Not many know that Asia has the largest population of heart failure patients in the world.
Not many know that Asia has the largest population of heart failure patients in the world. Southeast Asia alone is home to nine million heart failure patients, while the United States only has six million.
Despite the staggering numbers, comprehensive research on heart failure in Asia remains nascent and decades in the wake of Europe and the United States. One of the major research milestones in this part of the world was the establishment of the Asian-HF registry in 2012. Aimed at bridging the wide knowledge gap, the registry gathers real world data on the demographics and risk factors of heart failure patients from 11 regions: China, India, Japan, South Korea, Indonesia, Malaysia, Singapore, the Philippines, Thailand, Taiwan and Hong Kong.
A study led by Associate Professor Carolyn Lam, Senior Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS) analysed the prospective multinational Asian data from the registry and the late-breaking findings were recently published in the European Heart Journal in August 2016. It found that aside from getting heart failure about ten years earlier than their Western counterparts, Asian heart failure patients are in fact very different from each other based on their ethnicity and which region they are living in. The study was initiated by the National University Heart Centre, Singapore, in partnership with NHCS and other centres.
Heart failure in Singapore
5,276 heart failure patients were recruited for the study. Of the 1,066 patients from Singapore, 62 per cent had coronary artery disease, 70 per cent had hypertension and 58 per cent had diabetes. The Singaporean heart failure patients had an average body mass index (BMI) of 25.9; a BMI exceeding 23 is known to increase one’s risk for heart disease, diabetes and other health issues. Through the study, Singaporeans were also found to suffer from heart failure at the mean age of 61, a decade earlier than Caucasians.
About one in five of the 5,276 heart failure patients in the ASIAN-HF study came from Singapore.
“In Singapore, we have transitioned rapidly, and it is now the baby boomers who have reached that age of 60, and they are manifesting heart failure from these risk factors,” explained Associate Professor Lam, who is also a Clinician Scientist with the SingHealth Duke-NUS Cardiovascular Sciences Academic Clinical Programme and an Associate Professor with the Programme in Cardiovascular & Metabolic Disorders at Duke-NUS Medical School.
Fortunately, much of what culminates in heart failure can be prevented.
“The silver lining is that most cardiovascular risk factors are modifiable,” said Associate Professor Lam, “There is a lot we can do to reduce or prevent the risk of hypertension, diabetes and coronary artery disease. By extension, this means that most of us will be able to lower our risk of developing heart failure if we keep to a healthy lifestyle through a sensible diet and regular exercise.”
She added that simple acts like walking and taking the stairs more often can be effective in keeping heart failure at bay.
Simple acts like walking and taking the stairs more often can help prevent or delay the onset of heart failure.
No single Asian phenotype for heart failure
The study also painted an interesting and diverse picture of the Asian heart failure population when it compared the three risk factors across geographic regions, regional income levels and ethnicity.
Results showed that Chinese heart failure patients across the board were more than twice as likely to develop coronary artery disease as the Japanese or South Koreans. The team found differences when comparing patients of the same ethnicity who were living in different parts of Asia. For example, Indian patients living in higher income regions had five times the risk of developing diabetes than those from lower income regions.
The team plans to follow up with the patients for the next two to three years to see how they are faring and their outcomes.
The ASIAN-HF study is supported by grants from the Boston Scientific Investigator Sponsored Research Program, National Research Foundation Singapore under its Translational and Clinical Research Flagship Programme administered by the Singapore Ministry of Health’s National Medical Research Council, the Asian Network for Translational Research and Cardiovascular Trials programme funded by the Agency for Science, Technology and Research, and Bayer.
This article was first published in Murmurs Apr-Jun 2016 Issue 26, a quarterly publication of National Heart Centre Singapore.
