1.Clinical characteristics, treatment and 2-year outcomes in Malaysian and Bruneian patients with stable coronary artery within the worldwide CLARIFY registry
Kok Han Chee ; Gim Hooi Choo ; Ahmad Nizar Jamaluddin ; Kauthaman Mahendran ; Nicola Greenlaw ; Chandran Krishnan
The Medical Journal of Malaysia 2017;72(5):282-285
Introduction: The on-going, international, prospective,
observational, longitudinal CLARIFY registry is investigating
the demographics, clinical profiles, management and
outcomes of patients with stable coronary artery disease
(CAD). This paper assesses baseline characteristics,
treatment, and clinical outcomes at two years’ follow-up of
Malaysian/Bruneian patients compared with the overall
registry population.
Method: Between November 2009 and July 2010, outpatients
from 45 countries who met the criteria for stable CAD were
recruited into the registry. Baseline characteristics were
documented at enrolment, and patients were reassessed
during their annual visits over a five-year follow-up period.
Key outcomes measured were sudden death and
cardiovascular (CV) death, non-CV death and CV morbidity.
Results: At baseline, 33,283 patients were available for
analysis within the registry; 380 and 27 were Malaysians and
Bruneians, respectively. The mean ages of
Malaysian/Bruneian patients and the rest of the world (RoW)
were 57.83 ±9.98 years and 64.23 ± 10.46 years, respectively
(p<0.001). The median body mass index values were 26.6
(24.4-29.6) kg/m2 and 27.3 (24.8-30.3) kg/m2
, respectively
(p=0.014). Malaysian/Bruneian patients had lower rates of
myocardial infarction (54.55% versus 59.76%, p=0.033) and
higher rates of diabetes (43.24% versus 28.99%, p<0.001)
and dyslipidaemia (90.42% versus 74.66%, p<0.001)
compared with the RoW. Measured clinical outcomes in
Malaysian and Bruneian patients at 2-years follow-up were
low and generally comparable to the RoW.
Conclusion: Malaysian/Bruneian patients with stable CAD
tend to be younger with poorer diabetic control compared
with the RoW. However, they had similar outcomes as the
main registry following two years of treatment.
Coronary Artery Disease
;
Cardiovascular Diseases
;
Heart Rate
3.Updates in the management of Dyslipidaemia in the high and very high risk individual for CV risk reduction
Jeyamalar RAJADURAI ; Wan Azman Wan Ahmad ; Hapizah NAWAWI ; Choo Gim HOOI ; Ng Wai KIAT ; Rosli Mohd ALI ; Al Fazir OMAR ; Sazzli KASIM ; Oteh MASKON ; David Quek Kwang Leng
The Medical Journal of Malaysia 2018;73(3):154-162
mortality and an important cause of morbidity in Malaysiafor several years. To reduce global cardiovascular (CV) riskin the population, primary preventive strategies need to beimplemented. Hypercholesterolaemia is one of the majorrisk factors for CVD. This paper is an expert review on themanagement of hypercholesterolemia focusing on high andvery high risk individuals. In low and Intermediate riskindividuals, therapeutic lifestyle changes (TLC) and ahealthy lifestyle alone may suffice. In high and very high riskindividuals, drug therapy in conjunction with TLC arenecessary to achieve the target LDL-C levels which havebeen shown to slow down progression and sometimes evenresult in regression of atherosclerotic plaques. Statins arefirst-line drugs because they have been shown in numerousrandomized controlled trials to be effective in reducing CVevents and to be safe. In some high risk individuals, despitemaximally tolerated statin therapy, target Low DensityLipoprotein Cholesterol (LDL-C) levels are not achieved.These include those with familial hypercholesterolaemia andstatin intolerance. This paper discusses non-statintherapies, such as ezetimibe and the newer Proproteinconvertase subtilisin/kexin type 9 Inhibitors (PCSK9-i).