Alarming increase in cardiovascular disease cases

KUALA LUMPUR: The rising rate of cardiovascular disease in Malaysia is alarming, with the average age of patients undergoing coronary angioplasty at about 57, said National Heart Institute (NHI) senior consultant cardiologist and director of Women’s Cardiology Dr Tan Lay Koon.

“This is a significantly younger age group compared with Japan, where the average age of patients undergoing a coronary angioplasty is 71. We are very concerned that Malaysian patients are presenting these coronary conditions at a far younger age.“

Tan said cardiovascular mortality in Malaysia accounted for 16.1% of all certified deaths in 2022, or 20,322, with some 8% of total hospitalisations in government and private hospitals attributed to cardiovascular diseases that year.

“Data reveals a concerning upward trajectory in cardiovascular morbidity and mortality over the years, except 2021, when deaths from Covid-19 surpassed those of cardiovascular disease.”

Tan said in 2021, cardiovascular disease caused 13.7% of deaths, compared with 17% in 2020 and 15% in 2019.

She also said the rising trend is attributable to an ageing population and an increasing prevalence of risk factors such as hypertension, diabetes and elevated cholesterol levels amid an increasingly overweight population.

Emphasising the gender disparity in cardiovascular disease diagnosis and treatment, she said only about 17% of patients undergoing coronary angioplasty were women.

“The lower figure is likely due to women with coronary artery disease tending to have non-obstructive lesions, which do not necessitate coronary angioplasty.”

Tan said it also reflects an under diagnosis and under treatment 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.

“Health screening programmes like the NHI Wellness Programme aim to detect and treat cardiovascular risk factors early, thereby curbing the progression to more severe conditions such as heart attacks or heart failure.

“The NHI Women’s Clinic, which is one of the few in the country, strives to raise awareness of cardiovascular disease in women and provides specific risk stratification and tailored treatment to meet the needs of this group.”

Tan said advancements in medical technology have played a significant role in improving patient outcomes and that new drug classes in the treatment of diabetes mellitus, hypercholesterolemia, and heart failure have significantly elevated the quality of life and prolonged life expectancy compared with a decade ago.

She said newer technologies and devices now offer non-surgical correction of valvular heart disease, circumventing the need for conventional open-heart surgery.

Tan also said digital health technologies such as wearables and telemedicine have also revolutionised healthcare.

“These tools enhance the accuracy of diagnostics and treatment, as well as the delivery of healthcare services.”

Popular wearable devices can detect atrial fibrillation – an irregular heartbeat that may lead to a stroke if untreated. However, these devices lack the accuracy of medical equipment.

She said currently, the rise of telemedicine, particularly during the Covid-19 pandemic, has provided an alternative means for patients to receive medical consultations without leaving their homes.

“This is especially beneficial for those with busy schedules or those who find it challenging to arrange for childcare or take leave from work.”

Tan said telemedicine allows clinicians to observe a patient’s home environment, which can impact their health, while also communicating with family members to provide a more holistic approach to management.

“While cardiovascular disease remains a formidable challenge, ongoing efforts in preventive measures, advancements in treatment technologies, and the integration of digital health tools offer hope for better management and improved outcomes.

“Considering the current situation, a concerted effort must be made to raise awareness and tailor healthcare approaches for men and women. This is crucial to curb the rising tide of cardiovascular disease.”