Browsing by Author "Sharmini Selvarajah"
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- PublicationAssociation of BMI with risk of CVD mortality and all-cause mortality(Cambridge University Press, 2017)
;Chee Cheong Kee ;Mohd Ghazali Sumarni ;Kuang Hock Lim ;Sharmini Selvarajah ;Jamaiyah Haniff ;Guat Hiong Helen Tee ;Kaur Gurpreet ;Yusoff Ahmad FaudziNasir Mustafa AmalObjective To determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults. Design Population-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers. Setting All fourteen states in Malaysia. Subjects Malaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey. Results Total follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI<18·5 kg/m2) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥30·0 kg/m2) was associated with a heightened risk of CVD mortality. Overweight (BMI=25·0–29·9 kg/m2) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI≥35·0 kg/m2). Conclusions Underweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted. - PublicationClustering of cardiovascular risk factors in a middle-income country: a call for urgency(2012)
;Sharmini Selvarajah ;Jamaiyah Haniff ;Gurpreet Kaur ;Tee Guat Hiong ;Kee Chee Cheong ;Chiao Mei LimMichiel L BotsBackground: This study aimed to estimate the prevalence of cardiovascular risk factors and its clustering. The findings are to help shape the Malaysian future healthcare planning for cardiovascular disease prevention and management. Methods: Data from a nationally representative cross-sectional survey was used. The survey was conducted via a face-to-face interview using a standardised questionnaire. A total of 37,906 eligible participants aged 18 years and older was identified, of whom 34,505 (91%) participated. Focus was on hypertension, hyperglycaemia (diabetes and impaired fasting glucose), hypercholesterolaemia and central obesity. Results: Overall, 63% (95% confidence limits 62, 65%) of the participants had at least one cardiovascular risk factor, 33% (32, 35%) had two or more and 14% (12, 15%) had three risk factors or more. The prevalence of hypertension, hyperglycaemia, hypercholesterolaemia and central obesity were 38%, 15%, 24% and 37%, respectively. Women were more likely to have a higher number of cardiovascular risk factors for most age groups; adjusted odds ratios ranging from 1.1 (0.91, 1.32) to 1.26 (1.12, 1.43) for the presence of one risk factor and 1.07 (0.91, 1.32) to 2.00 (1.78, 2.25) for two or more risk factors. Conclusions: Cardiovascular risk-factor clustering provides a clear impression of the true burden of cardiovascular disease risk in the population. Women displayed higher prevalence and a younger age shift in clustering was seen. These findings signal the presence of a cardiovascular epidemic in an upcoming middle-income country and provide evidence that drastic measures have to be taken to safeguard the health of the nation. - PublicationIdentification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations(2013)
;Sharmini Selvarajah ;Jamaiyah Haniff ;Gurpreet Kaur ;Tee Guat Hiong ;Adam Bujang ;Kee Chee CheongMichiel L BotsBackground: Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Methods: Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. Results: 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Conclusions: Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening. - PublicationOptimal BMI cut-off values for predicting diabetes, hypertension and hypercholesterolaemia in a multi-ethnic population(2012)
;Kee Chee Cheong ;Ahmad F Yusoff ;Sumarni M Ghazali ;Kuang H Lim ;Sharmini Selvarajah ;Jamaiyah Haniff ;Geok L Khor ;Suzana Shahar ;Jamalludin Abd Rahman ;Ahmad A ZainuddinAmal N MustafaObjective: To determine the optimal cut-offs of BMI for Malaysian adults. Design: Population-based, cross-sectional study. Receiver operating characteristic curves were used to determine the cut-off values of BMI with optimum sensitivity and specificity for the detection of three cardiovascular risk factors: diabetes mellitus, hypertension and hypercholesterolaemia. Gender-specific logistic regression analyses were used to examine the association between BMI and these cardiovascular risk factors. Setting: All fourteen states in Malaysia. Subjects: Malaysian adults aged $18 years (n 32 703) who participated in the Third National Health and Morbidity Survey in 2006. Results: The optimal BMI cut-off value for predicting the presence of diabetes mellitus, hypertension, hypercholesterolaemia or at least one of these cardio vascular risk factors varied from 23?3 to 24?1 kg/m2 for men and from 24?0 to 25?4 kg/m2 for women. In men and women, the odds ratio for having diabetes mellitus, hypertension, hypercholesterolaemia or at least one cardiovascular risk factor increased significantly as BMI cut-off point increased. Conclusions: Our findings indicate that BMI cut-offs of 23?0 kg/m2 in men and 24?0 kg/m2 in women are appropriate for classification of overweight. We suggest that these cut-offs can be used by health professionals to identify individuals for cardiovascular risk screening and weight management programmes. - PublicationOptimal waist circumference cut-off values for predicting cardiovascular risk factors in a multi-ethnic Malaysian population(Elservier, 2013)
;Kee C. Cheong ;Sumarni M. Ghazali ;Lim K. Hock ;Ahmad F. Yusoff ;Sharmini Selvarajah ;Jamaiyah Haniff ;Ahmad Ali Zainuddin ;Chan Y. Ying ;Khor G. Lin ;Jamalludin A. Rahman ;Suzana ShaharAmal N. MustafaObjective: To determine the optimal cut-offs of waist circumference (WC) in pre dicting cardiovascular (CV) risk factors in the multi-ethnic Malaysian population. Methods: We analysed data from 32,703 respondents (14,980 men and 17,723 women) aged 18 years and above who participated in the Third National Health and Morbidity Survey in 2006. Gender-specific logistic regression analyses were used to examine associations between WC and three CV risk factors (diabetes mellitus, hypertension, and hypercholesterolemia). The Receiver Operating Characteristic (ROC) curves were used to determine the cut-off values of WC with optimum sensitivity and specificity for detecting these CV risk factors. Results: The odds ratio for having diabetes mellitus, hypertension, and hypercholes terolemia, or at least one of these risks, increased significantly as the WC cut-off point increased. Optimal WC cut-off values for predicting the presence of diabetes mellitus, hypertension, hypercholesterolemia and at least one of the three CV risk factors varied from 81.4 to 85.5 cm for men and 79.8 to 80.7 cm for women. Conclusions: Our findings indicate that WC cut-offs of 81 cm for men and 80 cm for women are appropriate for defining abdominal obesity and for recommendation to undergo cardiovascular risk screening and weight management in the Malaysian adult population. Keywords: Quit smoking; Adult smokers; Population study; Stages of cessation; Malaysia.