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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018

AFRICA

31

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Ten-year fall in blood cholesterol of Malaysia heart attack patients suggests statin impact

A 10-year decline in the blood cholesterol of heart attack

patients in Malaysia suggests that statins are having a positive

impact, according to an observational study in nearly 49 000

patients presented at the ASEAN Federation of Cardiology

Congress 2017 (AFCC2017).

AFCC2017 was hosted by the Brunei Cardiac Society,

with the support of the ASEAN Federation of Cardiology,

on 3 to 5 November in Brunei Darussalam. Experts from the

European Society of Cardiology (ESC) presented a special

programme.

‘Lifestyle changes appear to be responsible for falls in

blood cholesterol in the general populations of developed

nations while statins have reduced cholesterol in patients

with heart disease,’ said lead author Dr Sazzli Kasim,

Chair, Malaysian Society of Atherosclerosis and Associate

Professor of Medicine, University Technology MARA, Shah

Alam, Malaysia.

‘Blood cholesterol is still on the rise in the general

population of developing countries like Malaysia,’ he

continued. ‘This study investigated trends in cholesterol levels

in Malaysian patients with acute coronary syndromes.’

The study included 48 851 patients who had an acute

coronary syndrome between 2006 and 2015 in Malaysia

and were enrolled in the National Cardiovascular Disease

Database Acute Coronary Syndrome (NCVD-ACS) registry.

This ongoing registry is maintained by the National Heart

Association Malaysia with the support of the Ministry of

Health Malaysia. Total cholesterol was assessed on entry to

the registry.

The researchers examined trends in cholesterol levels of

ACS patients over the 10-year period and compared them

to previously published values for the entire population.

They found a significant trend for declining total cholesterol

from 2006 to 2015 in the ACS population (

p

= 0.012). This

was opposite to the total cholesterol trend in the Malaysian

population.

ACS patients with a history of coronary heart disease had

almost twice the declining rate in cholesterol as those with

no history of coronary heart disease. When the researchers

examined total cholesterol by type of ACS, they found that

patients with unstable angina had the lowest total cholesterol

level but the steepest rate of decline, followed by patients with

non-ST-elevation myocardial infarction and then patients

with ST-elevation myocardial infarction.

Dr Kasim said: ‘We found that blood cholesterol levels

have been falling in Malaysian patients with acute coronary

syndromes, which is the opposite of the national trend.’

‘Since cholesterol levels have increased significantly in the

Malaysian population as a whole, it is highly doubtful that

lifestyle change is the reason for the declining cholesterol

trend we observed in the ACS population,’ he continued.

Dr Kasim said: ‘While this was an observational study

and we cannot infer causality, it seems likely that cholesterol

levels decreased as a result of lipid-lowering medication such

as statins. ACS patients with a history of coronary heart

disease, who were more likely to be taking statins, had a

more rapid decline in cholesterol levels than those without a

history of coronary heart disease.’

He concluded: ‘These results appear to mimic findings

from developed countries in previous years and show that the

Malaysian population is reaching similar health milestones.

The findings also highlight the need to increase awareness of

the harm of raised lipid values and the treatment available.’

Dr Ezam Emran, scientific chair of AFCC 2017, said:

‘This large study suggests that statins are being effectively

used by heart attack patients in Malaysia. Rising lipid levels

in the general population need to be tackled by promoting

healthier lifestyles.’

Professor Michel Komajda, a past president of the ESC

and course director of the ESC programme in Brunei, said:

‘The benefits of statins for preventing a second heart attack

are unequivocal, as highlighted by the 2017 ESC guidelines.

Patients should also be encouraged to quit smoking, adopt a

healthier diet and be physically active.’

Source

: European Society of Cardiology Press Office