Epidemiology of Cardiovascular diseases in

Malaysia
 Objectives and Outcomes
Learning objectives:
Understanding of Epidemiology of CVS diseases in Malaysia.

Learning outcomes:
Discuss the epidemiology of CVS disorders in Malaysia.
Outlines
Types of CVDs

Why CVD is a serious public health problem

The importance of CVD epidemiology

Types of epidemiology related to CVD

Descriptive epidemiology
Types of Cardiovascular diseases (CVDs)
Cardiovascular diseases (CVDs) are a group of disorders of the
heart and blood vessels.
They include:
Coronary heart disease:
Diseases of the blood vessels supplying the heart muscle
examples are:, ischemic heart disease (myocardial
infarction, angina pectoris )

Cerebrovascular disease:
Diseases of the blood vessels supplying the brain
Peripheral arterial diseases:
Diseases of blood vessels supplying the arms and legs
Examples are Hypertensive heart disease
Types of Cardiovascular diseases (CVDs)
Rheumatic heart disease:
Damage to the endocardium and heart valves from
rheumatic fever, caused by streptococcal bacteria.
Cardiomyopathies
Cardiomegaly in the heart failure.

Congenital heart diseases:

Malformations of heart structure existing at birth.
Deep vein thrombosis and pulmonary embolism:
Blood clots in the leg veins, which can dislodge and
move to the heart and lungs.
 Why CVD is considered a serious
public health issue?
CVD is the leading global cause of death.
CVD is a leading cause of mortality in developed countries compared to
developing countries (disease of civilization).
Significantly contributes to morbidity and mortality rates in the middle
aged population: there is a significant association between morbidity rate
and mortality rate of CVD.
Mortality: nearly 30% of all cases.
Contributes to deterioration of the quality of life.
 CVD is a serious health problem in
Malaysia
.
Proportions of causes of death in Malaysia from
non communicable diseases
What is the importance of CVD epidemiology?
To detection and knowing of the occurrence and
distribution of CVD in populations, surveillance,
monitoring.
To study of the natural history of CVD.
Formulation and testing of etiological hypotheses
(risk factors).
To played a major role in determining the causes
of CVD.
To contribution to development of cardiovascular
prevention program and the measurement of their
effectiveness.
 Types of epidemiological studies related
to CVD
Descriptive epidemiology:
Describing distribution of cardiovascular disease by means of
certain characteristics such as : PERSON (i.e., age, gender,
ethnicity), TIME and PLACE.

Analytic epidemiology
Analyzing relationships between CVD and risk factors (which
elevate the probability of a disease at population level), risk model
and multicausal factors. Examples of those studies are case
control studies and cohort studies.

Experimental epidemiology/Interventions
Planning Strategies of cardiovascular prevention programmes
(primordial, primary, secondary, tertiary; individual and
community levels).
 Descriptive epidemiology
1. Age
Question: What is the relative amount of CVD in death rates in different
age groups?
Early age group childhood and youth death because CVD due to
congenital heart diseases
Increase in CVD morbidity and mortality: in age-group of 30-44 years
if any lesions of blood vessel (atherosclerotic smoking, dietary habits,
sporting behavior, etc.)
After the 65 years old increased the prevalence of death not only
because CVD but due to multiple ill health causes
Descriptive epidemiology
Descriptive epidemiology
2. Gender
Widespread idea: CVD is often thought to be a disease of middle-aged
men 40-65 years old.
Cardiovascular mortality (fatal cases) are more common among men
compared to women.
Women: special case (WHO, 2004)
a. Higher risk in women than men (smoking, high
triglyceride levels)
b. Higher prevalence of certain risk factors in women (diabetes mellitus,
depression)
c. Gender-specific risk factors (risks for women only) (oral
contraceptives, hormone replacement therapy, polycystic ovary syndrome)
 Descriptive epidemiology
3. Ethnicity
Before two decades ago the Chinese had the highest proportion of CHD
mortality compared with Malays and Indians. They accounted for 43.8%
of the total cases while the percentages for Malays and Indians were
20.8% and 31.1% respectively.
Last two decades the Chinese proportion has been on a decline with the
concomitant increase in the Malay proportion, which has surged to
38.2% in 1990, the highest level among the three ethnic groups.
This increase for the Malays may be due in part to the rapid rise in the
proportion of Malays in the urban population especially since 1970. The
Malay urban population rose 27.6% between 1970-90.
In this way increased Malay deaths due to CHD could be included among
the medically inspected and certified cases, as such cases tend to reflect
more the urban areas.
(reference: Ethnic characteristics of coronary heart disease risk factors and
mortality in peninsular Malaysia Asia Pacific (1994) 3, 93-98)
Descriptive epidemiology
4. World wide distribution
In the world: CVD deaths account for one third of all deaths (25-50%
depending on the level of economic development) among which 50%:
coronary deaths
Distribution of types of CVD in global deaths :
According to WHO An estimated 17.3 million people died from CVDs in
2008, representing 30% of all global deaths.
Of these deaths, an estimated 7.3 million were due to coronary heart
disease and 6.2 million were due to stroke.
WHO 2012
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Thanks For Your
Attention