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Experts Call For More Effective Management of High Cholesterol in Cardiovascular Fight
8 Jun 2023

Those with high LDL-cholesterol need to change their outlook. We see a lot of patients who are not willing or resistant to optimally managing their cholesterol levels - Dr Wan Azman

(Left) Jonathan Roberts, IQVIA, Dr Sri Wahyu Taher, Consultant Family Medicine Specialist, Ministry of Health, Dato’ Dr Wan Azman Wan Ahmad, Professor and Senior Consultant Cardiologist, Universiti Malaya Medical Centre, Dato’ Sri Dr Azhari Rosman, Senior Consultant Cardiologist, Institute Jantung Negara, Datuk Dr Zanariah Hussein, Consultant Endocrinologist, Hospital Putrajaya and Prof Dr Asrul Shafie, Professor of Pharmacoeconomic, Universiti Sains Malaysia.

Heart Matters Position Paper Highlights High Cholesterol As The Most Underdiagnosed Major Cardiovascular Risk Factor

Kuala Lumpur, June 8, 2023 – A panel of multi-disciplinary health experts today stressed the importance of detecting and managing high cholesterol, along with other cardiovascular (CVD) risk factors, to avoid heart attacks and strokes.

Cardiovascular disease is on the rise in Malaysia with patients presenting eight years earlier than the global average. In 2019, the National Health and Morbidity Survey reported that 1-in-2 Malaysians were overweight or obese; 4-in-10 had high cholesterol; 3-in-10 had hypertension; and 1-in-5 had type 2 diabetes mellitus.

Cholesterol Second Most Prevalent Risk Factor

However, despite high cholesterol being the second most prevalent risk factor, it had the lowest diagnosis rate (35%) amongst all risk factors. More worryingly, about one quarter (24.6%) of people were unaware they had high cholesterol.

(2nd from the Left) Dr Sri Wahyu Taher, Consultant Family Medicine Specialist, Ministry of Health, Dato’ Sri Dr Azhari Rosman, Senior Consultant Cardiologist, Institute Jantung Negara, Dato’ Dr Wan Azman Wan Ahmad, Professor and Senior Consultant Cardiologist, Universiti Malaya Medical Centre, Datuk Dr Zanariah Hussein, Consultant Endocrinologist, Hospital Putrajaya and Prof Dr Asrul Shafie, Professor of Pharmacoeconomic, Universiti Sains Malaysia at the panel discussion sharing on ‘Can we stem the tide of Cardiovascular disease’

This was highlighted during a media briefing held in conjunction with the launch of a position paper titled Heart Matters: The Rising Burden of Cardiovascular Disease in Malaysia and Potential Touchpoints for Interventions.

The panel of authors comprised leading Malaysian experts in cardiology, endocrinology, family medicine, public health, and pharmacoeconomics.

According to consultant cardiologist and author of the position paper, Dr Alan Fong, high cholesterol is often overlooked or taken for granted. He said: “High cholesterol typically presents no noticeable symptoms, that’s why people often perceive it as being less dangerous. Many do not realise that high cholesterol, particularly LDL-cholesterol, increases the likelihood of developing atherosclerotic cardiovascular disease or ASCVD, the most common type of heart disease out there.”

He explains: “Atherosclerosis is a condition where LDL-cholesterol and other substances accumulate inside the walls of blood vessels, forming atherosclerotic plaques. Over time, these plaques can grow, especially when cholesterol levels are high. As the plaques grow, they can cause severe narrowing of the blood vessels, and can lead to life-threatening features of ASCVD, such as heart attacks or strokes.”

Younger Malaysian Patients

As Dato’ Dr Wan Azman Wan Ahmad echoes the message. He said: “It’s concerning that Malaysian patients are getting younger. These days, we are seeing an earlier onset of CVD cases, with the average age of patients ranging from 56 to 59 years old. This is 10 years younger than in developed countries. And, worryingly, about 25% of our patients with acute coronary syndrome are below the age of 50.”

Consequently, he stresses that it is important for patients to proactively bring high cholesterol under control. He added: “Those with high LDL-cholesterol need to change their outlook. We see a lot of patients who are not willing or resistant to optimally managing their cholesterol levels. Beyond the necessary lifestyle changes, patients need to adjust their perception and beliefs towards cholesterol-lowering medication. Statins are generally the first-line medications prescribed to patients. There are also innovative treatments in the form of injectables available.”

