Cardiovascular Diseases - The Looming Threat to Malaysia and Singapore

Published: 11 May 2004

By Geeta Dhanoa, Research Analyst

If you said cardiovascular (CV) disease these days, most people would have a look of fear on their faces. CV diseases are those of the heart and blood vessel system, and thoughts of coronary heart disease, a heart attack, high blood pressure, stroke, angina (chest pain), or rheumatic heart disease would send people scurrying to medical professionals looking for a cure. And indeed it should, as according to the WHO, CV diseases are ranked as the number one killers in the world claiming an estimated 17 million lives annually. It is estimated that every one in three people around the world dies due to stroke or heart attack. WHO estimates that if no action is taken to improve CV health and current trends such as changes of lifestyle, lack of exercise, stress, and smoking continue, 25 percent more of healthy life years are likely to be lost to CV disease globally by 2020.

Alarming Statistics – The Scene in Malaysia and Singapore

While in the 1960s and 1970s, deaths due to CVD were levelling off in the United States, Asia was experinecing a different scenario altogether. Where in the early 1960s and 1970s, communicable diseases posed the greatest threat in this region, especially for Singapore and Malaysia, the late 1990s and early 2000 saw an increasing trend of lifestyle killer diseases such as heart disease, cancer, and stroke leading the way. The rapid pace of development has led to the changing pattern of diseases as countries underwent economic development.

The number of CV disease cases in Malaysia has increased to 14 percent in five years from 96,000 in 1995 to 110,000 in 2000. It is the leading cause of death in the country claiming a third of all its patients. In 2001, approximately 20 percent of all deaths at the Ministry of Heath hospitals were due to heart attacks and strokes. Two thirds of these deaths were due to heart diseases and the rest to strokes. In fact, it is estimated that 40,000 new stroke cases are recorded annually in Malaysia. Similarly in Singapore, CV diseases were responsible for more than 30 percent of all deaths in 2001, claiming the title sof second leading cause of death in Singapore after cancer. In fact, ischemic heart disease and heart failure accounted for 26 percent of deaths in Singapore in 2001.Figure 1 depicts the major causes of death in Malaysia and Singapore in 2001.

Many people go through life not knowing that they may be susceptible to CVD. Lifestyle changes, lack of exercise, stress, and smoking are responsible for the increase of risk factors leading to the development of CV diseases such as hypertension, hyperlipidemia, diabetes, and obesity. For example, in Singapore, the national health survey conducted in 2001 found that approximately 14.1 percent of its citizens aged 65 and above had high blood cholesterol levels, 32.6 percent were hypertensive, and 64.4 percent of those aged 70 and above had completely sedentary lifestyles. If left unchecked and no steps are taken to rectify the spiraling conditions, it could lead to heart attacks or strokes. However, most often, people do not realize that they may get CV diseases because the risk factors and symptoms associated with such diseases are also associated with ageing and other diseases.

Miracles at Work…..But at What Cost?

The standard course of therapy for the treatment of CV diseases and its related diseases such as hypertension, diabetes, and hyperlipidemia include classes of medications such as diuretics, ace inhibitors, angiotension II receptor blockers, beta blockers, alpha blockers, calcium channel blockers, vasodilators, statins, and antiplatelets. These medications are usually used in combinations with each other to get the optimal results.

However, there are certain patients whose conditions do not respond to medications. In the last decade or so, in line with Malaysia’s and Singapore’s drive to become leaders in healthcare, both countries have initiated and made technological break through in other methods of treating CV diseases, namely in treating heart failure patients. Heart transplants are now considered a treatment option after initial immunological obstacles. Drug-coated stents, which revolutionized the cardiology world in the early 1990s, are being increasingly used in angioplasty surgeries. The National Heart Institute, the premier cardiology centre in Malaysia, has used almost half of the 1,050 Cypher stents since its launch in May 2002. Singapore has also introduced cutting edge strategies such as implantable mechanical assist devices, ventricular reduction and remodeling surgery, and cardiac resynchronization therapy.

The costs of these treatments do not come cheap. In Singapore, the cost of treating cardiovascular diseases is estimated at about $64 million (Singapore $110 million) a year. The Malaysian Ministry of Health spends approximately $2.6 million (RM10 million) annually just on the use of statins in primary prevention of atherosclerosis. Additionally, the drug-coated stent, Cypher costs $2,632 (RM10,000) per stent. Patients with CV diseases are usually on life long treatment and may not be able to afford such high costs of medications. Thus, most often than not, unless it is a life and death situation, physicians usually leave the choice of medications to patients while providing all the pros and cons of each. For example, between taking an aspirin or Plavix, which are anti-platelets for the prevention of stroke, according to most physicians in Malaysia, patients opt to take aspirin as it is 10 to 20 times cheaper than Plavix.

What’s in Store for the Future?

The increasing prevalence of CV disease in this region provides a huge market for pharmaceuticals and CV market devices. With technological advancements and the need for more cost-effective medications and treatments, there is a large opportunity for these participants to jump in and take a slice of the pie.

In March 2003, a second drug-coated stent, Taxus, was launched in Malaysia and within a month, 150 units had been used. Additionally, the Malaysian Health Ministry is in talks with a vendor to set up a cardiac MRI at the Cardiac Centre at the Sarawak General Hospital, which may probably be the world’s first open, multi vendor, cardiac visual and data information integration system. Through this system, patients’ records and investigation results can be assessed online at any time by the doctors at any of the terminals in the hospital. Similarly, in Singapore, steps are being taken to develop heart failure surgery systematically over the next five to ten years. In fact, a new superstatin, Crestor, was launched in 2003 in Singapore to treat hypercholesterolemia, and it has received favorable response among the physicians. In future, many more medications and newer technologies are likely to become available in Malaysia and Singapore, and sometimes even ahead of many developed countries, as the cardiologists here readily adapt them for the benefit of the people.

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