Mr Chong Yi (not his real name) was 37 years old, happily married with his first child born just months earlier, and seemingly fit as a fiddle - when his health took a drastic turn for the worse.
"I started having difficulties walking up three or four flights of stairs at my workplace. I would break out in cold sweat, my heart would be pounding and the colours in front of me would fade to white as I felt close to passing out," he said, casting his mind back more than two decades.
At first, he dismissed it, thinking it was because he had stopped exercising for some months due to his heavy workload. After all, he "was the kind of guy who would do the most number of pull-ups in IPPT, run cross-country barefoot, rarely fall sick and if ill, would recover without needing to waste money seeing a doctor". The IPPT, or individual physical proficiency test, is a fitness assessment for Singapore Armed Forces personnel and national servicemen.
But over the next couple of months, his symptoms occurred more frequently and with greater intensity. He saw a doctor who referred him to a cardiologist.
That was when the bombshell landed - the cardiologist told him he had the arteries of an 80-year-old. When Mr Chong heard that, he felt "an eerie cold, gripping and squeezing me from the inside". His cholesterol level was high, and his arteries had multiple blockages, resulting in poor oxygen circulation.
His condition was so serious that an angioplasty was carried out on him that very night. The procedure, also called ballooning, cleared the plaque-induced blockages, and stents were placed to keep the arteries from getting blocked again.
"I had left the house in the morning to see a specialist, thinking that I might need to take some pills and start an exercise programme. But by lunchtime, it felt like my world was ending," he recalled. "There was nothing I could do. It was game over. I did not know how to tell my wife."
The procedure was not a total success. He said: "The cardiologist could not insert stents at all the necessary sites as there were many, and it was getting more painful for me as it dragged on.
"I still had blockages at other sites but the hope was that those that had been treated would be enough to allow oxygen to circulate sufficiently."
[[nid:643795]]
He was put on a high dose of medication to lower his cholesterol level before his condition improved. A couple of months later, "it was as though I got my fitness level back up again without having to exercise".
The cause of his high cholesterol level was not a matter of a poor lifestyle. He has an inherited condition called familial hypercholesterolemia (FH), which affects one in 140 people here.
These people have at least one mutated gene in their chromosome 19 that makes it difficult for their bodies to get rid of LDL (low-density lipoprotein), commonly known as bad cholesterol.
Some people with FH have high cholesterol levels from birth.
Mr Chong's cardiologist told him that even if he turned vegetarian, his LDL "would be dangerously high without medicine".
Mr Chong told The Sunday Times: "I do not drink or smoke. I started swimming. I avoid fatty food like the plague. Perhaps, I did not take it as seriously in the early days after the initial trauma wore off as I do now."
This is because he has since needed two further angioplasties - the second one eight years after the first, and the third one another four years later. "It is now nine years since my third and hopefully last procedure," he said.
The medication he is on has helped significantly in lowering his cholesterol levels. He said: "There are reasons to believe that it has somewhat reversed the plaque that had accumulated in my first 37 years. My ophthalmologist has noted that there is less plaque in the blood vessels in my retina now than in photos from 10 years ago."
As FH is inherited, the cardiologist told him to check his children when they were 10 years old. Both his sons have inherited this genetic variant and have high levels of LDL. Both have been put on medication and were cared for at KK Women's and Children's Hospital when they were children.
[[nid:627062]]
Although he had hoped the defect would skip a generation, Mr Chong said he wasn't "too devastated" when both his sons tested positive - after all, he had had a decade to come to terms with the condition.
His sons "do not think much of it", he said. "They have watched their father pop pills after meals, just like their mum takes multi-vitamins and health supplements, so it was not foreign or frightening." As a result of the early intervention, "their arteries are close to pristine, they are conscious of what they eat, they are repulsed by smoking and drinking, and exercise is a way of life".
Mr Chong added: "Since we now know that both my sons have the faulty gene, when their turn comes, they will send their children for testing too."
His advice to others who have a member diagnosed with FH is to get tested.
"It is not a terminal condition where knowing or not knowing makes no difference. There are medicines to counter the effects of FH, so why risk a much shorter life by not getting tested?
"If you suffer an unexpected heart attack in your 30s, thinking 'If only I knew beforehand', it's too late."
This article was first published in The Straits Times. Permission required for reproduction.