BY ADELINE ANTHONY ALPHONSO

The average age of patients undergoing coronary angioplasty , as reported by National Heart Institute ( NHI ) Senior Consultant Cardiologist Dr Emily Tan Lay Koon , is about 57 . This is in stark contrast to the average age for the same procedure in Japan , which is 71 , underscoring a troubling trend in Malaysia .

This discrepancy suggests that Malaysians are experiencing severe heart conditions at a much younger age . Dr Tan noted that cardiovascular mortality accounted for 16.1 per cent of all certified deaths in Malaysia in 2022 , with cardiovascular diseases contributing to eight per cent of total hospitalisations in both government and private hospitals .

She attributed this trend to an ageing population and an increase in risk factors such as hypertension , diabetes , and elevated cholesterol levels , compounded by a growing prevalence of overweight individuals .

However , Dr Jeyarajah Sivalingam , a consultant physician at M∙A∙C∙ Clinics , offered a different perspective on these statistics .

A former physician and senior lecturer in cardiology at the Faculty of Medicine , UiTM and Selayang Hospital , he believes that while the statistics are alarming , they may not fully reflect the reality .

THE NECESSITY OF ANGIOPLASTY

“ Coronary angioplasty is not a definitive endpoint ,” he explained . “ It ’ s often influenced by doctors persuading patients to undergo the procedure ,

Dr Jeyarajah Sivalingam

Dr Emily Tan Lay Koon

which can distort the statistics .”

Dr Jeya questioned the interpretation of these figures , suggesting that the frequency of angioplasty could be more related to insurance coverage and the availability of advanced screening tools rather than a genuine increase in severe heart conditions .

“ Are we seeing younger patients needing angioplasty because of better diagnostic tools , or is it because of an actual rise in severe cases ?” he asked .

He emphasised that coronary angioplasty should primarily be performed for major or minor heart attacks , noting that many procedures are conducted on patients with 50 to 60 per cent blockages , which do not necessarily require such interventions .

“ A significant proportion of angioplasties in Malaysia are carried out mostly under insurance for patients in this age group ,” he observed , suggesting that this practice could explain the younger age of patients undergoing the procedure .

Dr Jeya also challenged the assumption that angioplasty significantly improved life expectancy or prevented heart attacks in patients without severe symptoms .

“ Many patients would benefit more from lifestyle changes and medications like aspirin if they have risk factors ,” he advised .

He stressed the importance of public screening and education to manage these risk factors early rather than relying heavily on surgical interventions .

TECHNOLOGY ’ S ROLE IN HEART HEALTH

While Dr Tan highlighted advancements in medical technology and digital health tools like wearables and telemedicine , Dr Jeya remained cautious .

He acknowledged that these tools enhanced diagnostic accuracy and treatment but warned they should not

replace essential lifestyle changes and preventive measures .

However , Dr . Jeya advocated for a more conservative approach to managing cardiovascular health , especially in asymptomatic patients .

“ If someone has a 90 per cent blockage but lives a full life without chest pains and passes a stress test , they might not need a stent . The heart can often develop new blood vessels to bypass blockages naturally ,” he explained .

Dr Tan also emphasised the gender disparity in cardiovascular disease diagnosis and treatment , noting that only about 17 per cent of patients undergoing coronary angioplasty are women .

This lower figure likely reflects an underdiagnosis and undertreatment of women , stemming from a lack of awareness and the perceived low incidence of cardiovascular disease among them .

The National Cardiovascular Disease Database from 2019 to 2020 highlighted the need for increased awareness and tailored healthcare approaches for women .

In contrast , Dr Jeya underscored the necessity of lifestyle changes over medical procedures .

“ We need to focus on preventive measures like diet and exercise .

“ The Japanese population , according to all data , is definitely healthier than Malaysia ’ s . But using angioplasty as the barometer to compare heart health is wrong ,” Dr Jeya stressed .

Dr Jeya ’ s emphasis on public education and screening was not just a suggestion but a call to action . He pointed out these measures were crucial to manage and reduce risk factors effectively , making the patients feel informed and proactive in the fight against cardiovascular disease .

BALANCED APPROACH TO HEART HEALTH

While the statistics on cardiovascular disease in Malaysia are concerning , it ’ s crucial to interpret them in context .

Dr Jeya ’ s insights suggested that a balanced approach , combining early screening , lifestyle changes , and judicious use of medical interventions , could be more effective in managing the country ’ s cardiovascular health crisis .

As Dr Tan emphasised , raising awareness and tailoring healthcare approaches for both men and women remained essential .

However , to curb the rising tide of cardiovascular disease , the focus should also be on preventive measures and holistic patient management . – The HEALTH