Proefschrift

CHAPTER 3.2 140 is expected to place additional strain on the limited capacity of cardiology services in Malaysia, which for instance, has eight cardiologists per million population in 2013 as opposed to forty per million population in Singapore.[42,43] While epidemiological transitions were well-documented in western countries, it is likely that challenges are heightened in Asia due the dual infectious and non-communicable disease burden, shift to sedentary occupations and dietary changes.[44] Dietary habits in Malaysia have evolved as a direct consequence of urbanisation and higher incomes and can be characterised by rising trends of daily caloric intake, increase in the consumption of fats, oil, sugar and processed food.[45] Surveillance on traditional risk factors have revealed worrying trends in the community prevalence of diabetes, central obesity, hypercholesterolaemia. From the public health viewpoint, population-wide benefits can be instilled though multifaceted initiatives including the use of mass and social media to advocate the consumption of healthier food options and increased physical activity, economic subsidies on fresh vegetables and fruits, school- and workplace-based health programmes.[46] As some subgroups within the population are more susceptible to develop HF, targeted approaches to detecting and treating risk factors may be efficient measures to minimise overall population risks. In men, it appears that smoking is the major modifiable risk factor which drives the risk of cardiovascular events. Locally, a nationwide ban on all forms of smoking in all eateries in Malaysia has been in force since 2019 and it remains to be determined if this policy indeed leads to reductions in the incidence of cardiovascular diseases among men.[47] A 2017 clinical practice guideline for primary prevention of cardiovascular diseases has incorporated a recommendation for lowered age cut-off at 30 years for opportunistic screening for cardiovascular risk.[48] As resources are finite, the more cost-efficient move would be to perform targeted risk stratification, for instance early cardiovascular screening in adolescents and young adults who are at higher risk such as Indian women, than mass screening.[49] Strengths and limitations Among the strengths of this study was the use of a large hospitalization dataset and the availability of information over a span of ten years, which allowed us to stratify and examine incidence by demographic categories. There were several limitations in

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