Resource person: Dr Yew Kuan Leong, Consultant Cardiologist, Bukit Tinggi Medical Centre (BTMC)

We are seeing a concerning trend where heart disease is affecting Malaysians in their 40s and even 30s. One in four cases in Malaysia involves individuals under 50, which is alarming.

Heart disease remains the leading cause of death worldwide, with atherosclerotic cardiovascular disease (ASCVD) responsible for over 15 million deaths each year. Worryingly, Malaysians are experiencing ASCVD at a much younger age compared to other countries – about ten years earlier on average, placing a significant burden on public health.

Right now, we are seeing a concerning trend where heart disease is affecting Malaysians in their 40s and even 30s. One in four cases in Malaysia involves individuals under 50, which is alarming.

A silent killer called high cholesterol

One of the biggest contributors to ASCVD is high cholesterol, or hyperlipidaemia, which occurs when excessive lipids accumulate in the bloodstream. Often referred to as a silent killer, high cholesterol presents no immediate symptoms but can lead to severe cardiovascular issues, including heart attacks and strokes.

Many people assume that if they feel healthy, they are safe from heart disease. That is a dangerous misconception. The only way to know your cholesterol levels is through regular screening.

Cholesterol is produced both by the body and through diet. While lifestyle choices play a crucial role, genetics also determine cholesterol levels. About 70-80% of cholesterol is produced by the liver, meaning even individuals with a healthy diet and active lifestyle can still have high cholesterol.

Are you at risk?

Doctors classify risk factors for heart disease into two categories: modifiable and non-modifiable.

(1) Modifiable risk factors – These include diet, exercise, smoking, and overall lifestyle habits. Regular physical activity and a diet low in saturated fats can help manage cholesterol levels.

(2) Non-modifiable risk factors – These are beyond an individual’s control, such as age, gender, genetics, and family history.

Some individuals inherit a condition called Familial Hypercholesterolemia (FH), which causes dangerously high cholesterol levels from a young age. One in 250 people has FH, but it often goes undiagnosed until serious complications arise.

Taking control of your heart health

Given the high prevalence of heart disease in Malaysia, proactive management is essential.

(1) Get screened regularly – Healthy adults should check their cholesterol levels every 6 -12months, but those with risk factors should do it more frequently.

(2) Know your numbers – LDL-C (bad cholesterol) should ideally be kept between 1.4 – 2.6 mmol/L depending on your risk level.

(3) Adopt a heart-healthy lifestyle – This includes a balanced diet, regular exercise, and quitting smoking.

(4) Consider medical treatment when necessary – For those with high cholesterol, lifestyle changes alone may not be enough. There are effective medications and newer innovative therapies that significantly lower LDL-C levels and reduce cardiovascular risks. However, it is crucial to follow your doctor’s recommendations and not self-adjust medication.

Heart disease is preventable, but only if you take action early. We need to change the mindset that heart disease is an ‘old person’s problem.’ Young people are at risk too, and prevention should start now.

If you haven’t had your cholesterol checked recently, now is the time. Speak to your doctor about your heart health and take proactive steps to protect yourself from cardiovascular disease.

Related: Poor healthcare access afflicts babies, moms in Asia and the world

Healthcare inequality remains a major issue today, with marginalized communities and vulnerable populations encountering disproportionate barriers to obtaining healthcare and suffering from poor health outcomes. Global efforts are being made to overcome this gap and promote greater healthcare fairness for all people, regardless of their background or circumstances.

Marginalized groups miss out on basic healthcare services

According to a recent Blood Cancer UK survey, marginalized groups such as those from Asian, Black, Mixed, or other ethnic backgrounds are more likely to learn they have a type of blood cancer from “a faceless source such as the internet”. The survey also found that certain age brackets, respondents with a degree-level education, and those with a higher income were more likely to be told they had a type of blood cancer.¹

The report “Raise the profile, reduce the harm” by Blood Cancer UK examines public attitudes of blood cancer and how its low profile can prevent many people from receiving critical care. The findings, which were released on World Blood Cancer Day (May 28), contain results from a survey of 2,571 people, including those with blood cancer, healthcare practitioners, and those who are more broadly affected.

Blood cancer, which includes lymphoma, leukemia, myeloma, and the diseases MPN and MDS, is the fifth most prevalent cause of cancer in the UK, according to the organization.

