More Malaysians Are Suffering Heart Attacks at a Younger Age

January 20, 2020
heart attack in Malaysia
‘Heart attacks are for the old’ is a common misconception among young adults. The NCVD-ACS (National Cardiovascular Disease Database – Acute Coronary Syndrome) registry of 2014-2015 showed that Malaysians suffer heart attacks at a younger age compared to those in developed countries; the average age being 58.6 years compared to between 63.4 to 68 years in most developed countries. The heart of the matter (pun intended) is for us to realise that from a young age, our lifestyles play a role in our cardiovascular health.

When it comes to heart diseases, there is no one single cause. There are merely risk factors that when combined, could result in heart diseases. The more risk factors you have, the higher the chances of having a heart attack. Having heart diseases run in the family is a risk factor too but most risk factors are modifiable. Monitoring risk factors such as cholesterol, blood pressure, diabetes, obesity, sedentary lifestyle, stress and diet can lower the lifetime risk of developing heart diseases.
A Word About Atherosclerosis
The word ‘atherosclerosis’ is derived from ancient Greek, where ‘athero’ means ‘gruel-like’ and ‘pasty’. This merges with ‘sclerosis’ which means ‘abnormal hardening’. What it actually denotes is that atherosclerosis begins as lumpy, fatty deposits that subsequently come together and form plaques that harden, narrowing arterial walls. High amounts of the ‘bad cholesterol’ or LDL (low-density lipoprotein) will make their way into the lining of arteries and progressively build up from tiny crystals to large deposits, taking on the form of fatty streaks. These fatty streaks gradually increase in size to form plaques. They eventually develop fibrous caps and form mature plaques. These ‘stable’ plaques cause the narrowing of the arteries triggering a chest pain known as angina. But this is not what causes massive heart attacks.

A massive heart attack occurs when there is a sudden complete blockage of an artery due to a blood clot. When a plaque ruptures, the body immediately reacts by forming blood clots on the plaques as a way of damage control. These clots will lead to complete blocks of the artery which in turn reduces blood-flow to parts of the heart muscle, causing oxygen deprivation. Lack of oxygenation leads to death of the muscle cells and this generates a heart attack. This also results in a person experiencing sudden, intense chest pain.

Atherosclerosis is a slow, insidious process that takes years to build up, with its onset happening as early as during childhood. However, the heart attack that ensues happens rapidly within a matter of minutes.
heart attack in Malaysia
Birth weight matters
Certain connections have been documented between low birth weight and the risk of developing atherosclerosis years later. A review of 18 studies looking at the correlation between birth weight and occurrences of heart diseases later in life was done in 2007. The conclusion from this research was that being born with low birth weight is a risk factor of heart diseases in adulthood. It has also been found that there exists an association between low birth weight and risks of stroke. Infants of a smaller birth weight are known to be at risk of developing insulin resistance, high cholesterol and high blood pressure during childhood.

Furthermore, rapid catch-up weight gain in infancy adds to these risks. Some also hypothesise that maternal factors play a role such as poor maternal nutrition and smoking as well as a low socio-economic background.

The single most important culprit spanning across all ages for developing atherosclerosis is smoking. There is increasing evidence that exposure to second-hand smoke is just as hazardous as smoking. Another study done on children in 2007 showed that children who have been exposed daily to passive smoke display a significant impairment of the expansion abilities of their arteries when more blood-flow is required to their tissues. This kind of continuous exposure from a young age is what leads to the early onset of diseases and illnesses.
Youngsters, take heart!
The risk factors of heart disease are the same in both young adults and those of advanced age. As mentioned earlier, these include history of heart disease in the family, smoking, high cholesterol, hypertension, diabetes, obesity, metabolic syndrome, a sedentary lifestyle and low educational level.

One study in particular gave a good overall picture of these risk factors. The researchers evaluated over 5,000 young adults between the ages of 18 to 30 and monitored them up to 15 years. The reason was to find out how their risk factors influenced coronary artery calcifications, as detected by CT scanning. It was found that smoking 10 cigarettes a day increased the likelihood of coronary artery disease by 50 per cent; each 30 mg/dL rise in LDL cholesterol increased risk by 50 per cent; each 10 mm Hg rise in systolic blood pressure increased risk by 30 per cent; and each 15 mg/dL rise in blood sugar levels increased risk by 20 per cent.

Risk factors were found to increase during teenage years, particularly in boys. Following puberty, the level of insulin resistance and triglycerides rise in males while HDL cholesterol levels fall. For females, it is the opposite. While hormones play a part to some extent, habits that affect health cannot be discounted. For example; teenage boys smoke more and consume more fast food than girls from the same age group.
Educate our children
Suffering a heart attack at any age is indeed a significant occurrence with far-reaching consequences. Those who suffer an attack at a younger age have a better outcome because they often have single-vessel disease and well-preserved heart muscle. Despite this, remember that it is just a hint of what lies beneath and that the disease will progress if no serious action is taken. In one study of men who had a heart attack at an average age of just 36, 30 per cent died within 15 years. In another study of men and women who were afflicted before age 40, 25 per cent were dead in less than 15 years.

Heart attack has been the leading cause of death in Malaysia for the past 13 years. Despite great advances made in treating them, prevention is undoubtedly the management of choice. Children should be educated from a young age on healthy and positive lifestyle choices which will prove beneficial in later life. The issue that needs to be dealt with is getting the message across to young people that they should be screened even though they might appear to be of seemingly good health.
heart attack in Malaysia
Looking at the current state of affairs, many doctors do not routinely screen this group of people. Young adults remain oblivious to the possible consequences of their cardiovascular health. Despite various campaigns and awareness programmes, many remain in the dark about the risks of heart diseases. A survey consisting of over 4,000 healthy individuals with an average age of 30 found that more than 65 per cent were unable to identify any of the six major cardiac risk factors. Looking at how low birth weight is connected to heart diseases in later life, obstetricians and paediatricians play a role too in maintaining good heart health. Obstetricians can work towards improving maternal health habits while paediatricians can start screening for cardiac risk factors from a young age.
Take action now
On an individual level, here are some steps to take in order to stay abreast of one’s cardiovascular health. Getting information on significant family history for diseases such as heart disease, diabetes, stroke, and cholesterol would be a good place to start.

Next, let us remember one of the single most important and debilitating risk factors -- smoking. Avoid active and passive smoking as well as other forms of smoking such as e-cigarettes. Furthermore, begin monitoring blood pressure and cholesterol levels from your early twenties.

The American College of Cardiology defines high blood pressure as a reading exceeding 130/80 mmHg. It has also been found that the prevalence of high blood pressure is increasing steadily to a point that it is expected to triple in men and double in women under the age of 35.

Attention must be paid to diet and exercise. Incorporate more plant-based foods and reduce red meat in your diet. A recent study in 2017 found a connection between red meat and mortality that is linked to cardiovascular diseases, cancer, stroke and diabetes. As for exercise, allocate at least 30 minutes a day for it.

Be curious about the health of this integral organ of our body. Remember that it is never too early to start a healthy lifestyle. Start young and keep your heart pumping strong and as Confucius said, wherever you go, go with all your heart.

Consult with our heart specialists today for more advice and any concerns related to cardiovascular health

Dr. Nandakumar A/L Ramakrishnan
Consultant Cardiologist
Columbia Asia Hospital – Petaling Jaya
MBBS (India), MRCP(Edinburgh), Fellowship in Cardiology IJN (Malaysia)
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  This article first appeared in The Star Online, 16 October 2019
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