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In Malaysia, the age distribution of death caused by coronary artery is found to be similar to those western countries, mortality increasing with age. However, out of 2713 cases of death, 3.2% of them are below 40 years. As reported by R. Jeyemalar (1991), the average male : female ratio is 2.2:1 although this varies among the three ethnic groups; 2.5:1, 1.7:1, and 3.0:1 among Malays, Chinese and Indians respectively. The percentage of death due to coronary artery disease among the Chinese, Malays and Indians is found to be 39%, 34% and 26% respectively. According to the latest data presented by World Health Organization (WHO) in April 2011, deaths caused by coronary artery disease has reached 22701 or 22.18% of total death. The age adjusted death rate is 138.75 per 100000 of population which ranks Malaysia at the top 57 in the world. According to Professor Dr Sim Kui Hian (2009), 37,020 people were admitted with coronary artery disease while the other 10,242 people were admitted with heart failure in government hospitals nationwide. By clinical assessment without angiogram, the frequency of coronary artery disease is found to be 12% - 16% in Asian Indian as stated by Sharma and Ganguly (2005). Despite the limitations of the data stated previously, Indians are more vulnerable to coronary artery disease than Chinese, this ethnic prevalence of coronary artery disease is seven times higher in Indians than in Chinese and it is first noticed in Singapore. In addition, this has also been noted in other studies from Uganda, Trinidad, South Africa and UK.
The development of the coronary artery disease is mainly affected by a number of risk factors. Coronary artery disease is more likely to happen as the age increases especially over 40 years old. According to Lloyd-Jones D.M. (1999), the lifetime risk of developing coronary artery disease at age 40 years is 50% for men and 33% for women. This has proven that men have higher tendency than women to develop coronary artery disease. Besides that, there is a higher possibility of individuals to develop coronary artery disease if their close relatives have suffered early in life. This is stated in several studies done by Snowden C.B. (1982), to show that a parental history of coronary heart disease increases the chance of premature onset of coronary heart disease. However, there are other modifiable risk factors that lead to coronary heart disease. For instance, one's risk of coronary artery disease is much increased when he is suffering from elevated blood cholesterol, elevated blood pressure, obesity and excessive stress. It is not the end of the life even if someone discovers that he is suffering from coronary artery disease. Making simple changes to lifestyle can possibly save one's life. It is suggested to consume a diet rich in vitamins, high in fibre but low in saturated fats consistent with food recommendations in order to facilitate weight control and blood cholesterol level. For example, organ meats which are high in cholesterol should be avoided. Next, daily exercise helps to reduce the risk of getting coronary artery disease. The simplest form of exercise like walking for at least 20 minutes a day will do, if someone claims to have not enough time. According to Hennekens C.H. (1997), smoking is the most important preventable cause for the development of coronary artery disease among men and women. A clear relationship exists between the number of cigarettes smoked and the increased of risk of coronary artery disease. Fortunately, smoking cessation can reasonably reduce the risk of coronary artery disease in both genders, said by Kawachi I (1993). Besides that, aspirin in exact dosage dispensed by pharmacist can be taken to reduce the risk of coronary artery disease as it prevents the formation of blood clots in the arteries. Moreover, moderate intake of alcohol may be beneficial to those suffering from coronary artery disease.
At young age, the inner lining of the normal coronary artery is smooth, elastic and free of blockages. However, as we grow older, lipids and fatty substances are deposited as fatty streaks. The streaks do not produce any obstructions and symptoms as they are slightly raised on the surface of inner lining of coronary artery. Individuals with sedentary lifestyle and do not practise a balanced diet are more vulnerable to the increased built up of fatty layers. The fats deposited cause slight injury to the wall of coronary artery. Attempting to heal the injured walls may result in chemicals being released from cells to make the wall of coronary artery stickier. Substances such as cellular waste product, inflammatory cells, proteins and calcium that travel through the inner channel of coronary artery will begin to stick to the wall of coronary artery. They combine with the fatty layers to form plaque. Over time, different sizes of plaques develop. The plaque deposited is soft on the inside with a hard fibrous substance covering the outside. Whenever the hard surface ruptures, the fatty substances which are previously covered by hard fibrous substance are exposed. When platelets come into contact with the fatty substances, a blood clot formed around the plaque. Thus it causes the inner channel of coronary artery to become narrower. In certain cases, the size of the blood clot formed is big enough to block the coronary artery completely to cut off the supply of oxygen and nutrient to the heart muscle causing an acute coronary syndrome.
The effects of coronary artery disease cannot be neglected as it causes death at times. As supported by Mayo Clinic staff (2011), Myocardial infarction occurs when blood flow to a part of your heart is blocked for a long enough time that part of the heart muscle is damaged or dies. This is the result of a plaque that clogs up the inner channel of coronary artery. Furthermore, angina is a chest pain or discomfort which is also a symptom of coronary artery disease. It happens when the heart muscles do not get enough of oxygen. It may feels like a pressure or squeezing pain in the chest. It may also feels like indigestion with pain in the shoulders, arms, neck, jaw or back. Moreover, shortness of breath can be one of the effects as well as the heart muscles receive insufficient supply of oxygen. Coronary artery disease may cause sudden cardiac arrest (SCA) which results in a sudden death because the heart develops an arrhythmia that causes it to stop beating. In the social perception, individuals with coronary artery disease tend to be more depressed and stressed out as they have to consider the potential dangers that might arise among the family members if he were to experience a sudden death. He has to worry about the medical expenses as well. Being pessimistic will not improve the health condition at all, which in turn, worsen the state of illness.
According to Rebecca Canvin (2012), self-help, medicines, non-surgical treatment and surgery are 4 main categories for treatment of coronary artery disease. Self-help is about individuals who adopt a healthy lifestyle simply beginning with daily exercise, balanced diet, smoking cessation as well as a moderate intake of alcohol. Other than that, medicines aim to stop coronary heart disease from getting worse or prevent future heart attacks. For example, cholesterol-lowering medicines such as statins are used to slow down the process of atherosclerosis which in turn, slowing down the formation of plaque. Beta blockers help to slow down the pumping rate of the heart and help to control the rhythm of the heart, thus preventing the happening of arrhythmia. Anticoagulants help to stop the formation of blood clots while calcium-channel blockers relax and widen the arteries. The use of nitrates will help to relax the coronary arteries and allow more bloods to reach the heart so that the heart muscles will get enough of oxygen supply. In the other hand, according to the Cleveland Clinic medical staff, a small dosage of aspirin make the blood to have less possibility of forming clots and reduce the risk of getting heart attack. For the non-surgical treatment, coronary angioplasty is commonly used which helps to widen the narrowed coronary artery. Firstly, a collapsed balloon is passed through the blood vessels until it reaches the coronary artery and it will be inflated. A stent can be inserted to keep the artery open. According to Lee GA (2013), the most commonly performed surgical procedure is Coronary Artery Bypass Graft Surgery (CABGS). A piece of a vein from the leg or artery from the chest or wrist is used in the surgery. The surgeon attaches this to the coronary artery above and below the narrowed area or blockage. This enables blood to bypass the blockage. The number of bypass needed depends on the individual.
In a nutshell, suffering from coronary artery disease is not the end of one's life yet, one should be more optimistic and having a strong will that he is going to be alright. Healthy individuals with no coronary artery disease should take suitable precautionary steps to prevent the development of coronary artery disease, simply because the old saying, prevention is better than cure.