Tuesday, April 26, 2016

Malaysia - Young people, ageing arteries

It used to be that only the elderly suffered heart attacks and strokes. Not any more.

More Malaysians are succumbing to cardiovascular diseases prematurely as their unhealthy lifestyles contribute to vascular ageing, a condition that used to be seen only in the elderly.

Two studies by researchers at Universiti Kebangsaan Malaysia (UKM) and UKM Medical Centre (PPUKM) revealed that early vascular ageing (EVA) is common among many young and middle-aged Malay-sians.

Some patients in their 30s have arteries that look like they belong to old folk in their 70s.

Vascular ageing is a natural process brought on by structural and functional damage to the blood vessels, particularly the arteries, because of prolonged stress and hormonal changes as we grow older.

For some people, this process begins at an earlier age because of unhealthy lifestyles. Arterial stiffness is one of the main features of EVA.

In a pioneer study to screen subjects, using a locally designed non-invasive home-based cardiovascular health monitoring system, it was found that 80 per cent of those tested had a higher vascular age than their chronological age.

Dr Kalaivani Chellappan, a senior lecturer at UKM’s Faculty of Engineering and Built Environment, who came up with the model, says over a period of four years, 1,200 people aged 20 to 65 were tested using the low-cost and operato-independent system.

“From the study, we gathered that young Malaysians are ageing faster than they think they are due to early arterial ageing.

“We tested male and female subjects in urban and suburban areas and found a significant difference between the chronological age of a majority of them and the age of their arteries.

“Young people in their 30s, for example, have arteries of 70 year olds.

“As we age, our arterial walls stiffen, placing us at higher risk of heart attacks. However, our chronological age is not the only thing that affects our arteries. Poor lifestyle habits also influences vascular ageing,” she said.

Kalaivani said the first novel finding on fitness level, vascular age and cardiovascular risk was made in 2009.

However the type of risk involved — such as diabetes, hypertension or other diseases — could not be specified.

She said the research work was now focused on specific risks, such as hyperlipidemia (lipid in blood), atrial fibrillation (irregular heart rhythm) and left ventricular hypertrophy (enlargement and thickening of the heart’s main pumping chamber).

“It would be great to run this study across the country to establish a better model for the country’s population. We hope to obtain funding for the study as it is important to understand and prevent EVA and CVD risk ,” says Kalaivani.

In a study conducted by Dr Amilia Aminuddin, a lecturer at the Department of Physiology, PPUKM, it was found that EVA was common among young people with CVD risk factors, such as smoking, dyslipidemia, hypertension, obesity and those with a family history of premature CVD.

Her research, which focused on people between the ages of 20 and 40, revealed that the highest prevalent risk factor among the young was dyslipidemia, and those with at least two risk factors had EVA.

“Multiple factors can lead to EVA, such as smoking, hypertension, lack of physical activity, unhealthy dietary habits (high fat, high salt, low fibre) dyslipidemia, excessive alcohol intake, obesity, diabetes mellitus and stress.

“Nevertheless, these risk factors are modifiable or curable and can be prevented or reduced by following a healthy lifestyle and proper guidance, with or without medication.

“However, there are also non-modifiable risk factors, such as genetic and fetal growth patterns (low birth weight),” said Dr Amilia.

She said young subjects were included in her studies as there was an increasing trend of heart attacks and stroke among this group. In addition, stroke and heart disease are among the top five causes of mortality among Malaysians.

She said the Malaysian National Cardiovascular Disease Database 2006 showed that 23 per cent of the 3422 patients admitted to coronary care units for heart attacks, were below 50.

Dr Amilia said CVD prevalence continued to rise and was probably due to the increased prevalence of CVD risk factors.

The National Health and Morbidity Survey showed that the prevalence of diabetes had increased from 8.3 per cent in 1996 to 20.8 per cent in 2011.

In the same period, the prevalence of hypercholesterolemia (excess cholesterol in the bloodstream) had increased from 11.5 per cent to 38 per cent and the prevalence of hypertension in subjects aged above 30 increased from 33 per cent to 43.5 per.

Dr Amilia says blood vessels play a crucial role in maintaining heart health. As such, she says, it is important to understand EVA.

“Vascular ageing occurs as we grow older. We can slow down the process and prevent EVA by practising a healthy lifestyle.

“These include regular physical exercise, managing stress well, practicing good dietary habits and refraining from smoking and drinking alcohol.”

She also recommends regular medical check-ups to see whether CVD risk factors are present. Those with CVD risk factors should seek advice from medical experts.

“Hypertensive and dyslipidemic patients should attain a normal range of blood pressure and lipids level which can be controlled by living healthy lifestyles and medications.

“Obese subjects should lose weight by increasing physical activity and caloric restrictions, and smokers should stop smoking.”

By Chandra Devi Renganayar


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