By Karen Bong
YOU only have one heart, and once it stops, everything is over. That is why understanding your heart, knowing your risk factors and taking action before symptoms appear is crucial.
Cardiovascular disease remains one of the leading causes of death in Malaysia, and one of its greatest dangers is that it often develops silently. Many people feel perfectly healthy while serious disease is already progressing inside their blood vessels.
By the time warning signs emerge, significant damage may have occurred. For some, the first symptom may be a heart attack or sudden cardiac arrest, leaving little or no time to act.
“If your eyes fail, medical advances may help restore your vision. Damaged teeth can be repaired or replaced. Wealth lost can be rebuilt. Careers can be restarted.
“But our health, especially our heart health, is different. In many cases, there might be no second chance. Protect your heart. Protect your career. Protect your future,” Kuching South City Council (MBKS) Mayor Dato Wee Hong Seng said during his ShallWeeTalk live session on Sept 12.
Appearing on the session in conjunction with World Heart Day which falls on Sept 29, cardiologist and cardiac electrophysiologist Dr Ho Kian Hui said the silent nature of cardiovascular disease made awareness, early detection and prevention essential.
The silent threat
Dr Ho treated a 63-year-old non-smoker who exercised daily and could hike up to 10km. He had never experienced chest pain and considered himself healthy.
However, a CT calcium scan conducted during a promotional screening in Brunei revealed a very high calcium score. Further investigations found severe disease affecting all three major coronary arteries, with one was 100 per cent blocked while the other two were about 90 per cent blocked.
“The man was stunned because he had no warning symptoms,” Dr Ho said.
He advised the patient to stop exercising until his condition had been treated.
“Exercise is very important, but you cannot rely on exercise alone. Exercise is not a medication,” he said.
The case highlights why people should understand their cardiovascular risk instead of relying on their fitness level or the absence of symptoms as proof of good heart health.
Heart disease can affect all ages
Heart disease is not a single condition. It encompasses a wide range of disorders, including coronary artery disease, heart attacks, heart rhythm abnormalities, heart failure and congenital heart conditions. Some conditions predominantly affect older adults, while others can occur in children, teenagers and young adults.
The challenge is that coronary artery disease, the narrowing or blockage of arteries supplying blood to the heart, can develop over many years without causing symptoms.
As an electrophysiologist, he treats disorders of the heart’s electrical system, including abnormally fast, slow or irregular heart rhythms.
He recalled treating a 16-year-old with severe disease involving all three major coronary arteries, while more recently he treated a 29-year-old with extensive three-vessel disease who presented with breathlessness, leg swelling and heart failure.
Dr Ho cautioned that heart-related symptoms could sometimes be mistaken for gastric problems. Persistent upper abdominal discomfort or indigestion that does not improve with gastric medication should be medically assessed, particularly in people with cardiovascular risk factors.
“At the very least, get checked,” he said, adding that an ECG and other investigations could help determine whether symptoms were cardiac-related.
Similarly, irregular heartbeats, unexplained breathlessness, reduced exercise tolerance and swelling of the legs may also warrant medical assessment.
Control the risk factors
High blood pressure, elevated cholesterol and diabetes are among the most significant contributors to cardiovascular disease. These conditions damage the inner lining of blood vessels and accelerate the development of atherosclerosis, the buildup of fatty plaques within artery walls.
Dr Ho compares the body’s circulatory system to a network of pipes. If one of those pipes becomes narrowed or blocked, the organ that depends on it may be affected. Just as excessive pressure can damage household plumbing, uncontrolled blood pressure can injure blood vessels over time.
He said controlling blood sugar, blood pressure and cholesterol remained central to preventing heart attacks and strokes.
Elevated LDL cholesterol, commonly known as “bad” cholesterol, contributes to plaque formation and can affect arteries supplying the heart, brain, kidneys and legs.
He said cholesterol was produced naturally by the body, particularly by the liver, meaning diet alone may not always be sufficient to bring LDL cholesterol to an appropriate level. Depending on an individual’s overall risk, medication may therefore be required.
Poorly controlled diabetes can also cause widespread damage. Dr Ho likened persistently high blood sugar to “acidic water flowing through pipes, gradually damaging their inner surfaces”.
Over time, this can increase the risk of heart disease, stroke, kidney failure and blockages in the arteries supplying the legs, potentially leading to amputation in severe cases.
Addressing concerns about statins, Dr Ho said serious side effects were uncommon and that, for appropriately selected patients, the benefits of lowering LDL cholesterol generally outweighed the risks.
“I hope everyone develops a better understanding of statins,” he said, stressing that treatment decisions should be based on an individual’s cardiovascular risk rather than social-media claims.
He also cautioned against relying solely on supplements to control cholesterol, diabetes or blood pressure.
“Supplements may provide some benefit, but the effect is generally limited. We cannot rely solely on supplements to control cholesterol,” he said.
Prevention should start early
Dr Ho’s central message was that cardiovascular health should be addressed before a major event occurs.
People should understand their individual risk factors, undergo appropriate medical assessments and take action to control conditions such as diabetes, high blood pressure and high cholesterol.
“Understanding your risk and treating your risk factors before a serious event occurs is extremely important,” he said.
For most adults, routine health checks should include monitoring blood pressure, blood sugar and cholesterol levels. Dr Ho recommends annual blood tests for people without major risk factors and more frequent monitoring for those at higher risk.
“Depending on age, symptoms and risk factors, doctors may recommend additional investigations such as stress tests, coronary artery calcium scoring or CT coronary angiography. These tests help identify individuals who may have significant coronary artery disease before a major event occurs,” he explained.
Importantly, Dr Ho added that screening should be individualised, as not every test is appropriate for everyone.
Rather than waiting for the first heart attack to reveal an underlying problem, he urged people to take ownership of their cardiovascular health now. — DayakDaily
