Heart disease is a major concern in Malaysia, where people are experiencing heart attacks approximately ten years earlier than those in developed countries. According to Datuk Dr Rosli Mohd Ali, a consultant cardiologist at Cardiac Vascular Sentral Kuala Lumpur, this trend has been consistent over the past several years.
I’m still young, no need to worry yet.” However, Datuk Dr Rosli notes that this mindset is one of the biggest barriers to improving heart health in the country.
The national cardiovascular registries reflect this trend, with approximately one in four patients with acute coronary syndrome being below the age of 50. Heart disease has remained Malaysia’s leading cause of death for most of the past two decades.
Datuk Dr Rosli explains that raised low-density lipoprotein cholesterol (LDL-C), or ‘bad cholesterol’, is a major contributor to the build-up of fatty deposits in blood vessels, which can narrow arteries and increase the risk of heart attack and stroke.
While diet plays a role in high cholesterol, Datuk Dr Rosli notes that genetics and the body’s cholesterol metabolism are also important factors. An individual’s LDL-C levels are influenced by how much cholesterol the body produces and clears, including factors such as liver metabolism and genetic factors like inherited conditions or family predisposition.
Datuk Dr Rosli recalls a case where an 18-year-old patient sought medical attention after experiencing chest discomfort, which was later found to be related to a strong family history of premature heart disease. This case highlights that cardiovascular risk is not always visible and can affect younger adults.
Understanding the Risks
Another case Datuk Dr Rosli treated was a 40-year-old sportsman who exercised regularly and maintained a healthy body weight, but was found to have significant blockages in his coronary arteries. The fact that he was slim, physically active, and appeared healthy did not protect him from heart disease.
Datuk Dr Rosli stresses that prevention begins with understanding personal risk factors like family history, diabetes, high blood pressure, obesity, and smoking. Malaysian health guidelines advise cholesterol checks for adults over 30, with high-risk individuals starting at 18.
Initial health checks usually involve cholesterol, blood pressure, and diabetes tests. Doctors then evaluate overall cardiovascular risk and decide if further tests are needed. Those at higher risk may require additional screening for early cardiovascular disease signs.
Effectively managing LDL-C involves a wide-ranging approach to heart health, combining healthy eating, regular exercise, and medical treatment to lower cardiovascular risk. Datuk Dr Rosli emphasizes lifestyle changes as the foundation but notes that additional treatment may be necessary to meet LDL-C targets.
Treatment decisions should always be individualized based on a person’s cardiovascular risk, LDL-C levels, and treatment goals. Datuk Dr Rosli explained that if treatment is needed, it is better to start earlier rather than later.
Importance of Early Screening
Malaysian guidelines recommend cholesterol screening for all adults aged 30 and above, while those at high risk of developing cardiovascular disease should begin screening from the age of 18. Initial assessments typically include cholesterol testing, blood pressure measurements, and diabetes screening. Doctors may then assess a person’s overall cardiovascular risk and determine whether additional investigations are required.
Current recommendations generally advise LDL-C levels below 1.8 mmol/L for individuals at high risk and below 1.4 mmol/L for those at very high risk. Datuk Dr Rosli said the earlier LDL-C is controlled, the lower it is maintained and the longer it stays under control, the better the outcomes are likely to be.
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