Dato’ Dr Wan Azman adds that innovative treatments have shown better potential in intensifying the lowering of LDL-cholesterol levels in very high-risk patients with minimal side effects and helping patients achieve greater compliance to their treatment regimen.

Dr Feisul Mustapha, co-author of the Heart Matters position paper, hopes the public will take ownership over their heart health not only for their personal and family’s well-being, but also the country’s sake.

The Deputy Director of Public Health at the State Health Department of Perak was formerly the Deputy Director (Non-Communicable Diseases) at the Disease Control Division in the Ministry of Health.

Dr Feisul says: “CVD also places a tremendous burden on the healthcare system. It incurred the highest proportion of costs in hospitalisations (47.77%), medical tests (46%), and medications (53.77%) compared to other non-communicable diseases (NCDs).”

Younger Malaysian Patients

As Dato’ Dr Wan Azman Wan Ahmad echoes the message. He said: “It’s concerning that Malaysian patients are getting younger. These days, we are seeing an earlier onset of CVD cases, with the average age of patients ranging from 56 to 59 years old. This is 10 years younger than in developed countries. And, worryingly, about 25% of our patients with acute coronary syndrome are below the age of 50.”

Consequently, he stresses that it is important for patients to proactively bring high cholesterol under control. He added: “Those with high LDL-cholesterol need to change their outlook. We see a lot of patients who are not willing or resistant to optimally managing their cholesterol levels. Beyond the necessary lifestyle changes, patients need to adjust their perception and beliefs towards cholesterol-lowering medication. Statins are generally the first-line medications prescribed to patients. There are also innovative treatments in the form of injectables available.”

Dato’ Dr Wan Azman adds that innovative treatments have shown better potential in intensifying the lowering of LDL-cholesterol levels in very high-risk patients with minimal side effects and helping patients achieve greater compliance to their treatment regimen.

Dr Feisul Mustapha, co-author of the Heart Matters position paper, hopes the public will take ownership over their heart health not only for their personal and family’s well-being, but also the country’s sake.

The Deputy Director of Public Health at the State Health Department of Perak was formerly the Deputy Director (Non-Communicable Diseases) at the Disease Control Division in the Ministry of Health.

Dr Feisul says: “CVD also places a tremendous burden on the healthcare system. It incurred the highest proportion of costs in hospitalisations (47.77%), medical tests (46%), and medications (53.77%) compared to other non-communicable diseases (NCDs).”

“CVD also accounts for a significant 61.72% of productivity loss caused by premature deaths and a staggering 59.4% of healthy years lost when compared to other NCDs.”

Additionally, he emphasises that 1-in-3 Malaysians have low health literacy, which could hinder their ability to understand the disease and seek out treatment when necessary. He suggests that community involvement and educational programmes are crucial in raising awareness of cholesterol and its connection to CVD.

The event ended with an engaging panel discussion among the authors. Drawing on their personal experiences in working directly with patients and the practical realities of managing high cholesterol, they concurred that everyone has a shared responsibility to address the growing problem of CVD. By working together, we can stem the tide of this disease and improve health outcomes for all.

QUOTABLE QUOTES
from other authors of the Heart Matters position Paper

DATO' SRI DR AZHARI ROSMAN, Senior Consultant Cardiologist, Institut Jantung Negara: “Underestimating the importance of early detection of high cholesterol increases the likelihood of coronary artery disease and heart attacks in the country.”

DATUK DR ZANARIAH HUSSEIN, Consultant Endocrinologist, Hospital Putrajaya:
“All patients with type 2 diabetes mellitus should have their cholesterol levels closely monitored and effectively managed to minimise the risk of cardiovascular events.”

DR SRI WAHYU TAHER, Consultant Family Medicine Specialist, Ministry of Health:
“Screening for high cholesterol in primary care is a crucial first step, and patients should work with their healthcare providers to understand their levels and what they mean for their health.”

PROF DR ASRUL AKMAL SHAFIE, Professor of Pharmacoeconomic, Universiti Sains Malaysia:
“Treating high cholesterol should not only be evaluated based on the cost of medications. Studies indicate that the benefits, including improved quality of life and increased lifespan, outweigh the expenses associated with the medication.”