The changing face of heart disease
Resource person: Datuk Dr Rosli Mohd Ali, consultant cardiologist, Cardiac Vascular Sentral Kuala Lumpur, Malaysia
Malaysians are experiencing heart attacks approximately ten years earlier than those in developed countries. [[1]] Yet many younger adults still view heart disease as something that only happens later in life.
“Heart disease? I’m still young, no need to worry yet.”
Cardiologist Datuk Dr Rosli Mohd Ali said this mindset remains one of the biggest barriers to improving heart health in Malaysia.
“Malaysians are now getting heart attacks at a younger age, around ten years younger than the global average. This has been true for the past several years, and it’s unlikely to change if Malaysians don’t change their attitude towards heart health,” he said.
The trend is reflected in national cardiovascular registries, where approximately one in four patients with acute coronary syndrome is below the age of 50.[[2]]
At the same time, heart disease has remained Malaysia’s leading cause of death for most of two decades. [[3]] [[4]]
“While cardiovascular disease may not account for the largest proportion of hospital admissions, heart disease and stroke remain among the leading causes of death [[5]],” said Datuk Dr Rosli.
The hidden risk of LDL-C
One reason heart disease often catches people by surprise is that elevated low-density lipoprotein cholesterol (LDL-C), commonly known as ‘bad cholesterol’, remains asymptomatic for years.
LDL-C contributes to the build-up of fatty deposits, or plaques, within blood vessels. Over time, these plaques can narrow arteries and increase the risk of heart attack and stroke.
While many people associate high cholesterol solely with an unhealthy diet, Datuk Dr Rosli explained that genetics, along with the body’s cholesterol metabolism, also play an important role.
An individual’s LDL-C levels are influenced by how much cholesterol the body produces and clears, which includes factors such as liver metabolism and other genetic factors such as an inherited condition or family predisposition.
Explaining further, Datuk Dr Rosli said, “The majority of LDL-C is actually produced by the body. In some people who naturally produce more cholesterol than others due to genetic factors, heart disease and stroke may occur at a much younger age.”
“Diet remains important, particularly as diets high in saturated and trans fats can stimulate the liver to produce more LDL-C, raising cholesterol levels and increasing cardiovascular risk.”
“However, lifestyle alone may not fully explain why some seemingly healthy individuals develop cardiovascular disease. Hence, it can be a huge misconception to believe that if you feel healthy, you must be healthy,” he added.
When heart disease strikes the young
One of the youngest patients Datuk Dr Rosli has encountered was just 18 years old.
The teenager sought medical attention after experiencing chest discomfort. Further investigations revealed a strong family history of premature heart disease. His father had developed heart disease in his 30s and died suddenly, while several siblings had also been diagnosed with cardiovascular disease at a young age.
“In his case, his family background may be a factor,” said Datuk Dr Rosli. “Cases like this remind us that cardiovascular risk isn’t always visible and it doesn’t only affect older adults.”
At the same time, appearances can be deceiving in the opposite direction.
Datuk Dr Rosli recently treated a 40-year-old sportsman who exercised regularly, maintained a healthy body weight and believed he was doing everything right.
“He told me that he was careful with his diet and got regular exercise. Generally, he took good care of his health. But when he underwent further testing, we found significant blockages in his coronary arteries.”
The experience underscores an important reality: being slim, physically active, or appearing healthy does not always mean a person is protected from heart disease.
“You never really know your cardiovascular risk until you check,” he said.
Prevention starts with knowing your risk
For the general population, the fundamentals remain unchanged: maintain a healthy diet, exercise regularly, manage body weight, avoid smoking, and ensure that the key cardiovascular risk factors are regularly monitored and adequately controlled.
However, Datuk Dr Rosli stressed that individuals with a family history of premature heart disease, diabetes, hypertension, obesity or smoking history may require earlier and more frequent 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.[1] While screening recommendations vary according to individual risk, Datuk Dr Rosli believes Malaysians should become more proactive about understanding their cardiovascular health.
“If you have significant risk factors or a family history of heart disease, do not wait until you experience a cardiovascular event. Get checked earlier.”
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.
For higher-risk individuals, further testing may be considered to detect early signs of cardiovascular disease.
The heart health trifecta
Managing LDL-C effectively requires more than a single intervention.
Datuk Dr Rosli advocates a holistic approach to heart health, where healthy eating, regular physical activity and appropriate medical treatment work together to reduce cardiovascular risk.
“These three components should not be viewed separately. Lifestyle changes remain the foundation, but for some people, additional treatment may be needed to help achieve and maintain recommended LDL-C levels.”
Every patient has a different cardiovascular risk profile and corresponding LDL-C target. 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.[6]
“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,” he said.
Staying the course
One of the biggest challenges in cholesterol management is that high LDL-C is often asymptomatic, making it difficult for some individuals to appreciate the importance of long-term management.
He believes that informed patients are often the most successful patients.
“The patients who ask questions and understand their condition are usually the ones who stay committed to managing it.”
Treatment decisions should always be individualized based on a person’s cardiovascular risk, LDL-C levels and treatment goals. While lifestyle measures remain the foundation of heart health, healthcare professionals may recommend cholesterol-lowering therapies for individuals who require additional LDL-C reduction to achieve recommended targets.
Datuk Dr Rosli explained that if treatment is needed, it is better to start earlier rather than later. Similarly, the higher a person’s risk, the lower their LDL-C levels should be in order to prevent cardiovascular events like heart attack and stroke.[6]
The guidelines recommend statins as the first-line treatment, with the possibility of combination therapy so that the necessary LDL-C targets can be achieved. For those whose levels remain above the recommended targets despite oral lipid-lowering therapy, or who are unable to tolerate statins, doctors may consider injectable therapies. [6]
Ultimately, Datuk Dr Rosli hopes Malaysians will shift from a reactive mindset to a preventive one.
“Don’t be complacent or remain ignorant,” he advised. “Heart disease can remain silent for years. The only way to know is to get checked, understand your risk and have an informed discussion with your doctor about the best way to protect your heart health.”
[1] Heart Matters: The Rising Burden of Cardiovascular Disease in Malaysia and Potential Touchpoints for Interventions. Available at: https://www.malaysianheart.org/management.file/doc/202312231133720341.pdf.
[2] Annual Report of the Acute Coronary Syndrome (ACS) Registry 2022 – 2023. Available at: https://www.malaysianheart.org/management.file/doc/202605057871297674.pdf
[3] Department of Statistics Malaysia. Statistics on Causes of Death, Malaysia, 2023. Available at: https://www.dosm.gov.my/portal-main/release-content/statistics-on-causes-of-death-malaysia-2023.
[4]Department of Statistics Malaysia. Statistics on Causes of Death, Malaysia, 2025. Available at: https://www.dosm.gov.my/portal-main/release-content/statistics-on-causes-of-death-malaysia-2025.
[5]Ministry of Health Malaysia. Health Facts 2022.
[6] National Heart Association of Malaysia. Clinical Practice Guidelines: Management of Dyslipidaemia 2023 (6th Edition). Available at: https://www.malaysianheart.org/management.file/doc/202312237439134019.pdf.
Category: Health alert, MJN enews
