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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