Atherosclerosis is one of the most common — and most dangerous — conditions affecting Malaysians today. It underlies the majority of heart attacks and strokes, yet it develops silently over decades with no obvious symptoms until a vessel becomes critically narrowed or blocked.
What is Atherosclerosis?
Atherosclerosis is the build-up of plaques — deposits of fat, cholesterol, calcium and inflammatory cells — within the walls of arteries. Over time, these plaques harden and narrow the artery, reducing blood flow. If a plaque ruptures, it can trigger a blood clot that blocks the artery completely, causing a heart attack or stroke.
The disease begins as early as childhood and progresses slowly over a lifetime. Many people have significant atherosclerosis without knowing it until a cardiovascular event occurs.
Key fact: Heart disease is the leading cause of death in Malaysia. Atherosclerosis is the underlying cause of most heart attacks and strokes. Understanding your risk is the first step to prevention.
How Atherosclerosis Develops
The process begins with injury to the endothelium — the delicate inner lining of artery walls. Common causes of this injury include high blood pressure, elevated LDL cholesterol, smoking and chronic high blood sugar. Once injured, the endothelium becomes permeable to LDL cholesterol, which accumulates in the artery wall and becomes oxidised. White blood cells rush to the site, engulf the oxidised LDL and become "foam cells," forming a fatty streak. Over years, these evolve into atheromatous plaques with a lipid core and a fibrous cap.
Risk Factors
Modifiable risk factors (can be changed):
- Smoking — damages the endothelium and lowers HDL cholesterol
- High LDL cholesterol — primary driver of plaque formation
- High blood pressure (hypertension) — mechanical stress on artery walls
- Diabetes or high blood sugar — promotes vascular inflammation
- Obesity, particularly abdominal fat
- Physical inactivity
- Unhealthy diet — high in saturated fat, refined carbohydrates, salt
Non-modifiable risk factors:
- Age — risk increases significantly after 45 (men) and after menopause (women)
- Family history of early cardiovascular disease
- Male sex (though women's risk equalises after menopause)
- Ethnicity — South Asian populations carry higher baseline cardiovascular risk
Symptoms — Why It's Called a "Silent" Disease
Atherosclerosis typically produces no symptoms until an artery is at least 70% blocked, or until a plaque ruptures suddenly. When symptoms do appear, they reflect which organ is affected:
- Heart: Angina (chest tightness on exertion), breathlessness, heart attack
- Brain: TIA (mini-stroke), stroke, sudden weakness or speech difficulty
- Legs: Claudication (calf pain on walking), poor wound healing, cold feet
- Kidneys: Difficult-to-control hypertension, declining kidney function
Laboratory Tests for Cardiovascular Risk
The following blood tests are commonly used to assess atherosclerosis risk and monitor cardiovascular health:
| Test | What It Detects | Target |
|---|---|---|
| Fasting Lipid Profile | LDL, HDL, total cholesterol, triglycerides | LDL <3.4 mmol/L (lower in high-risk patients) |
| Fasting Glucose / HbA1c | Diabetes and pre-diabetes | Fasting glucose <6.1 mmol/L; HbA1c <5.7% |
| hsCRP | Vascular inflammation | <1.0 mg/L (low risk) |
| Apolipoprotein B (ApoB) | Atherogenic particle number | <0.9 g/L |
| Lipoprotein(a) | Genetically elevated cardiovascular risk | <75 nmol/L |
| Renal Function | Kidney health — closely linked to CVD risk | eGFR >60 mL/min/1.73m² |
| Thyroid (TSH) | Thyroid disorder affecting lipid metabolism | 0.4–4.0 mIU/L |
Prevention and Treatment
Atherosclerosis cannot be fully reversed, but its progression can be significantly slowed — and in some cases partially reversed — through:
- Statins — the most effective medication for lowering LDL and stabilising plaques
- Blood pressure control — target below 130/80 mmHg for high-risk individuals
- Diabetes management — keeping HbA1c below 7.0%
- Smoking cessation — the single most impactful lifestyle change
- Mediterranean-style diet — high in fish, vegetables, olive oil, legumes and nuts
- Regular aerobic exercise — 150 minutes per week minimum
- Antiplatelet therapy — aspirin or equivalent in high-risk patients
Get tested: If you are over 40, or have any risk factors listed above, ask your doctor about a cardiovascular risk screen. Early detection through a simple blood test can be life-saving. See our guide on health screening packages for more information.
Medical disclaimer: This article is for general health education only and does not constitute medical advice. Please consult a qualified doctor for personal health concerns.