Meanwhile, it said that 6% of survey participants discovered they had blood cancer while taking part in its research.The likelihood of discovering a type of blood cancer through its survey doubled for those over 85 (8% vs 4% of 45-55s), those with a secondary level education (8% vs 4% undergraduate degree level), those with a below-average income (8% vs 4% above-average income), and those who identify as an ethnic minority (14% vs 6% who identify as white).²

Despite the fact that the majority of people affected by blood cancer (88% of 2,571 survey respondents) agreed that they should be told they have a type of blood cancer at diagnosis, Blood Cancer UK discovered that two out of every ten people from the identified groups have never been informed by a healthcare professional that they have a type of blood cancer. ³

Everyone has the right to make informed choices, especially when it comes to their health.  According to Tanya Kumar, assistance Services Officer at Blood Cancer UK, getting a thorough diagnosis assists people to understand their treatment options while also understanding their rights and accessing personalized assistance. ⁴

The more we can raise awareness among marginalized groups, the more people will be aware of the services available to them, and we can help unlock that assistance for those in need, said Helen Rowntree, Chief Executive of Blood Cancer UK.⁵

Poverty and inequities

Health specialists have investigated what is causing these discrepancies. Health disparities, according to the World Health Organization (WHO), are “systematic differences in the health status of different population groups across income brackets, and these inequities have significant social and economic costs both to individuals and societies.” Education, employment status, income level, gender, and ethnicity are among social characteristics that may influence a person’s health. The most striking fact, however, is that the lower an individual’s socioeconomic status, the greater their chance of bad health.⁶

It appears to be disproportionate, yet it is what it is. According to the WHO report, persons who are economically or socially disadvantaged have poorer health than those who are better off.

The rising cost of food makes it difficult for people, particularly those in lower economic strata or living in low-income nations, to afford better nourishment. Economic constraints also limit people’s access to safe drinking water, sanitation, and suitable shelter.

High rates of illness, particularly infectious disease and malnutrition, are believed to be common in low-income countries, which are also more likely to fail in coping with surroundings rife with infectious agents and a lack of competent medical care.⁷

NCD prevalence in Southeast Asia

Noncommunicable diseases (NCDs) such as heart disease, cancer, chronic respiratory disease, and diabetes are the top causes of death worldwide and are a growing global health concern. NCD mortality now outnumber all communicable disease deaths combined. According to the CDC, NCDs kill 41 million people each year, accounting for more than 7 out of every 10 deaths worldwide.⁸

A rising proportion of the burden of noncommunicable diseases falls disproportionately on the poor.  High rates of NCDs in low- and middle-income nations foster poverty, impede economic development, and strain frail health systems, rendering these countries less resilient in the face of emergencies such as infectious disease outbreaks or natural catastrophes, CDC said.

However, addressing NCDs is critical because, according to the CDC, every dollar invested in proven NCD interventions in low- and middle-income countries will generate at least $7 in greater economic development or reduced health-care expenditures by 2030. ⁹

According to WHO, the South-East Asia (SEA) Region contains a number of countries that are not only impoverished but also bear a considerable amount of the global illness burden. Despite improvements in the health of poorer populations in all countries, the gap between the poor and the rest of the population is growing. ¹⁰

Eliminating access gaps to benefit society

The goal of healthcare policies is to strengthen healthcare systems. However, it has never been emphasized that correcting health and healthcare imbalances will benefit societies. Increasing efforts to eliminate health disparities across social groups strengthens healthcare systems and adds considerably to economic growth.

According to a McKinseyHealth Institute report, reducing health inequities will necessitate “a comprehensive and multi-faceted approach” that will include improving access to affordable and high-quality food, healthcare services and products, and other resources essential to good health, making them available to all; investing in healthcare innovations that will address the needs of the disadvantaged; and increasing efforts to engage underserved populations.¹¹

SOURCES:

1. https://bloodcancer.org.uk/
2. Ibid
3. Ibid
4. Ibid
5. Ibid
6. https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes
7. Ibid
8. https://www.cdc.gov/globalhealth/healthprotection/ncd/global-ncd-overview.html
9. https://www.cdc.gov/globalhealth/healthprotection/resources/fact-sheets/global-ncd-fact-sheet.html#:~:text=Noncommunicable%20diseases%20(NCDs)%2C%20such,of%20death%20and%20disability%20worldwide.
10. https://apps.who.int/iris/handle/10665/205241
11. https://www.mckinsey.com/mhi/focus-areas/equity-and-health