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Showing posts with label high cholesterol. Show all posts
Showing posts with label high cholesterol. Show all posts

Friday, June 16, 2023

Taking vital signs to heart

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 Cardiovascular diseases hitting Malaysians at an earlier age 

'The most common risk factors for CVDs are uncontrolled blood sugar levels (diabetics), hypertension and high cholesterol (hypercholestrolaemia' - Dr Wan Azman.

“It has been estimated that CVD-related deaths will reach approximately 31,000 cases annually by 2025 if no concrete measures are put in place to reduce CVD rates,” said Dr Wan Azman, adding that this would form about 55% of all non-communicable diseases related deaths in the country.

With the arrival of Covid-19 in Malaysia in 2020, CVDs still formed a substantial part of deaths, with ischaemic heart diseases and cerebrovascular diseases combining to contribute 20.2% of deaths in 2022, as per the data from the Statistics Department.

“CVDs account for the largest share in costs for hospitalisation (47.77% or RM1.01bil) and medication (46% or RM792mil) compared to other non-communicable diseases, while resulting in annual productivity losses of approximately RM4bil,” said Dr Wan Azman.

He said the most common risk factors for CVDs are uncontrolled blood sugar levels (diabetics), hypertension and high cholesterol (hypercholestrolaemia)

While monitoring blood sugar and blood pressure are relatively straightforward things, monitoring one’s cholesterol level, especially levels of the “bad” cholesterol otherwise known as the low-density lipoproteins (LDLs), has proven to be more challenging, for a variety of reasons.

A person with high cholesterol has no symptoms, he said, adding that a comprehensive blood test was the only way to detect it.

“What makes it more complicating is that while a person’s total cholesterol (combination of high-density lipoproteins and LDL) count may be fine, the percentage of LDL in the total cholesterol count may have breached risky levels,” added Dr Wan Azman.

Health Ministry family medicine specialist consultant Dr Sri Wahyu Taher who was another member of the panel at the event said blood pressure (BP) and blood sugar could be measured easily in public health clinics or general practitioners or at retail pharmacies.

“Checking for cholesterol is not as easy as there is a need to draw a blood sample from the vein to be tested in the laboratory,” she said.

Typically, LDL testing are part of a lipid panel test (that measures total cholesterol, breakdown between HDL and LDL, as well as triglycerides) that are done in comprehensive health screenings.

The challenge includes disseminating information that cholesterol screening is readily available even at government health clinics.

“It is not necessary for a person to go to the hospital to get a cholesterol test done,” added Dr Sri Wahyu. 

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Many misconceptions about cholesterol, survey finds - The Star

PETALING JAYA: As many as 85% of Malaysians claim that their level of knowledge of cholesterol-related issues ranges from “average to good,” according to a recent survey.

The State of Health of the Nation perception survey conducted online nationwide in December 2022, was designed to be representative of the overall population by location, gender, and race.

Conducted by The Green Zebras on behalf of the Malaysian Medical Association (MMA) and Novartis, a pharmaceutical company, the survey polled 500 Malaysians aged between 40 and 64 years.

ALSO READ:Taking vital signs to heart

The not-so-good news is that cholesterol myths are still prevalent, with 75% saying there would be symptoms if a person has high cholesterol, which is untrue.

In a statement, MMA said the survey also found other misconceptions about cholesterol, such as that cholesterol could be managed through a change in lifestyle (92%), while only 40% believe that cholesterol could only be controlled with medication.

Slightly more than half (56%) of the respondents aged from 40 to 60 assumed that cholesterol testing was needed at least every five years or more frequently, and 49% disagreed that someone within a healthy weight range could actually have unhealthy cholesterol levels.

Despite these misconceptions, most Malaysians (89%) are aware that poorly managed high cholesterol levels could lead to severe diseases such as cardiovascular diseases that include stroke and heart problems, with 84% of the respondents wishing for easier ways to manage high cholesterol.

MMA president Dr Muruga Raj Rajathurai said while the response in the survey showed that Malaysians claimed to be well-informed on cholesterol, there were some fallacies in their sentiments.

He said there were no symptoms for high cholesterol and that a blood test was the only way to detect it.

The recommended cholesterol screenings for adults between 45 to 65 years are every one to two years and should be done annually for those above 65, he added.

“Therefore, taking charge of your health and doing regular health screenings is relatively important. Do not wait to visit the doctor when you feel unhealthy or unwell, everything may be too late.

“I strongly advise them not to rely on health-related information from friends, family, and social media only as these are often skewed through the sharing process,” he said in a statement.

Mohamed ElWakil, country president of Novartis Malaysia, said many people were unaware that cholesterol was one of the silent killers, along with high blood pressure and diabetes.

“There are no obvious symptoms. However, cholesterol can be managed if it is detected early.

