MALAYSIANS are experiencing heart attacks about 10 years earlier than the global average.
The trend is reflected in national cardiovascular registries, where one in four patients with acute coronary syndrome is below the age of 50.
It’s a worrying pattern reflecting the state of cardiovascular health among young adults.
Heart disease has remained Malaysia’s leading cause of death for the last two decades.
Heart attacks in younger adults come as a shock to family and friends. Many Malaysians assume that a person who appears healthy is not at risk or someone who is young is unlikely to get a heart attack.
One reason heart disease often catches people by surprise is that elevated low-density lipoprotein cholesterol (LDL-C), commonly known as “bad cholesterol” remains asymptomatic for years, explains consultant cardiologist Datuk Dr Rosli Mohd Ali.
LDL-C contributes to the build-up of fatty deposits, or plaques, within blood vessels. Over time, these plaques can narrow arteries and increase the risk of a heart attack or stroke.
BEYOND THE PLATE
While many people associate high cholesterol solely with an unhealthy diet, genetics, along with the body’s cholesterol metabolism, also play an important role.
An individual’s LDL-C levels are influenced by how much cholesterol the body produces and clears, which includes factors such as liver metabolism and genetic influences such as inherited conditions or family predisposition.
“The majority of LDL-C is actually produced by the body. In some people who naturally produce more cholesterol than others due to genetic factors, heart disease and stroke may occur at a much younger age,” says Dr Rosli.
Diet remains important though, as those high in saturated and trans fats can stimulate the liver to produce more LDL-C, raising cholesterol levels and increasing cardiovascular risk.
However, lifestyle alone may not fully explain why some seemingly healthy individuals develop cardiovascular disease.
“It’s a huge misconception to believe that if you feel healthy, you must be healthy.”
Dr Rosli recalls the case of an 18-year-old who sought medical attention after experiencing chest discomfort.
Further investigations revealed a strong family history of premature heart disease. His father had developed heart disease in his 30s and died suddenly, while several siblings had also been diagnosed with cardiovascular disease at a young age.
Dr Rosli says in this situation, family background may be a factor and such cases remind us that cardiovascular risk isn’t always visible and doesn’t only affect older adults.
At the same time, appearances can be deceiving.
Dr Rosli says another case involved a 40-year-old sportsman who exercised regularly, maintained a healthy body weight and believed he was doing everything right.
He was careful with his diet and got regular exercise but when he underwent further testing, there were significant blockages in his coronary arteries.
Dr Rosli says this underscores an important reality — being slim, physically active or appearing healthy does not always mean a person is protected from heart disease.
“You never really know your cardiovascular risk until you check.”
KNOW YOUR RISK
For the general population, the fundamentals remain unchanged: maintain a healthy diet, exercise regularly, manage body weight, avoid smoking and ensure that key cardiovascular risk factors are regularly monitored and adequately controlled.
Individuals with a family history of premature heart disease, diabetes, hypertension, obesity or smoking may require earlier and more frequent screening.
Malaysian guidelines recommend cholesterol screening for all adults aged 30 and above, while those at high risk of developing cardiovascular disease should begin screening from the age of 18.
While screening recommendations vary according to individual risk, Dr Rosli says Malaysians should become more proactive about understanding their cardiovascular health.
“If you have significant risk factors or a family history of heart disease, do not wait until you experience a cardiovascular event. Get checked earlier.”
Furthermore, managing LDL-C effectively requires more than a single intervention.
Dr Rosli advocates a holistic approach to heart health, where healthy eating, regular physical activity and appropriate medical treatment work together to reduce cardiovascular risk.
These three components should not be viewed separately, he adds. Lifestyle changes remain the foundation, but for some people, additional treatment may be needed to help achieve and maintain recommended LDL-C levels.
One of the biggest challenges in cholesterol management is that high LDL-C is often asymptomatic, making it difficult for some individuals to appreciate the importance of long-term management.
Dr Rosli says informed patients are often the most successful patients. These are the people who ask questions and understand their condition and are usually the ones who stay committed to managing it.
“The earlier LDL-C is controlled, the lower it is maintained and the longer it stays under control, the better the outcomes are likely to be.”