KUALA LUMPUR – Cardiovascular disease is on the rise in Malaysia.

A paper released by a panel of medical experts in June revealed that Malaysians are getting heart disease eight years younger than the global average.

The average age of Malaysians who suffer a heart attack is 58, compared with 63 in Thailand and 68 in Singapore.

One of the main causes is high cholesterol going undiagnosed among many Malaysians.

Despite high cholesterol being the second most prevalent risk factor for heart disease, it had the lowest diagnosis rate of 35 per cent among the risk factors, according to the study.

About a quarter, or 24.6 per cent, of Malaysians were unaware they had high cholesterol.

“The relative age of cardiovascular disease (CVD) patients in Malaysia is lower compared with other countries,” said the paper titled Heart Matters: The Rising Burden Of Cardiovascular Disease In Malaysia And Potential Touchpoints For Interventions.

“In 2019, the mean age of these patients was 56 to 59 years, which is approximately 10 years younger than those in advanced countries, and as at 2019, almost one in four CVD patients was aged below 50.”

Dr Alan Fong, consultant cardiologist and author of the position paper, said high cholesterol is often overlooked.

“High cholesterol typically presents no noticeable symptoms – that’s why people often perceive it as being less dangerous,” he added.

A separate survey conducted in December 2022 on behalf of the Malaysian Medical Association and pharmaceutical company Novartis found that 75 per cent of Malaysians believe that high cholesterol comes with symptoms, which is untrue.

A blood test is the only way to detect it.

High cholesterol, particularly LDL cholesterol, increases the likelihood of developing atherosclerotic cardiovascular disease, the most common type of heart disease.

Atherosclerosis is a condition where LDL cholesterol and other substances accumulate inside the walls of blood vessels, forming atherosclerotic plaque. Over time, this can grow, especially when cholesterol levels are high, and cause severe narrowing of the blood vessels, which can lead to heart attack or stroke.

The paper’s co-author and consultant family medicine specialist Sri Wahyu Taher told The Straits Times that screening for the public at outreach events in places such as malls involves a simple finger prick test for total cholesterol levels. But this does not reveal LDL-cholesterol levels, whose tracking requires drawing blood from the arm in a healthcare set-up.

While she cautioned that the data compiled may not be representative of the entire population of the countries, she noted that Malaysia has the highest prevalence of obesity among South-east Asian countries, which could be one of the factors leading to Malaysians getting heart attacks at a younger age.

In 2019, the National Health and Morbidity Survey reported that one in two Malaysians was overweight or obese and four in 10 had high cholesterol.

Dr Sri Wahyu’s advice is for people to get a health screening at least once a year to check their blood pressure, blood glucose and cholesterol, and monitor their body mass index at home.

“People need to be active, undergo regular screening and pay attention to their health. Everybody needs to have that awareness,” she said.

Beyond the necessary lifestyle changes, the paper’s co-author and senior consultant cardiologist at Universiti Malaya Medical Centre, Datuk Wan Azman Wan Ahmad, said patients need to adjust their perception and beliefs towards cholesterol-lowering medication.

“Statins are generally the first-line medications prescribed to patients. There are also innovative treatments in the form of injectables available,” he added.

A cardiologist who declined to be named said the Malaysian patient demography differs from Singapore’s, and that different races have different prevalence rates for cardiovascular diseases.

Countries that are more affluent also tend to have patients experiencing heart attacks at an older age.

“Singapore is a small nation with a good public health system, good screening, and patients are compliant,” he added.

In comparison, he noted, Malaysia has a wide spectrum of patients, with people in urban areas who have greater health awareness and easier access to healthcare facilities, while those in rural areas may not know where to go for screening, or may not take medication even if they have healthcare access.

“In countries with a high economic status, you have access to a better and balanced diet,” he said, adding that their populations are unlikely to eat at hawker stalls every day.

In 2019, CVD was the leading cause of mortality and ranked fourth as a cause of hospitalisations in Malaysia’s public hospitals.

Treating CVD costs RM3.9 billion (S$1.1 billion) annually – more than 40 per cent of the total healthcare costs for non-communicable diseases in Malaysia, according to a report by its Health Ministry and the World Health Organisation.

A 2017 study estimated that CVD results in annual productivity losses of about RM4 billion.

Engineer and start-up founder Ammar Zolkipli, 44, had a sudden heart attack in 2022.

He initially experienced what felt like gastric pain. He felt pale, was short of breath and had numbness in his left arm.

A doctor at a clinic carried out an electrocardiogram (ECG) to check if there were any problems with his heart rate or heart rhythm.

The results were normal, and he was diagnosed with gastritis and told to go home.

That night, he had gastric pain again. His wife drove him to the emergency department at a private hospital, but the medical officer there was also convinced it was gastritis.

“By midnight, the pain had become worse and he was admitted to an isolation ward while waiting for his Covid-19 test results to be ready. By morning, he said he could hear a gurgling sound when he breathed, and the ECG finally picked up something. He was wheeled to the operating theatre immediately and an angioplasty was done,” his wife Bibi Misbah told ST.

Angioplasty is a procedure used to open blocked coronary arteries.

Mr Ammar is now on eight types of medication for heart failure, blood thinning and blood pressure.

He was previously diagnosed with elevated cholesterol in 2011 but had gone on a strict diet then and got it under control. However, his last health check was in 2018.

“The heart attack took us by surprise,” Mrs Bibi said. “I was very worried at the time, as he had a 100 per cent blockage of the left anterior descending artery and, because treatment was delayed, his heart was damaged. As a result, he now has heart failure.”

Mr Ammar has changed his diet to include foods that have more fibre, a low glycaemic index and are plant-based. He has cut out sugary items. He exercises daily and tries to get enough sleep and reduce stress.

His advice is for people to get a regular check-up, especially those aged 35 and above, and who have a strong genetic disposition to high cholesterol, high blood pressure and diabetes.