The escalating rate of cardiovascular disease in Malaysia is not just a cause for concern but a pressing issue that demands our immediate attention.

The average age of patients undergoing coronary angioplasty, as reported by National Heart Institute (NHI) Senior Consultant Cardiologist Dr Emily Tan Lay Koon, is about 57. This is in stark contrast to the average age for the same procedure in Japan, which is 71, underscoring a troubling trend in Malaysia.

This discrepancy suggests that Malaysians are experiencing severe heart conditions at a much younger age. Dr Tan noted that cardiovascular mortality accounted for 16.1 per cent of all certified deaths in Malaysia in 2022, with cardiovascular diseases contributing to eight per cent of total hospitalisations in both government and private hospitals.

She attributed this trend to an ageing population and an increase in risk factors such as hypertension, diabetes, and elevated cholesterol levels, compounded by a growing prevalence of overweight individuals.

However, Dr Jeyarajah Sivalingam, a consultant physician at M·A·C· Clinics, offered a different perspective on these statistics.

A former physician and senior lecturer in cardiology at the Faculty of Medicine, UiTM and Selayang Hospital, he believes that while the statistics are alarming, they may not fully reflect the reality.

THE NECESSITY OF ANGIOPLASTY

“Coronary angioplasty is not a definitive endpoint,” he explained. “It’s often influenced by doctors persuading patients to undergo the procedure, which can distort the statistics.”

Dr Jeya questioned the interpretation of these figures, suggesting that the frequency of angioplasty could be more related to insurance coverage and the availability of advanced screening tools rather than a genuine increase in severe heart conditions.

“Are we seeing younger patients needing angioplasty because of better diagnostic tools, or is it because of an actual rise in severe cases?” he asked.

He emphasised that coronary angioplasty should primarily be performed for major or minor heart attacks, noting that many procedures are conducted on patients with 50 to 60 per cent blockages, which do not necessarily require such interventions.

“A significant proportion of angioplasties in Malaysia are carried out mostly under insurance for patients in this age group,” he observed, suggesting that this practice could explain the younger age of patients undergoing the procedure.

Dr Jeya also challenged the assumption that angioplasty significantly improved life expectancy or prevented heart attacks in patients without severe symptoms.

“Many patients would benefit more from lifestyle changes and medications like aspirin if they have risk factors,” he advised.

He stressed the importance of public screening and education to manage these risk factors early rather than relying heavily on surgical interventions.

TECHNOLOGY’S ROLE IN HEART HEALTH

While Dr Tan highlighted advancements in medical technology and digital health tools like wearables and telemedicine, Dr Jeya remained cautious.

He acknowledged that these tools enhanced diagnostic accuracy and treatment but warned they should not replace essential lifestyle changes and preventive measures.

However, Dr. Jeya advocated for a more conservative approach to managing cardiovascular health, especially in asymptomatic patients.

“If someone has a 90 per cent block age but lives a full life without chest pains and passes a stress test, they might not need a stent. The heart can often develop new blood vessels to bypass blockages naturally,” he explained.

Dr Tan also emphasised the gender disparity in cardiovascular disease diagnosis and treatment, noting that only about 17 per cent of patients undergoing coronary angioplasty are women. This lower figure likely reflects an underdiagnosis and undertreatment of women, stemming from a lack of awareness and the perceived low incidence of cardiovascular disease among them.

The National Cardiovascular Disease Database from 2019 to 2020 highlighted the need for increased awareness and tailored healthcare approaches for women.

In contrast, Dr Jeya underscored the necessity of lifestyle changes over medical procedures.

“We need to focus on preventive measures like diet and exercise.

“The Japanese population, according to all data, is definitely healthier than Malaysia’s. But using angioplasty as the
barometer to compare heart health is wrong,” Dr Jeya stressed.

Dr Jeya’s emphasis on public education and screening was not just a suggestion but a call to action. He pointed out these measures were crucial to manage and reduce risk factors effectively, making the patients feel informed and proactive in the fight against cardiovascular disease.

BALANCED APPROACH TO HEART HEALTH

While the statistics on cardiovascular disease in Malaysia are concerning, it’s crucial to interpret them in context.

Dr Jeya’s insights suggested that a balanced approach, combining early screening, lifestyle changes, and judicious use of medical interventions, could be more effective in managing the country’s cardiovascular health crisis.

As Dr Tan emphasised, raising awareness and tailoring healthcare approaches for both men and women remained essential.

However, to curb the rising tide of cardiovascular disease, the focus should also be on preventive measures and holistic patient management.