News & Updates

Researchers from the Chinese University of Hong Kong (CUHK) have discovered PDE1A rs10171703 as a novel genetic marker for coronary heart disease (CHD) in Chinese patients with type 2 diabetes mellitus (T2DM), indicating its potential utility for predicting CHD risk in this patient population.

Using alternative anthropometric measurements, a post hoc analysis that used data from the PARADIGM-HF* trial debunked the BMI-related ‘obesity paradox’ in a large cohort of patients with chronic heart failure with reduced ejection fraction (HFrEF).

The cost of treatment for cardiovascular disease (CVD) amounts to almost RM3.9 billion annually. This makes up about 40 percent of healthcare expenditure and subsequently, causes an annual productivity loss of close to RM4 billion.

Speaking at the Sunway Monash Cardiovascular Summit, held in Kuala Lumpur recently, Dr Alan Fong, consultant cardiologist, Sarawak Heart Centre, said ischaemic heart disease and stroke account for the top two causes of death and disabilities in 2019. Ischaemic heart disease accounts for 2,500 disability-adjusted life years (DALYs) per 100,000 population in comparison with 1,400 for advanced countries such as Japan, Korea, UK, Taiwan, Australia, and Singapore. In the same year, the Malaysian DALY for stroke stood at 1,638 per 100,000 population. In comparison, advanced countries had a DALY rate of 1,200 for the same disease. Thus, it is obvious Malaysia suffers from a disproportionate number of DALYs compared to advanced countries.

Fong said: “A lot of these [contributing causes to high DALY] is not to the onset of acute disease, but the morbidity associated with nonfatal disease at the end of treatment. So, the patients are safe when they get to the hospitals. It is what happens before and after they leave the hospital.”  

One of the driving forces of the increase in CVD cases is the rising prevalence of risk factors. Between National Health and Morbidity Survey (NHMS) 2011 and 2019, hyperlipidaemia rates rose from 35.1 percent to 38.1 percent while diabetes rates rose from 15.2 percent to 18.3 percent. Compounding these risk factors is the increasingly ageing population.  [Available at https://iku.gov.my/nhms-2011 Accessed on 9 May 2023, Available at https://iku.gov.my/nhms-2019 Accessed on 9 May 2023]

The CVD burden is expected to amplify over the next decade with existing research predicting that mortality risk due to major adverse cardiac events (MACE) will increase three to five times for CVD patients with comorbidities. Prolonged uncontrolled hypercholesterolaemia itself will increase incidence of MACE by almost 46 percent. In Malaysia, CVD-related deaths are expected to reach 31,000 annually by 2025, or 55 percent of all NCD-related deaths in the country, should no concrete measures be put in place to stimy this progression. This year, two new clinical practice guidelines (CPGs) centred on heart failure will be launched.  

A disparity in distribution
Fong noted there is also great disparity in the distribution of cardiologists within the nation. He noted half of the country’s board certified 327 cardiologists are based in or around the Klang Valley while the others are spread across the rest of Malaysia, including Sabah and Sarawak. The dearth of cardiologists outside of the Klang Valley creates a gap in care. Compounding this disparity is the fact that 80 percent of cardiologists practice in private facilities—meaning the remaining 20 percent of cardiologists, numbering around 60, are left to manage the bulk of patients thronging the public facilities.

Apart from this disparity in distribution of cardiologists, there is also a lack of women in the field of cardiology, Fong noted. He said women only make up around 10 percent of cardiologists. He called for more women to specialize in cardiology.

This involves community engagement and health screening. There is also a need to address the social and personal determinants of health. He gave the example of the COVID-19 pandemic, which drove everyone to learn more about the virus, how it spreads, and its symptoms. The same is necessary for CVD.

2. Risk stratification
This involves tailored management of targeted cardiovascular (CV) risk profiles. There is a need for standardized risk stratification across all care facilities in the nation. The stratification should be supported by CV risk score calculator.

3. Capability enhancement
This aspect requires the establishment of a continuous training and clinical performance auditing mindset. It should also involve the adoption of existing Clinical Practice Guidelines across every care setting and sectors.  

4. Improving access to innovative and optimal care

This involves providing access to the best available treatments for those at the highest risk of CVD progression.

5. Use of health analytics to monitor patients’ progress

Data analytics will also help monitor the real-world impact of CVD initiatives, powering decisions that will result in the best outcomes.

White paper a signal of hope
Fong ended his talk by briefly speaking on the upcoming release of the White Paper on Health by the Director-General of Health. The white paper is a much-awaited guide towards healthcare reform in the country, said Fong. It is hoped that the white paper will usher in a new and better era of healthcare in the country.

Singaporeans with higher triglyceride-glucose index are at higher risk of developing hypertension, as reported in a study.