“Following the doctor’s recommended treatment plan and lifestyle changes may help prevent severe heart-related problems.

“In fact, there are now easier and more convenient treatment plans available. Patients should actively seek the best treatment options from their doctors.””

The dangers of too much processed and fast foods

GEORGE TOWN: Unhealthy lifestyles have led to people suffering from cardiovascular diseases (CVD), including heart attack and stroke, at a younger age.

Universiti Sains Malaysia (USM) family medicine specialist Dr Mastura Mohd Sopian said CVD among young people is mainly caused by high levels of low-density lipoprotein (LDL), commonly known as bad cholesterol.

“CVD is the leading cause for morbidity and mortality globally and Malaysians are not spared from it,” she said.

Aside from poor dietary habits, she said a largely sedentary lifestyle and stress have added to the increase in CVD and metabolic diseases.

“Too much fast food and processed food, which are cheaply available, are among the main reasons the younger generation has become more prone to these diseases,” she added.

The medical lecturer said to combat these diseases, prevention was better than cure.

Dr Mastura urged people to stick to healthy diets, and for those who smoke, to kick the habit.

She said one must move more and exercise often – as much as 30 minutes of moderate exercise every day or at least three days a week.

“We should all learn how to manage our stress, seek help and advice when needed and see the doctor yearly for a health screening,” she said, adding that getting six to eight hours of sleep each night was vital.

For those dealing with diabetes or other non-communicable diseases (NCD), Dr Mastura said these healthy habits were necessary to manage their condition.

She said the greatest visible indicator of being at risk of CVD was being overweight or worse, obese.

Public health expert Datuk Dr Zainal Ariffin Omar said too much food consumed by Malaysians now were laden with saturated and even trans fats.

This, he said, were among factors causing Malaysians, especially the younger generation, to be at risk of CVD.

Dr Zainal said it was important to maintain a healthy balance of cholesterol in the body by limiting their intake of saturated and trans fats.

LDL is the type of cholesterol that can cause build-ups and blockages in arteries that can lead to heart diseases and strokes. 

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Thursday, April 6, 2023

How dangerous are India’s generic drugs? Very

 

India relies on the weak oversight of developing countries that make up the bulk of its exports – that’s how it can continue to push substandard and often deadly medicines there. — Bloomberg

 

FOR a nation that seeks to claim the mantle of “pharmacy to the world,” India is scandalously short on regulatory oversight.

In the last six months, its generic cough syrups have killed dozens of children, its eye drops have caused blindness and its chemotherapy drugs have been contaminated.

The children who died – mostly under the age of five years – were given Indian-made over-the-counter products contaminated with industrial solvents and antifreeze agents that are fatal in even small amounts.

The eye drops that contained extensively drug-resistant bacteria? So far 68 patients across 16 US states have been affected. Three people died, several had to have their eyeballs removed, some went blind, the Centres for Disease Control and Prevention reported on March 21.

The Indian company, Global Pharma Healthcare, issued a voluntary nationwide recall for the drops. India is the largest provider of generic medicines, producing 20% of the world’s supply, according to the government’s Economic Survey.

Its US$50bil (RM220bil) drug-manufacturing industry exports medicines to over 200 nations and makes 60% of all vaccines. It boasts “the highest number” of US Food and Drug Administration or FDA-compliant plants outside America, and indeed, some of its generic pharmaceutical companies produce high-quality medicines.

That may well provide consumers with a level of comfort, but history suggests it is unwise to trust that feeling.

The latest drug recalls just add to a long line of scandals that have tainted the sector.

In 2013, a US subsidiary of major Indian drug manufacturer Ranbaxy Laboratories Ltd pleaded guilty to US federal criminal charges and agreed to pay US$500mil (RM2.2bil) lion for selling adulterated generic drugs, fabricating data, and committing fraud. Serious flaws in the FDA compliance regime allowed these breaches to go undiscovered, until a years-long investigation laid bare the endemic corruption.

A generic drug made in India and modelled on Lipitor sold in the US to treat high cholesterol, for example, was contaminated with shards of blue glass, as journalist Katherine Eban documented in her book, Bottle of Lies: The Inside Story of the Generic Drug Boom. Her book draws in part on the experience of whistleblower Dinesh Thakur, who worked at Ranbaxy.

You would think such a damning indictment would prompt India to develop a safer, better pharmaceutical oversight regime. Think again.

The systemic fraud exposed by the investigation – where data was routinely falsified to fool inspectors, increase production and maximise profit – did not result in a regulatory overhaul.

Still, a two-day “brainstorming session” held in February appeared to acknowledge the system’s inherent weaknesses, with Health Minister Mansukh Mandaviya telling participants India needed to “move from generic to quality-generic drugs.”

