• Mortality due to CAD (coronary artery disease) in Malaysia has increased by more than 3-fold over the last 40 years and is still rising. Indians had a higher mortality due to CAD than Chinese and Malays consistent with the pattern in Singapore.1
  • Indians comprise only 10% of the Malaysian population, but more than half (56%) of patients who had a heart attack before age 40 were Indians.2-4 This is consistent with extreme prematurity of CAD observed in this population worldwide.
  • The Indians have the highest prevalence of the three major risk factors─ diabetes, high blood pressure, and high cholesterol.5, 6
  • The same pattern is observed among the patients who had coronary bypass surgery with very high prevalence of the three most common risk factors: dyslipidemia 89%; high blood pressure 79%; and diabetes 46%.6
  • Among patients with a heart attack in Malaysia, Indians had 54% higher and Chinese had 29% lower rate of diabetes compared with Malays.5
  • Indians have the highest rate of obesity and the lowest rate of physical activity as is true of Indians in other countries.7, 8 The high prevalence of diabetes, high blood pressure, dyslipidemia, and sedentary lifestyles among Asian Indians in Malaysia may contribute to the high incidence of CAD in this ethnic group.8 Control of these risk factors could therefore substantially reduce the burden of heart disease.
  • Genetic risk factors, particularly lipoprotein(a), has not been studied in Malaysia.


1. Khoo KL, Tan H, Khoo TH. Cardiovascular mortality in Peninsular Malaysia: 1950-1989. Med J Malaysia. Mar 1991;46(1):7-20.

2. Rajadurai J, Arokiasamy J, Pasamanickam K, Shatar A, Mei Lin O. Coronary artery disease in Asians. Aust N Z J Med. 1992;22(4):345-348.

3. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. Clin Cardiol. Mar 1995;18(3):131-135.

4. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2010.

5. Rampal S, Rampal L, Rahmat R, et al. Variation in the prevalence, awareness, and control of diabetes in a multiethnic population: a nationwide population study in Malaysia. Asia Pac J Public Health. Apr 2010;22(2):194-202.

6. Chiam P, Abdullah F, Chow HK, Adeeb SM, Yousafzai MS. The ethnic characteristics and prevalence of diabetes mellitus, hypertension and hyperlipidaemia in patients who underwent coronary artery bypass grafting in Hospital Universiti Kebangsaan Malaysia. Med J Malaysia. Dec 2002;57(4):460-466.

7. Khambalia A Z, Seen LS. Trends in overweight and obese adults in Malaysia (1996-2009): a systematic review. Obes Rev. Jun 2010;11(6):403-412.

8. Dhanjal TS, Lal M, Haynes R, Lip G. A comparison of cardiovascular risk factors among Indo-Asian and caucasian patients admitted with acute myocardial infarction in Kuala Lumpur, Malaysia and Birmingham, England. Int J Clin Pract. Dec 2001;55(10):665-668.

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