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Everyone has fat (lipids) in the blood, i.e. cholesterol, triglycerides and high and low-density
lipoproteins. Abnormal levels of lipids (dyslipidaemia) contribute to the development of
atherosclerosis.
This is a condition in which there is a build-up of plaque – which consists of fat, cholesterol, calcium
and other substances – in the arteries, leading to narrowing of the arteries, and consequently, a
reduction in oxygen-rich blood flow to various organs.
Atherosclerosis can result in cardiovascular disease, which is manifested by heart attacks, strokes and
even death.
Cardiovascular disease (CVD) is the leading cause of death in Malaysian men and women. It includes
coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease.
CHD ranges from angina, which is chest pain or discomfort due to poor blood flow through the blood
vessels in the heart, usually during excessive physical activity, to heart attack (acute coronary
syndrome, ACS) when blood flow to the heart is blocked.
The causes of dyslipidaemia may be primary (genetic) or secondary to various conditions, such as
excessive dietary intake of fat, diabetes, chronic kidney disease, hypothyroidism, excessive alcohol
consumption and some medicines like thiazides and beta-blockers.
According to the NCVD-ACS Registry for 2011-2013, 96.8% of patients had at least one
cardiovascular risk factor, i.e. high blood pressure (65%), diabetes (46%) and dyslipidaemia (37%).
These risk factors have been on an increasing trend. – AFP
Too many undiagnosed and inadequately controlled
There was one person diagnosed with hypercholesterolaemia compared to four with undiagnosed
hypercholesterolaemia, i.e. a ratio of 1:4 in NHMS 2015, which was similar to NHMS 2011.
Control of hypercholesterolaemia was inadequate, with only 53.8% of those aged 60 years or more in
NHMS 2011 having adequate control (Source: Hypercholesterolaemia Prevalence, Awareness,
Treatment and Control among the Elderly: The 2011 National Health and Morbidity Survey,
Malaysia. British Journal of Medicine & Medical Research 13(6): 1-9, 2016).
CVD has been the leading cause of death in Malaysian men and women in the past decade.
Malaysians get ACS at a younger age than Thais, mainland Chinese and Westerners.
CHD and cerebrovascular disease were the first and second causes of deaths in 2016, with an increase
of 39.6% and 23.8% respectively since 2005. They were also the top two causes of death and
disability combined.
According to the local National Cardiovascular Disease – Acute Coronary Syndrome (NCVD-ACS)
Registry for 2011-2013, 96.8% of patients had at least one cardiovascular risk factor, i.e. high blood
pressure (65%), diabetes (46%) and dyslipidaemia (37%).
These risk factors have been on an increasing trend. These data are not surprising seeing as the
numbers of undiagnosed and inadequately controlled hypercholesterolaemia are so high.
Going forward
The magnitude of the dyslipidaemia problem needs particular attention. Screening in primary care
settings and frequent health promotion to enhance increased community awareness and commitment
to healthy living and care need to be continually emphasised.
The MOH’s target for 2025 is that there be no increase in the prevalence of hypercholesterolaemia
from the 47.7% in 2015 (Source: National Plan of Action for Nutrition of Malaysia 2016-2025, page
82).
The task of reducing the prevalence of hypercholesterolaemia may appear daunting but the
consequences of not even trying would impact negatively on the healthcare delivery system in general,
and on individuals and families in particular.
How will the MOH’s approach towards hypercholesterolaemia contribute to its target of reducing the
risk of premature mortality from non-communicable diseases from 20% to 15% by 2025?
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations
and the Malaysian Medical Association. The views expressed do not represent that of organisations
that the writer is associated with. The information provided is for educational and communication
purposes only and it should not be construed as personal medical advice. Information published in
this article is not intended to replace, supplant or augment a consultation with a health professional
regarding the reader’s own medical care. The Star disclaims all responsibility for any losses,
damage to property or personal injury suffered directly or indirectly from reliance on such
information.