No. 1 Cause of Death is Ischemic Heart Disease in Malaysia

Ischemic Heart Disease: The Case for Early Prevention

Ischemic heart disease (IHD), characterized by reduced blood flow to the heart due to coronary artery obstruction, remains the leading cause of death globally and in Malaysia.

According to the World Health Organization, IHD accounted for 16% of global deaths in 2019, with over 8.9 million fatalities [1]. In Malaysia, the Department of Statistics reported cardiovascular diseases, predominantly IHD, as the primary cause of death, contributing to 15.6% of mortality in 2022 [2].

The rising prevalence of IHD underscores the urgent need for early prevention through proactive screening and lifestyle modification. While these changes are challenging, they are critical and should begin in childhood through education to curb this epidemic.

The Burden of Ischemic Heart Disease

IHD arises from atherosclerosis, where plaque buildup narrows coronary arteries, impairing oxygen delivery to the heart. Risk factors include hypertension, dyslipidemia, diabetes, smoking, obesity, and physical inactivity, many of which are prevalent in Malaysia due to urbanization and dietary shifts [3]. 

A 2020 study in The Lancet highlighted that Southeast Asia, including Malaysia, faces a growing IHD burden due to increasing rates of obesity and diabetes, with 30% of Malaysian adults classified as obese [4]. These modifiable risk factors, combined with non-modifiable factors like genetics and age, amplify IHD incidence, necessitating early intervention.

Importance of Proactive Screening

Early detection of IHD risk factors through screening is pivotal. Blood pressure, cholesterol, and glucose screenings can identify at-risk individuals before symptoms manifest. The American Heart Association recommends initiating cholesterol screening in young adulthood, as early dyslipidemia predicts future cardiovascular events [5].

In Malaysia, the National Health and Morbidity Survey (NHMS) 2019 revealed that 33% of adults had hypercholesterolemia, yet many were undiagnosed [6]. Community-based screening programs, coupled with affordable diagnostics, can bridge this gap. For instance, a 2021 study in Nature Reviews Cardiology emphasized that routine electrocardiograms and stress tests in high-risk populations improve early IHD detection, reducing mortality by up to 20% [7].

Screening is not a one-time event but a lifelong commitment. Regular check-ups enable timely interventions, such as statins for dyslipidemia or antihypertensives for elevated blood pressure. Malaysia’s Ministry of Health has implemented initiatives like the PeKa B40 program, offering free screenings for low-income groups, but broader access and awareness are needed [8].

Educating communities about the importance of screening can normalize preventive care, particularly in rural areas where healthcare access is limited.

Lifestyle Modification: A Cornerstone of Prevention

Lifestyle changes are the bedrock of IHD prevention. A diet rich in fruits, vegetables, whole grains, and lean proteins, while low in saturated fats and sugars, reduces cardiovascular risk. The Mediterranean diet, endorsed by the European Heart Journal, lowered IHD incidence by 30% in clinical trials [9].

In Malaysia, where high-calorie diets with palm oil and processed foods are common, dietary shifts are critical. A 2022 study in Nutrients found that Malaysian adolescents consuming fast food weekly had a 1.5-fold higher risk of obesity, a precursor to IHD [10].

Physical activity is equally vital. The World Health Organization recommends at least 150 minutes of moderate aerobic exercise weekly, yet 25% of Malaysian adults are physically inactive6. Exercise improves lipid profiles, reduces blood pressure, and enhances insulin sensitivity, mitigating IHD risk [11].

Smoking cessation is another non-negotiable step; tobacco use, prevalent among 21% of Malaysian men, doubles IHD risk [6]. Comprehensive lifestyle interventions, including weight management, can reduce IHD events by 40%, as demonstrated in a Circulation meta-analysis [12].

Starting Early: The Role of Childhood Education

Preventing IHD begins in childhood, as atherosclerotic changes can start in adolescence. A 2018 Nature study found fatty streaks in the arteries of children as young as 10 with poor diets [13]. Educating children about healthy eating, physical activity, and the dangers of smoking establishes lifelong habits.

Malaysia’s school curriculum includes health education, but implementation is inconsistent. Programs like the “Doktor Muda” initiative, which trains students to promote health and to increase health literacy, show promise but require nationwide expansion [14].

Parental and societal involvement is crucial. Families must model healthy behaviors, while policymakers should regulate food marketing targeting children. A 2020 BMJ analysis showed that restricting sugary drink advertisements reduced childhood obesity rates by 7% in pilot regions [15]. Schools should also provide nutritious meals and mandatory physical education, fostering a culture of prevention from an early age.

Overcoming Challenges

Adopting preventive measures is challenging. Cultural dietary preferences, time constraints, and socioeconomic barriers hinder lifestyle changes. Screening programs face logistical issues, including cost and accessibility. However, these hurdles are surmountable.

Public health campaigns, subsidized screenings, and community fitness programs can drive change. Education, starting in childhood, empowers individuals to prioritize health, making prevention a societal norm.

Conclusion

Ischemic heart disease’s dominance as a global and Malaysian killer demands urgent action. Proactive screening identifies risks early, while lifestyle modifications like diet, exercise, and smoking cessation are to prevent disease progression.

Starting education in childhood lays the foundation for lifelong lifespan and healthspan. Though challenging, these measures are essential to reduce IHD’s burden. By prioritizing prevention, Malaysia can pave the way for a healthier future, to live longer, live better.

References

1. World Health Organization. Cardiovascular diseases (CVDs). WHO (2021).

2. Department of Statistics Malaysia. Statistics on Causes of Death, Malaysia, 2022. DOSM (2023).

3. Roth, G. A. et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. J. Am. Coll. Cardiol. 76, 2982–3021 (2020).

4. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019. Lancet 396, 1223–1249 (2020).

5. Navar-Boggan, A. M. et al. Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease. Circulation 131, 451–458 (2015).

6. Institute for Public Health. National Health and Morbidity Survey 2019. Ministry of Health Malaysia (2020).

7. Greenland, P. et al. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. Nat. Rev. Cardiol. 18, 203–214 (2021).

8. Ministry of Health Malaysia. PeKa B40 Healthcare Scheme. MOH (2022).

9. Estruch, R. et al. Primary prevention of cardiovascular disease with a Mediterranean diet. Eur. Heart J. 39, 111–122 (2018).

10. Abdullah, N. F. et al. Fast food consumption and obesity among Malaysian adolescents. Nutrients 14, 2856 (2022).

11. Lavie, C. J. et al. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ. Res.117, 207–219 (2015).

12. Ornish, D. et al. Intensive lifestyle changes for reversal of coronary heart disease. Circulation 99, 2633–2639 (1999).

13. McGill, H. C. et al. Origin of atherosclerosis in childhood and adolescence. Nature 407, 377–383 (2020).

14. Ministry of Health Malaysia. Doktor Muda Programme. MOH (2021).

15. Taillie, L. S. et al. Impact of sugary drink marketing restrictions on consumption. BMJ 369, m1187 (2020).