ABCDE of Heart Attack Prevention

Heart disease is one of the leading causes of morbidity and mortality in Malaysia, with heart attack being the major manifestation. Approximately 90% of first heart attacks may be attributed to the following nine modifiable lifestyle factors: smoking, excessive alcohol intake, poor diet, lack of exercise, obesity, stress, high blood sugar, high blood pressure and high blood cholesterol.1 We can take steps to prevent a heart attack from occurring.

The first step is Assessing cardiovascular risks. In clinics or hospitals, doctors can estimate the 10-year risk of patients having a heart attack and stratify them into low, borderline, intermediate or high-risk groups. Treatment can then be tailored accordingly, whether it involves intensifying medications or continuing the current treatment plan.

High Blood pressure is the persistent elevation of blood pressure, typically measured at least twice on two separate occasions, with readings above 140/ 90 mmHg. The higher the blood pressure, the greater the chance of heart attack. Therefore, it is crucial to monitor Blood pressure regularly, as patients with high blood pressure do not experience any symptoms. In fact, blood pressure should be measured at every chance encounter.

Excessive bad Cholesterol buildup in the main blood vessel walls reduces the flow of oxygenated blood to the heart muscle. Therefore, it is advisable to screen blood cholesterol levels annually and discuss with medical practitioners for further cholesterol-lowering therapy if the levels are found to be abnormally high. Various chemicals found in Cigarette smoke can thicken the blood and promote the formation of plaque or clots inside blood vessels. Fortunately, smoking Cessation can help reverse this process, although it may take many years for the blood vessels to fully recover. For smokers who are willing to quit, a combination of behavioural interventions and nicotine replacement therapy maximizes the likelihood of cessation success.

Maintaining a healthy Diet (with at least 5 servings of fruits and vegetables daily and appropriate calorie intake) is good for achieving an optimal body weight. For those who are overweight or obese, weight loss is strongly recommended and a healthy body mass index (BMI) between 18.5 and 24.9 kg/m2 should be aimed for. Additionally, it is widely recognized that adhering to a Diet rich in whole grains, seafood, beans, nuts, fruits and vegetables can offer cardioprotective benefits. For diabetic patients (especially those with uncontrolled blood sugar), it is important to monitor carbohydrate intake and avoid sugar-sweetened beverages.

Aerobic Exercise helps build stronger heart muscles. World Health Organization recommends engaging in weekly Exercise of moderate intensity (such as brisk walking, vacuuming, mopping) for at least 150 minutes or vigorous intensity (such as hiking, jogging, or playing football) for at least 75 minutes per week. Nevertheless, those who are not able to reach the recommended levels should be encouraged to attain some level of Exercise as any form of exercise is better than nothing. Furthermore, exercise stimulates the production of endorphins in the brain, which can be effective at reducing stress levels.

In line with the ‘Wellness Month’ (Bulan Malaysia Sihat Sejahtera) launched by the Ministry of Health, which is celebrated annually in September, we should always embrace healthy lifestyles by following the heart-protective ABCDE approach.

A – Assessing risk

B – Blood pressure management

C – Cholesterol lowering/ Cigarette cessation

D – Diet

E – Exercise

Written by Dr Yap Jun Fai, Professor Dr Moy Foong Ming and Dr Lim Yin Cheng. They are affiliated with the Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya and the Department of Public Health, Universiti Malaya Medical Centre.

This piece is published in :


1. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-952.

2. Blumenthal RS, Alfaddagh A. The ABCDE’s of primary prevention of cardiovascular disease. Trans Am Clin Climatol Assoc. 2022;132:135-154.

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