Hoo Yee Yin
B.Pharm, M.Clin.Pharm, BCPS, R.Ph
Mr A is a 35-year-old survivor of a heart attack. He was previously admitted due to severe chest pain. Two of his coronary arteries were blocked. He had no known medical illness prior to this event. He was lucky that he was admitted to a heart center in time and the cardiologist saved him by inserting a few stents into his blocked coronary artery. Mr. A was finally discharged after 5 days of hospital admission and he was given 5 types of medications. Although he survived his first heart attack, some part of his heart was already damaged.
Malaysians develop heart attacks (acute coronary syndrome) at a younger age (58.5 years old) compared to our neighboring countries (greater than 60 years old). Mr. A who is young, with an average body size (65kg), energetic, exercised frequently, never consumed alcohol; may have appeared healthy from the outside. He would not have predicted that his smoking status and unknown high cholesterol levels would have caused him a serious disease at such a young age.
How do we know whether we are at risk of getting cardiovascular disease (CVD)* in the next 10 years?
If you recently celebrated your 30th birthday, do check whether you have any of these characteristics which increase the likelihood of getting CVD:
- high blood pressure
- high cholesterol level
- cigarette smoking
- diabetes mellitus
- first degree relatives who has heart disease at a young age
- chronic kidney disease
Many of these tests are easily available in clinics, blood test centers and pharmacies.
What’s next? After you get all the readings, do get help from doctors or pharmacist to calculate your CVD risk. The latest primary and secondary prevention of cardiovascular disease guideline which has just been released this year suggests that Framingham risk score is currently more appropriate for the Malaysian population to calculate the risk of getting CVD in the next 10 years. Included on our website below is the Framingham risk score calculator. This calculator assesses the risk by using either the cholesterol level or body mass index and various factors such as gender, age, systolic blood pressure (the blood pressure reading that is usually written on top and has a greater value), smoker and diabetes status. Do remember to take the average of at least 2 measurements for blood pressure, total cholesterol (TC) and high-density lipoprotein (HDL)
Following the calculation, risks may be classified into 4 categories, namely very high risk (>30%), high risk (>20%), moderate risk (10 – 20%) or low risk (<10%). Many of us may fall into the low risk category (<10%) due to our young age, just like Mr A. However, due to his high cholesterol levels and prolonged exposure to certain risk factors, his lifetime risk may be high. Healthcare providers must keep in mind to help this group of people to reduce their risk by lifestyle changes or medications if necessary, and reassess their risk periodically (every 4 to 6 years).
If you have moderate risk, do not worry. Your risk can be reduced or managed by lifestyle changes alone while medication therapy is only needed if goals are not achieved. On the other hand, for those who are at high or very high risk, lifestyle modification and drug therapy are required. Do consult your doctor or healthcare professional. There are many useful advices available online, but one may need to refer to a reliable source. Get your health check today! Hope you pass your health exam with flying colors.
Cardiovascular disease: Heart and blood vessel diseases such as heart attack, stroke, total or partial blockage of the blood vessels in the abdomen, legs and hands
- CPG on primary and secondary prevention of cardiovascular disease 2017
- Image credit: https://dc3qtar97pgxg.cloudfront.net/wp-content/uploads/2016/03/ataque-cardiaco-en-jovenes.jpg
Instructions for use of risk calculator
- Sex: Your gender male (m) or female (f)
- Age: Your age in years
- Systolic Blood Pressure: This is usually the value that is written on the top after taking a blood pressure reading. It is also the number with greater value of the two numbers
- Treatment for Hypertension: Choose yes (y) if you currently are on treatment or taking medication for high blood pressure
- Smoking: Choose yes (y) if you are currently an active smoker or an ex-smoker who has quit for less than 2 years
- Diabetes: Choose yes (y) if you have been diagnosed with diabetes. Choose no (n) for those who have not been diagnose with diabetes before or those who have been diagnosed with gestational diabetes (diabetes during pregnancy) only
- HDL: High-Density Lipoprotein reading from blood report in mmol/L
- Total Cholesterol: Total Cholesterol reading from blood report in mmol/L
When using mobile, this calculator is best viewed in landscape mode