Malaysians Developing Heart Disease at Younger Age

National Heart Institute (IJN) consultant cardiologist Datuk Dr Ahmad Khairuddin Mohamed Yusof (LEFT) and Cardiac Vascular Sentral Kuala Lumpur – a cardiac and vascular hospital – consultant cardiologist Dr Choo Gim Hooi (RIGHT) during the launch of Repatha, a new cholesterol-lowering drug that is injected into the body, in Kuala Lumpur recently. fotoBERNAMA (2018) ALL RIGHTS RESERVED

By Erda Khursyiah Basir

KUALA LUMPUR (Bernama) -- Malaysians are developing heart disease at a younger age compared with their peers in other countries.

Citing Health Ministry statistics, National Heart Institute (IJN) consultant cardiologist Datuk Dr Ahmad Khairuddin Mohamed Yusof said in 2017, Malaysians developed heart disease at the age of 58 years, compared to populations in Thailand (65 years), mainland China (63 years), western countries (66 years) and Canada (68 years).

According to the World Health Organisation, in 2014 the Malaysian proportional mortality rate of cardiovascular diseases (CVDs) stood at 36 percent. Worldwide, an estimated 17.7 million people died from CVDs in 2015, representing 31 percent of all global deaths.

Dr Ahmad Khairuddin said high levels of cholesterol in the blood may lead to CVDs, which include heart attacks and strokes.

According to the 2015 National Health and Morbidity Survey, an estimated 47.7 percent of Malaysians aged 18 and above have high blood cholesterol, which is also known as hypercholesterolemia. This figure is a relative increase compared to 32.6 percent in 2011.

“Individual behavioural modifications are important, especially those related to one's lifestyle (to reduce cholesterol levels). Exercising, eating healthy food, avoiding alcohol and foodstuff containing polyunsaturated fat and lower calorie intake are all important," he told Bernama, here, recently at the launch of Repatha, a new cholesterol-lowering drug that is injected into the body.

Although treatment, including statin medication, can help to reduce high cholesterol, prevention is always better than cure, the cardiologist said, adding that CVDs can not only lead to physical dysfunction (disability) and extra financial burden but can also be emotionally taxing and cause depression among the patients and even the caregivers.

RISK FACTORS

Cholesterol is a waxy, fat-like substance found naturally in the blood and is predominantly produced in the liver. It can also be found in foods such as red meat, high-fat cheese, butter and eggs.

Dr Ahmad Khairuddin said cholesterol may exist in two forms, namely high-density lipoprotein cholesterol (HDL-C or good cholesterol) and low-density lipoprotein cholesterol (LDL-C or bad cholesterol).

While HDL takes cholesterol from tissues to the liver to be excreted from the body – thus, lowering the risk of heart disease – LDL carries cholesterol to tissues which may result in the obstruction of blood vessels. Therefore, high levels of LDL are recognised as a major risk factor for CVDs.

“Unhealthy lifestyle, as well as poor diet, obesity, smoking, high sugar intake and diseases such as diabetes mellitus or low thyroid gland activity, are among the causes of elevated cholesterol in the blood," he said, adding that genetic abnormalities can also cause high levels of LDL-C, a condition known as Familial Hypercholesterolemia (FH).

There are two types of FH – Heterozygous Familial Hypercholesterolemia (HeFH) and Homozygous Familial Hypercholesterolemia (HoFH).

HeFH occurs when the genetic mutation is inherited from only one parent while HoFH, a more severe version, is inherited from both parents.

It is important to treat these conditions early as they can cause an increased risk of premature CVDs. 

ASYMPTOMATIC CONDITION

Since most people with elevated cholesterol do not show any symptoms, many are unaware of their health conditions.

As high cholesterol levels are only detected when a blood test is carried out, it is also known as a silent killer.

“If the situation is left unattended, it may lead to atherosclerosis, which is the accumulation of cholesterol within the arteries that form deposits called plaque," explained Dr Ahmad Khairuddin.

The plaque, which is made up of fat, cholesterol, calcium and other substances found in the blood, will harden and cause the arteries to become more narrow, which eventually limit the flow of oxygen-rich blood to the organs and other parts of the body.

“This can cause ‘angina’ or chest pain which occurs when the blood supply to the heart is affected due to clogged arteries, or heart attack if the plaque-ridden arteries rupture and blood clots form, or also stroke if the blood flow to the brain is blocked due to clogged arteries."

Dr Ahmad Khairuddin, however, pointed out that although there were no clear symptoms, one may look out for "warning signs", especially on their skin, that indicate elevated cholesterol.

The signs include yellow patches around the skin of the eyelid, which is a condition known as ‘xanthelasma palpebrarum’; the appearance of a white or gray discoloured "arc" in the eye (‘Arcus cornealis’); or yellowish deposits on the tendons of the hands and feet (‘tendon xanthomata’).

REPATHA TREATMENT

Statins, a class of drugs, are commonly prescribed to lower high LDL cholesterol. However, sometimes statins alone may not be sufficient and in such a case, a new drug called Repatha may be used to further reduce LDL-C in patients who cannot reach optimum results with standard statin therapy. 

Cardiac Vascular Sentral Kuala Lumpur – a cardiac and vascular hospital – consultant cardiologist Dr Choo Gim Hooi said the combination of Repatha and statins may additionally reduce LDL-C by up to 77 percent compared to stand-alone statin therapy.

"Repatha is also known as 'evolocumab', a fully human monoclonal antibody which is designed to attach to a natural protein called PCSK9 that affects the uptake of cholesterol from the bloodstream into the liver.

"By attaching to and inactivating PCSK9, the medicine increases the amount of cholesterol entering the liver, hence lowering the level of cholesterol in the blood," he said.

Available in Malaysia since April 2018, Repatha is distributed by Zuellig Pharma and manufactured by Amgen, a biotechnology company with its headquarters based in the United States. 

Edited by Rema Nambiar

BERNAMA