Discussions involved “how to make the country’s drugs regulatory systems transparent, predictable and verifiable,” according to a health ministry media release.

Consumers shouldn’t hold their breath, though. A national law on drug recalls has been under discussion since 1976 without resolution, and the government – at least publicly –remains in denial: Since the Ranbaxy scandal, Thakur has campaigned for the reform of India’s main regulator, the Central Drugs Standard Control Organisation, and, with lawyer T. Prashant Reddy, has written his own book, The Truth Pill: The Myth of Drug Regulation in India, which was published in October.

They note that adulterated Indian drugs aren’t just killing children in developing-world export markets like Gambia and Uzbekistan. They’re also killing children at home: In 2019, at least 11 infants died in the state of Jammu because of cough syrup containing diethylene glycol. 

The World Health Organisation (WHO) sent alerts in October and January, asking for the cough medicine to be removed from the shelves. (It also issued a warning last year for cough syrups made by four Indonesian manufacturers sold in that country, where 203 children died in similar circumstances.)

Maiden Pharmaceuticals, whose medicines were sold in Gambia and linked by the WHO to the deaths of at least 70 children, has denied wrongdoing. And India’s regulator rejected the WHO’s findings, saying no toxic substances had been found in samples taken from Maiden’s plant. 

It shouldn’t have taken more deaths for Prime Minister Narendra Modi’s administration to act. The red flags have been there for years. What’s lacking is political will, and transparency. The FDA publishes different reviews of new drug applications on its website, along with detailed notes. 

So why does contamination with such deadly substances occur so regularly?

“The simple answer is that Indian pharmaceutical companies quite often fail to test either the raw materials or the final formulation before shipping it to market,” Thakur said.

India relies on the weak oversight of developing countries that make up the bulk of its exports – that’s how it can continue to push substandard and often deadly medicines there.

In the absence of a global framework for pharmaceutical safety, what can be done to make the generic drugs that consumers around the world have come to rely on safer and effective?

For a start, the WHO’s prequalification programme, which facilitates the purchase of billions of dollars’ worth of medicines through international agencies such as Unicef, must be overhauled. Then there’s the question of holding these companies to account for the harm they cause inside and outside India via legal avenues and victims’ compensation. — Bloomberg 

- Ruth Pollard is a Bloomberg Opinion columnist. The views expressed here are the writer’s own.

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Tuesday, November 8, 2022

Not the best for weight

 Although BMI is widely used as a measure of weight, it is not very accurate and can lead to the mistreatment of obesity and eating disorders.

Measuring a person’s waistline might give a better representation of their health than their bmi, as those with abdominal obesity are prone to developing certain chronic medical conditions. — Photos: TNS

 

BMI in Adults: Is Yours Healthy, and if Not, How Can You Lose ...

PEOPLE who seek medical treatment for obesity or an eating disorder do so with the hope their insurance plan will pay for part of it.

But whether it’s covered or not often comes down to a measure invented almost 200 years ago by a Belgian mathematician as part of his quest to use statistics to define the “average man”.

That work, done in the 1830s by Adolphe Quetelet, appealed to life insurance companies, which created “ideal” weight tables after the turn of the century.

By the 1970s and 1980s, the measurement, now dubbed body mass index (BMI), was adopted to screen for, and track, obesity.

Now it’s everywhere, using an equation – essentially a ratio of mass to height – to categorise patients as overweight, underweight or at a “healthy weight”.

It’s appealingly simple, with a scale that designates adults who score between 18.5 and 24.9 as within a healthy range.

But critics – and they are widespread these days – say it was never meant as a health diagnostic tool.

“BMI does not come from science or medicine,” said Dr Fatima Stanford, an obesity medicine specialist and equity director of the endocrine division at Massachusetts General Hospital in the United States. 

She and other experts said BMI can be useful in tracking population-wide weight trends, but it falls short by failing to account for differences among ethnic groups, and it can mislabel some people, including athletes, as overweight or obese because it does not distinguish between muscle mass and fat.

Still, BMI has become a standard tool to determine who is most at risk of the health consequences of excess weight – and who qualifies for often-expensive treatments.

Cut-offs for coverage

Despite the heavy debate surrounding BMI, the consensus is that people who are overweight or obese are at greater risk for a host of health problems, including diabetes, liver problems, osteoarthritis, high blood pressure, sleep apnoea and cardiovascular problems.

The BMI measure is commonly included in the prescribing directions for weight-loss drugs.

Some of the newest and most effective drugs, such as semaglutide, limit use to patients who have a BMI of 30 or higher – the obesity threshold – or a lower level of 27, if the patient has at least one weightrelated medical condition, such as diabetes.

Doctors can prescribe the medications to patients who don’t meet those label requirements, but insurers might not cover any of the cost.

