Recently, the National Heart Association of Malaysia has published the updated clinical practice guidelines for 2017. (The document can be downloaded from the association’s website.)

The guidelines featured ways in which the onset and progression of cardiovascular disease can be prevented – taking into account local factors that affect health.

Prevalence of cardiovascular disease in Malaysia

According to a 2015 survey conducted by the Ministry of Health (MOH), approximately one in every two Malaysians has excess cholesterol, a potent risk factor for cardiovascular disease (CVD). In 2016, updated guidelines for the prevention of cardiovascular disease in women were issued – stressing on the importance of increasing awareness of risk factors, such as hypertension and diabetes.

A recent statistic has revealed that cardiovascular disease has been the primary cause of mortality in the country for ten years (2005 – 2014). This represents a considerable amount of mortality that can be reduced by altering lifestyle factors and increasing awareness about methods to prevent the onset of CVD.

Guidelines updated to adhere to WHO’s targets

The most important cardiovascular risk factors include diabetic and prediabetic states, hypertension, hypercholesterolemia, a sedentary lifestyle, tobacco smoking and obesity. The new guidelines focus on an individual assessment of cardiovascular risk based primarily on these risk factors and an increase in the use of preventative interventions to preclude progression of preexisting cardiovascular disease.

The guidelines were updated in order to remain relevant with new “developments in the field” and adhere to the targets published by the World Health Organisation (WHO).

The updated guidelines also serve to encourage a more “integrated approach” towards the prevention of cardiovascular disease by focusing on both primary and secondary prevention. As cardiovascular disease is multifactorial, it is also essential to encompass a range of healthcare professionals in the prevention of CVD.

Guidelines focus on lifestyle changes

As cardiovascular disease is primarily related to lifestyle factors, the updated guidelines focus on educating healthcare professionals on key elements, such as the avenues patients can pursue for smoking cessation and exercises which can be performed by elderly individuals.

Primary prevention can be implemented by assessing the overall cardiovascular risk of individuals and quantifying this by calculating the “Framingham Risk Score”. This score is a quantitative assessment and enables individuals to be classified into high or low risk categories.

The guidelines suggest that individuals at high risk of cardiovascular disease should make the appropriate lifestyle modifications to lower their risk and pharmacological therapy may also be used to regulate risk. For instance, statins can be prescribed to control hyperlipidemia and angiotensin receptor blockers are often used to treat patients with severe hypertension.

For the purpose of secondary prevention, dual antiplatelet therapies are often administered to patients after they suffer a cardiovascular accident such as a myocardial infarction or stroke. These therapies have traditionally included a combination of aspirin and a P2Y12 receptor inhibitor such as clopidogrel, which prevent the accumulation of platelets and therefore lower the risk of thrombus formation.

As the guidelines highlight simple principles for individuals to follow – such as obtaining eight hours of sleep and consuming a diet rich in fibre – individuals can easily adapt their lifestyles to accommodate these suggestions into their daily routines. MIMS

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