Presented at the ASEAN Federation of Cardiology Congress 2017 (AFCC2017) in Brunei, the study looked at 48,851 patients between 2006 and 2015 – zooming into the trends in cholesterol levels among local patients with acute coronary syndromes (ACS).
These patients were enrolled in the National Cardiovascular Disease Database Acute Coronary Syndrome (NCVD-ACS) Registry. The registry is maintained by the National Heart Association Malaysia (NHAM), with the support of Malaysia’s Ministry of Health (MOH).
According to the World Health Organisation (WHO), globally, a third of ischaemic heart disease was attributable to high cholesterol levels, which was estimated to cause 2.6 million deaths (4.5% of total) and 29.7 million disability adjusted life years (2% of total).
In Malaysia alone, 13.2% of the 162,201 total deaths recorded in 2016 was due caused by ischaemic heart diseases, according to the Department of Statistics Malaysia.
The number of non-communicable diseases (NCDs) in the nation is showing worrying trend – with recent report released by the MOH echoing that NCDs are responsible for nearly 73% of total deaths in Malaysia. Half of this number were caused by cardiovascular diseases (CVD).
Healthy lifestyle and medicine to combat bad cholesterolThe importance of cholesterol management in preventing heart attacks has been long debated. The two major ways of cholesterol management, are lifestyle changes – a proper diet, adequate exercise, as well as limit on alcohol consumption and smoking – and medicinal intake.
"On average, diet and exercise can reduce bad cholesterol by about 10% in our body while medications can lower bad cholesterol by another 20% to more than 50%," expressed senior consultant cardiologist Dr David Quek.
On the other hand, medicinal drugs such as statins may reduce LDL-C levels by up to 50%, even though they vary in intensity.
"Lifestyle changes appear to be responsible for falls in blood cholesterol in the general populations of developed nations while statins have reduced cholesterol in patients with heart disease," said Dr Sazzli Kasim, Chair, Malaysian Society of Atherosclerosis and Associate Professor of Medicine, University Technology MARA, and author of the study.
Statin helps to reduce heart attack, not just lifestyle changes, reveals Malaysian studyBy examining the total cholesterol by type of ACS, patients with unstable angina were found to have the lowest total cholesterol, yet the sharpest rate of decline. This was followed by patients with non-ST-elevation myocardial infarction and then patients with ST-elevation myocardial infarction.
"Since cholesterol levels have increased significantly in the Malaysian population as a whole, it is highly doubtful that lifestyle change is the reason for the declining cholesterol trend we observed in the ACS population," remarked Dr Sazzli.
He carefully added that the study was simply observational and causality could not be inferred. However, the declining rate in cholesterol among ACS patients with a history of coronary heart disease is almost twice as those without the history of coronary heart diseases. This shows the rapid decrease in the risks of heart attacks with the use of statins.
“These results appear to mimic findings from developed countries in previous years and show that the Malaysian population is reaching similar health milestones,” he concluded.
On a final note, Dr Kasim urged to increase awareness of the dangers of raised lipid values among the general Malaysian population.
"This large study suggests that statins are being effectively used by heart attack patients in Malaysia. Rising lipid levels in the general population need to be tackled by promoting healthier lifestyles," echoed Dr Ezam Emran, scientific chair of AFCC2017. MIMS
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