While most insurers cover some forms of bariatric surgery for weight loss, they might require a patient to have a BMI of at least 35, along with other health conditions, such as high blood pressure or diabetes, to qualify.

With medications, it can be even trickier.

US national health insurance programme Medicare, for example, does not cover most prescription weight-loss drugs, although it will cover behavioural health treatments and obesity screening. Coverage for weightloss medications varies among private insurance plans.

“It’s very frustrating because everything we do in obesity medicine is based on these cut-offs,” said Dr Stanford.

Over and under

Critics say that BMI can err on both ends of the scale, mistakenly labelling some larger people as unhealthy and people who weigh less as healthy, even if they need medical treatment.

For eating disorders, insurers often use BMI to make coverage decisions and can limit treatment to only those who rank as underweight, missing others who need help, said Serena Nangia.

Nangia is the communications director for Project Heal, a US non-profit organisation that helps patients get treatment, whether they are uninsured or have been denied care through their insurance plan. 

“Because there’s such a focus on BMI numbers, we are missing people who could have gotten help earlier, even if they are at a medium BMI,” she said.

“If they are not underweight, they are not taken seriously, and their behaviours are overlooked.” 

Dr Stanford said she too often battles insurance companies over who qualifies for overweight treatment based on BMI definitions, especially some of the newer, pricier weight-loss medications, which can cost more than US$1,500 (RM7,114.50) a month.

“I’ve had patients doing well on medication and their BMI gets below a certain level, and then the insurance company wants to take them off the medication,” she said, adding she challenges those decisions.

“Sometimes I win, sometimes I lose.”

Not accurate for health

While perhaps useful as a screening tool, BMI alone is not a good arbiter of health, said Dr Stanford and many other experts.

“The health of a person with a BMI of 29 might be worse than one with a 50 if that person with the 29 has high cholesterol, diabetes, sleep apnoea, or a laundry list of things,” said Dr Stanford, “while the person with a 50 just has high blood pressure.

“Which one is sicker? I would say the person with more metabolic disease.”

Additionally, BMI can overestimate obesity for tall people and underestimate it for short ones, experts say.

And it does not account for gender and ethnic differences.

Case in point: “Black women who are between 31 and 33 BMI tend to have better health status even at that above-30 level” than other women and men, Dr Stanford said.

Meanwhile, several studies, including the long-running Nurses’ Health Study, found that Asian people had a greater risk of developing diabetes as they gained weight, compared with whites and certain ethnic groups.

As a result, countries such as China and Japan have set lower BMI overweight and obesity thresholds for people of Asian descent.

Other measurements

Experts generally agree that BMI should not be the only measure to assess patients’ health and weight.

“It does have limitations,” said David Creel, a psychologist and registered dietitian at Cleveland Clinic’s Bariatric and Metabolic Institute.

“It doesn’t tell us anything about the difference between muscle and fat weight,” he said, noting that many athletes might score in the overweight category, or even land in the obesity range due to muscle bulk.

Instead of relying on BMI, physicians and patients should consider other factors in the weight equation.

One is being aware of where weight is distributed.

Studies have shown that health risks increase if a person carries excess weight in the midsection.

“If someone has thick legs and most of their weight is in the lower body, it’s not nearly as harmful as if they have it around their midsection, especially their organs,” he said.

Dr Stanford agreed, saying midsection weight “is a much better proxy for health than BMI itself”, with the potential for developing conditions like fatty liver disease or diabetes “directly correlated with waist size”.

Patients and their doctors can use a simple tool to assess this risk: the tape measure.

Measuring just above the hipbone, women should stay at 35 inches or less, and men at 40 inches or less, researchers advise.

New ways to define and diagnose obesity are in the works, including a panel of international experts convened by the prestigious Lancet Commission, said Dr Stanford, a member of the group.

Any new criteria ultimately approved might not only help inform physicians and patients, but also affect insurance coverage and public health interventions.

She has also studied a way to recalibrate BMI to reflect gender and ethnic differences.

It incorporates various groups’ risk factors for conditions such as diabetes, high blood pressure and high cholesterol.

Based on her research, she said, the BMI cut-off would trend lower for men, as well as Hispanic and white women.

It would shift to slightly higher cut-offs for Black women.

(Hispanic people can be of any race or combination of races.)

“We do not plan to eliminate the BMI, but we plan to devise other strategies to evaluate the health associated with weight status,” she said. – Kaiser Health News/tribune News Service

Although BMI is widely used as a measure of weight, it is not very accurate and can lead to the mistreatment of obesity and eating disorders.

Kaiser Health News (KHN) is a US national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programmes at Kaiser Family Foundation (KFF). KFF is an endowed non-profit organisation providing information on health issues to the US. 

-The Star Malaysia By JULIE APPLEBY 

 

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