that for cancer.

Stroke

Cerebrovascular disease was the fourth most common cause of death in 2020, accounting for 6.0% of all deaths in Singapore. Stroke is a type of cerebrovascular disease. The data recorded by the NRDO on Strokes shows that the occurrence of strokes is quite common in Singapore, although less so than cancer or heart attacks. Moreover, there has really been no trend increase or decrease in the rate of occurrence of strokes, over the past decade, with the rising number attributable mainly to the increasing number of aged:

Stroke Incidence in Singapore (2010 – 2020)

Trends in Stroke Incidence (2010 – 2020)

Stroke Incidence and Age (2010 – 2020)

Source: NRDO

Just like heart attacks, there are two main types of stroke – ischaemic stroke (IS) and haemorrhagic stroke (HS). IS is more prevalent and it occurs due to blockage of blood vessel, which limits blood flow to the brain. HS is more severe and it occurs due to ruptured blood vessel that causes bleeding in the brain. IS is commonly treated with blood thinning drugs, such as anti-platelets and anti-coagulants, while HS is usually treated with surgery or endovascular therapy.

Ischaemic and Haemorrhagic Stroke Incidence

Source: NRDO

For stroke, a critical illness is usually defined as “A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, intracerebral embolism and cerebral thrombosis resulting in permanent neurological deficit“. This also means that transient ischaemic attacks are excluded from this definition. Hence, we will assume here that critical strokes only consists of the haemorrhagic strokes. And from the chart above, we can see that such hemorrhagic strokes usually account for about 20% of all strokes.

So once again, let us benchmark the risk of a critical stroke against the risk of death from any cause across the ages of 30 to 80 for both genders:

Critical Stroke Risk for Men, compared to Risk of Death from Any Cause (2020)

Critical Stroke Risk for Women, compared to Risk of Death from Any Cause (2020)

Overall across all ages and both genders, the risk of a critical stroke is very low, compared to the risk of death. Compared to the risk of critical cancer, critical stroke risk is even lower, at about a quarter that for cancer.

Conclusions: What’s My Risk of a Critical Illnesses like Heart Attack and Stroke?

Until not too long ago, mankind had a healthy fear of death. Which is not surprising, given the short life expectancies, and a range of wildlife, illnesses and accidents which can cut one’s life short very quickly! But in recent times, this fear of death has receded, perhaps thanks to urban living, and improvements in medical science. You just need to look at the number of people indulging in active holidays and extreme sports to realise that we have lost our fear of death!

But we still fear the unknown. With sedentary lifestyles nowadays and a richer diet, plus lack of exercise, critical illnesses such as heart attack and stroke and cancer have replaced death as our number one fear. But is this warranted? What we have set out to do here is to gather the statistics on these critical illnesses to work out whether we need to fear them.

And the answer appears to be that we do not need to fear critical illnesses. The big three, which account for the most number (90%) of critical illness claims (heart attack, stroke and cancer) at insurance companies only collectively amount to a level of risk equal to the risk of death from any cause.

Comparing the Annual Risks of Death and Critical Illnesses for Men

Age	Death	Cancer	Heart Attack	Stroke
30 – 39	0.0485%	0.0396%	0.0101%	0.0054%
40 – 49	0.1279%	0.0995%	0.0534%	0.0245%
50 – 59	0.3479%	0.2599%	0.1369%	0.0635%
60 – 69	0.9102%	0.6845%	0.2440%	0.1168%
70 – 79	2.3957%	1.3782%	0.4223%	0.2019%
80+	5.0840%	1.8960%	1.0770%	0.4501%

Comparing the Annual Risks of Death and Critical Illnesses for Women

Age	Death	Cancer	Heart Attack	Stroke
30 – 39	0.0269%	0.0390%	0.0036%	0.0031%
40 – 49	0.0750%	0.1039%	0.0192%	0.0143%
50 – 59	0.2096%	0.2026%	0.0493%	0.0370%
60 – 69	0.4890%	0.3417%	0.0878%	0.0680%
70 – 79	1.4008%	0.5865%	0.1520%	0.1176%
80+	3.0370%	0.9331%	0.3876%	0.2622%

Net, what the statistics tell us is not to fear critical illnesses in Singapore. Instead, fear death!

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