THINK of your body as a brand new car. It's bright and shiny and in tip top condition when you drive it out of the showroom.
The moment you use this "car" regularly, wear and tear sets in and over the years, it doesn't function as it used to.
If you don't address repairs, your car will break down frequently and in the end, may end up as scrap metal.
This simple analogy describes the importance of taking charge of our health, especially as we age and face conditions that impact general wellbeing.
Atherosclerotic cardiovascular disease (ASCVD) is a general term referring to disorders of the heart and blood vessels. It includes conditions such as stroke, coronary artery disease and peripheral artery disease.
One of the known risk factors for ASCVD is high cholesterol. Yet, many people with high cholesterol are not aware they have it or are not taking charge of the condition in the right way.
According to the National Health and Morbidity Survey 2019 (NHMS2019), 4 in 10 Malaysians have high cholesterol.
Almost 80 per cent of these people are on cholesterol medication yet heart disease remains the leading killer of Malaysians so we need to ask ourselves why this is happening, says National Heart Institute (IJN) senior consultant cardiologist Datuk Seri Dr Azhari Rosman.
"The current landscape is quite troubling. There are people on cholesterol medication who still have a high incidence of ASCVD. Despite being on medication, they're still at risk and their cholesterol level hasn't come down."
This leads to the question of whether patients are being supported in the right way to understand their condition, be aware of risk factors and given specific guidelines to achieve their target of cholesterol reduction.
NOT JUST THE DIET
Most people assume that diet is the main contributing factor to cholesterol, adds Dr Azhari. It does, but not as much as your own body manufacturing cholesterol.
"80-85 per cent of cholesterol is made by the body and only around 15 per cent is contributed by diet."
What makes one person's body manufacture more cholesterol than another?
Dr Azhari says genes certainly play a role. Some people's bodies are prone to manufacturing more cholesterol even if they're young or thin.
The second group refers to those who don't have a genetic predisposition for high cholesterol but who make their bodies so unwell that it manufactures high cholesterol.
"This happens when you become overweight or obese. You turn your body from healthy to an unnatural producer of cholesterol and Malaysia has the highest incidence of obesity/overweight in Asia."
People who are overweight or obese, and in addition smoke, don't exercise and have other risk factors, become prime candidates for ASCVD.
Additionally, the premature death rate in Malaysia is increasing, he adds. This refers to death below the average life expectancy of 75.
More than two-thirds of premature deaths reported in NHMS2019 were linked to non-communicable diseases (NCD) which went undetected.
DELAY LEADS TO DEATH
Delay in screening for high cholesterol and taking charge of the condition is a contributing factor to premature deaths.
"If your cholesterol level is high, your chances of having a heart attack at the age of 40 is high. If you lower your cholesterol, this event may be delayed by up to 20 years."
Keep in mind that Malaysians are presenting symptoms of ASCVD eight years earlier than the global average.
"So 80 per cent of patients are on cholesterol medication, cardiac centres in the country are increasing and the government is actively spending on managing ASCVD but it continues to be the number one killer. Are there shortcomings in how we are delivering these drugs or is accurate information not reaching the patient?"
Doctors don't have the time to sit and explain in detail to every patient, which is why it's crucial to involve other healthcare professionals such as nurses and dietitians to help patients meet their cholesterol reduction targets, adds Dr Azhari.
These people can provide more specific advice on how to control risk factors, make lifestyle changes and address issues with medication.
IJN'S Cardiovascular Risk Reduction Clinic (CRRC) has taken this multidisciplinary approach and successfully helped patients achieve their targets.
Dr Azhari says follow-ups with 600 patients at this clinic have shown that 40 per cent were able to achieve their targets and sustain it too.
There are two types of cholesterol medication he adds - oral tablets and injectables and patients would naturally want the option that best suits their needs and condition.
"What's important is that we provide them with the right information from the right source and have people who can answer their queries and tailor their treatment plan to their individual needs."
The goal is to ensure that our body can still "perform" somewhat like a brand new car even if it has been on the road for years.
