Unravelling The Connection Between Heart Disease & Stroke
16 June 2022
Heart disease remains to be a growing national health concern with it being the principal cause of death in Malaysia. As the years progress, deaths caused by heart disease are on a steady upward trend rousing the worries of many.
Statistics are also showing that there is a rise in the number of heart disease patients. Some types of heart diseases found amongst Malaysians are found to increase the risk of stroke and other accompanying health issues. All these upward trends create a sense of urgency and proves that we need to make a change. We’ve invited Dr. Mohd Kamal Mohd Arshad, Consultant Cardiologist to share further insights and some heart-to-heart advice on this matter.
Is there a direct link between heart disease and stroke?
Yes, there is. Coronary artery disease which is the most common type of heart disease is caused by the same risk factors as those that cause a stroke. In fact, coronary artery disease and strokes are also known as cardiovascular disease. Basically, it is the same process involving build-up of plaques in the blood vessels in the heart, the coronaries and the blood vessels in the brain. The plaques cause blockage of these blood vessels which can lead to heart attacks and strokes.
The major risk factors for cardiovascular disease are diabetes mellitus, high blood pressure, high cholesterol, smoking, obesity and physical inactivity. Abnormal heart rhythms or arrhythmias, specifically an arrhythmia called atrial fibrillation increases the risk of stroke. In this instance, blood clots can form in the heart and migrate to the brain causing a stroke. Some valve disease, especially narrowing of the opening of the mitral valve is also a risk of stroke. This can cause a clot to form in the heart that can migrate to the brain.
What are the causes of heart disease and stroke?
Coronary artery disease and strokes are part of cardiovascular disease. The causes are the risk factors such as diabetes mellitus, high blood pressure, high cholesterol, smoking, obesity and physical inactivity.
What are the types of heart diseases?
- Coronary artery disease affects the blood vessels of the heart. This is when youhave plaque build-up in the coronary arteries.
- Heart rhythm abnormalities-arrhythmias.
- Valve disease.
- Heart muscle abnormalities.
- Congenital heart disease since birth.
- Heart infection.
Could you explain to the readers how heart disease affects Malaysians?
Coronary artery disease makes up the bulk of heart disease in Malaysia and in the world. Coronary artery disease is the number one cause of death in Malaysians for many years. In 2020, there are 18515 deaths in Malaysia from coronary artery disease. That’s an average of 50 deaths a day. The death from coronary artery disease has increased from 11 percent of all deaths in 2000 to 17 percent of all deaths in 2020.
Are there any particular age groups that are predisposed to heart diseases and stroke?
For coronary artery disease and stroke, age is a risk factor. Hence the older you are, the more you are predisposed to coronary artery disease and strokes. In 2020, coronary artery disease is the number one cause of death in the age group 41 to 59 years (20 percent of all deaths) and above 60 years (18 percent of all deaths) in Malaysia.
Are there any specific groups of people that are more vulnerable to heart diseases and stroke?
Those with risk factors, especially more than one risk factor are vulnerable. This includes people with diabetes mellitus, high blood pressure, high cholesterol, smokers, obesity and people who lack exercise. Those with a family history of coronary artery disease are vulnerable as well. In terms of gender, males more than females. In 2020, coronary artery disease caused more deaths in males with 12,707 deaths compared to females with 5,808 deaths.
What lifestyle changes can we make to reduce the risks of experiencing heart diseases and stroke?
Exercise is a good way to go. We can try 150 minutes of moderate exercise a week and that includes activities like walking and gardening. We can also try 75 minutes of vigorous exercise a week such as playing football and running.
Next, having a healthy diet is important too. This includes eating in moderation, avoiding excessive sugar and trans fats. Do not smoke. Avoid second hand smoke or passive smoking.
Many echo the notion that if a heart disease runs in their family, there’s nothing much they can do to stop it. What are your thoughts on this notion?
It is true that if you have a first degree relative (parents and siblings) with heart disease at a younger age, then yes, you are at risk of developing the condition. You are at risk, but it doesn’t necessarily mean you will get it. You can reduce the risk of getting heart disease by screening for the other risk factors and treating or preventing it by living a healthy lifestyle as well as by taking medications if needed. Remember, the more risk factors you have, the higher your risk of developing the disease.
What are your thoughts on the notion that young people do not have to worry about getting heart diseases?
Young people should think about their health early on. Although heart disease is a disease that takes years to develop, one can start to have risk factors at a younger age, in their 20’s or 30’s for example. The process of getting heart disease starts then, hence it is important to detect the risk factors early.
Above the age of 30, one should always get a simple routine of yearly medical check ups to check for simple risk factors that may predispose you to getting heart disease. A check of your blood pressure, Body Mass Index (BMI), waist circumference and blood glucose and cholesterol are all you need.
Based on your observation, has there been an increase in heart diseases among the younger generation?
Yes. Even heart attacks are happening in younger adults and this has been a trend for a few years. The youngest heart attack I have treated is a patient aged 27 years old. The average age of a heart attack in Malaysia is 58 years old, a lot younger compared to our neighbours who average 63 years old in Thailand and 68 years old in Singapore.
What could possibly be contributing to this rise in heart diseases among the younger generation?
The high prevalence of risk factors in Malaysia also affects the younger generation. We have a high number of the population with diabetes mellitus (about 20%), high blood pressure (about 30%), high cholesterol (about 40%), obesity (about 50%) and smoking (about 20%). We are also the fattest nation in SouthEast Asia. Additionally, 25% of our adult population do not exercise.
Do you think those who have heart disease should avoid exercising?
No, they should exercise. Exercising helps to improve your health and your heart. Benefits of exercise include weight loss, lowers your blood pressure and sugar. However, those with diagnosed heart disease should have their risk factors and heart disease controlled and should seek the advice of their doctor before embarking on exercise.
Regular check-ups are important as it helps with early detections and diagnosis. Please report any symptoms or risk factors to your doctor. On top of that, healthier lifestyle choices pertaining to exercising and food intake also helps. Let’s take charge of our health before it’s too late.