CVD bigger killer than cancer, often neglected
Cardiovascular diseases (CVD) have been the main cause of death in the Malaysian population since 2007. This trend has continued, with the number of people dying from CVD-related causes increasing year on year.
Tan Sri Robaayah Zambahari, senior consultant cardiologist, National Heart Institute, said the call to place more attention on heart and circulatory diseases (collectively known as cardiovascular diseases) is timely and appropriate, as CVD kill more people a year than all cancers. Robaayah said the urgency and importance of dealing with CVD is all too commonly drowned out by concern with other diseases and happenings.
The call to address CVD is particularly important in Malaysia, as according to Malaysia’s own National Cardiovascular Diseases (NCVD) Registry, our population develops CVD about 7 to 8 years earlier, at 59 years, than the global average of 66 years, as determined by the Global Registry of Acute Coronary Events (GRACE). What’s more alarming in this country is that 49 percent of those afflicted with CVD fall in the 40 to 60 year age group.
Speaking to the media at a CVD awareness session, Robaayah said: “As you can see, these are people in the prime of their lives.” These people are still productive; if they are stricken with a heart attack or associated disease, this will lead to a big loss for the family and the country. Therefore, it makes sense to focus on CVD prevention and to create more awareness about the disease. In fact, Robaayah said it was important to keep reminding the public as well as healthcare personnel about CVD so that they won’t ‘forget’ about the disease. This is important both for those already suffering from CVD who are undergoing treatment (statins, blood thinners, etc), and for those who have not yet developed the disease, to ensure that they do not ignore their health.
Prevent and treat risk factors
Robaayah said CVD could be prevented by preventing its risk factors, namely obesity, diabetes, hypertension and hypercholesterolemia. Awareness and reminders will mean that people will monitor their own condition; this will serve to allow detection of risk factors early and thus allow people to be treated early. Early treatment before heart damage and scarring occur will greatly reduce disability and also prevent death. Many of the risk factors associated with CVD, such as hypertension and hypercholesterolemia, are silent. This makes CVD another silent killer.
For those with one or two risk factors, lifestyle modifications such as exercise and diet monitoring are sufficient to bring the person back to health. However, a person with severe dyslipidemia may need medication to aid in balancing cholesterol levels. Typically, statins, fibrates, resins, nicotinic acid and cholesterol absorption inhibitors can be used to help lower cholesterol levels. Statins are usually the drug of choice to address dyslipidemia. In cases where monotherapy is insufficient, additional agents such as nicotinic acid or cholesterol absorption inhibitors may be added.
Alluding to the recently published Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), Robaayah said the trial provided sufficient evidence that dual therapy with a statin plus cholesterol absorption inhibitor provided better reduction of LDL cholesterol compared to statin alone in patients with recent acute coronary syndrome. The reduction in cholesterol levels also correlated to a reduction of major vascular events.