Get the Flu Shot to Prevent a Heartbreaking Holiday Season!

In Malaysia, flu can occur year-round. Older persons, especially those with chronic diseases such as diabetes and high blood pressure, are advised to make flu vaccination an annual priority, especially during the holiday seasons when mingling and traveling are often inevitable. It’s important to strike a balance between staying safe and creating beautiful memories!


Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu.

This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. In industrialized countries, most deaths associated with flu occur among older persons aged 65 years and above!

Among older persons, influenza can present as a relatively mild respiratory illness; it may also present without any symptoms (no fever and/or no cough). It can also lead to fatigue and confusion, potentially setting off a sequence of catastrophic events.

Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, explains: “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”


When the flu virus enters your system, your immune system strings into action.

Just like fights in real life, collateral damage may result; when an infection triggers a strong response from your immune system, the immune cells can also damage your own healthy tissues and organs.

One example is COVID-19, which can trigger very high activation of the immune system, resulting in the uncontrolled release of cytokines, small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.

This uncontrolled release (“cytokine storm”) may lead in failure and death of many organs in the body.


An illustration of cytokine storm, sometimes called hypercytokinemia, and how it affects both healthy and infected cells. Click on the image for a larger version.

Studies suggest that the same inflammatory response described above can trigger effects that can damage the heart (cardiovascular events) when you have an influenza infection.

Dr Alan Fong, the President of the National Heart Association Malaysia (NHAM) and a consultant cardiologist, shares that your body’s immune response, when present along the direct effects of flu on the inner lining of your blood vessels or atherosclerotic plaques, may cause rupture of such plaques or blockage in the arteries–effects that can lead to a heart attack or stroke.


In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence.

Professor Dr Tan Maw Pin, a consultant geriatrician that chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG), tells us: “In addition to this, ageing contributes to chronic, non-infectious, low-grade inflammation—known as inflammaging—which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”

She further adds that ageing also promotes the development and progression of atherosclerosis, the most common cause of acute coronary syndrome. This syndrome gives rise to situations in which the blood supplied to the heart is suddenly blocked.”

“Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke,” Prof Tan reiterates.


Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and those that have recent acute coronary syndrome had a 45% lower risk.

There is also an 18% reduced risk of death reported in patients with heart failure.

For people with type 2 diabetes mellitus, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.

Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.

This article is contributed by Immunise4Life (IFL), a collaboration of the Ministry of Health Malaysia with the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).

The article has been edited by HealthToday for publication on this website.

For more information on flu, you can visit IFL’s website Act of Love (link opens in a new tab).


  1. Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. The European respiratory journal, 51(3), 1701794.
  2. Michos, E. D., & Udell, J. A. (2021). Am I getting the influenza shot too?: Influenza vaccination as post-myocardial infarction care for the prevention of cardiovascular events and death. Circulation, 144(18), 1485–1488.
  3. Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza vaccine in heart failure. Circulation, 139(5), 575–586.
  4. Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(14), E342–E351.
  5. King, S. C., Fiebelkorn, A. P., & Sperling, L. S. (2020, November 2). Influenza vaccination: Proven and effective cardiovascular disease prevention. American College of Cardiology.
  6. Vetrano, D. L., Triolo, F., Maggi, S., Malley, R., Jackson, T. A., Poscia, A., Bernabei, R., Ferrucci, L., & Fratiglioni, L. (2021). Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing research reviews, 69, 101351.

Could Stem Cell Therapy Be the Future of Medicine in Malaysia?


Stem cells are a unique type of cell in our body. This is because they are the only type of cells that can develop, under the right triggers and condition, into a variety of more specialized cells, such as blood cells, muscle cells, bone cells, and more.

  • Researchers can generate a variety of human cells from stem cells in the laboratory. These cells are then used to test new medications for possible side effects.
  • Research is also conducted on generating healthy cells that can replace those in our body that are dying or damaged due to age or disease. Such use of stem cells is called regenerative medicine.
  • Hematopoietic stem cells (usually abbreviated as HSCs), which are found in cord blood, bone marrow, and peripheral blood
  • Mesenchymal stem cells (MSCs), which as found in the gel-like substance (Wharton’s jelly) of the umbilical cord, bone marrow, fat tissue, and tooth pulp

Judging from the versatility of stem cells when used to produce of a variety of healthy human cells, regenerative medicine has obvious benefits for people whose tissues are damaged or dying due to diseases as well as people in need of tissue transplant.

Just some of the cells that can be generated from stem cells in the laboratory. Click the image above for a larger version.
Promising for treating heart diseases

Dr Lee Tjen Jhung, a cardiologist affiliated with the National Heart Institute (IJN), says, “While heart diseases are usually treated with medication, angioplasty and by-pass surgery, cell-based regenerative therapy is gaining popularity in the cardiovascular field due to the ability of mesenchymal stem cells to provide new blood in areas affected by restricted blood flow as well as promote the formation of new blood vessels.”

An answer to ageing-related health issues?

Dato’ Dr Rajbans Singh, the President of the Malaysian Wellness Society, points out that stem cells can play a crucial role in treating aging-related health problems.

He elaborates: “At birth, the human body has approximately 80 million active stem cells However, by age 40, less than 25 million active stem cells are functional. Ageing leads to a massive loss of stem cells in the body, affecting the ability of organs and tissues to repair and regenerate as the body gradually ages and deteriorates.”

Here’s a general, simplified overview of how the whole procedure works
  1. Stem cells are grown in a laboratory, and then manipulated to grow and specialize into a more specific type of cells (heart muscle cells, blood cells, etc)
  2. These cells are then implanted into the person that can benefit from this procedure, for example a person with heart disease could be implanted with heart muscle cells, injected into their heart
  3. These transplanted cells will then play a role in repairing and/or replacing the affected damaged tissue or organ of that person.

In reality, the procedure is not so straight forward, as there are many potential complications to take into account.

Nonetheless, the promise of regenerative medicine is too good to resist, hence researchers are continuously looking into creating and fine-tuning various procedures that can hopefully one day reduce or even replace our reliance on medications!


There is considerable ethical debate on the use of stem cells that are sourced from fertilized egg cells or embryos that are donated for research.

These days, many centres that offer stem cell therapy claim to source their stem cells ethically—from the umbilical cords of young and healthy women after they have delivered their babies.

In Malaysia, the sourcing and processing of stem cells are governed by the Current Good Manufacturing Practices or cGMP, issued by the National Pharmaceutical Regulatory Agency (NPRA). You can view it here (link opens in a new tab).

A Health-Centric Wishlist for the Malaysian GE15


Executive Director
ALTY Orthopaedic Hospital

Building upon the successful collaboration between public and private healthcare during the pandemic, a long-term policy on greater partnership will benefit both the government and the private sector, with all Malaysians being the key beneficiary.

There still are waiting lists for procedures in the public hospitals, and these can certainly be reduced if there is a structure long term arrangement for the private hospitals and centres to assist in reducing and maintaining a short wait time, especially for elective procedures which can greatly enhance an individual’s productivity, although it may not be life threatening.


These include the necessary social safety nets, proper care facilities and also post hospitalization care and support.

Here, the government should consider partnering the many physio and home care organisations to ensure patients have good compliance to post hospital care, including physio, wound care and others.

An aging population also typically means reduced mobility due to various issue—for example orthopaedic-related issues, where it can be address with proper intervention, and where needed surgery.

Government subsidy for implants, such as knee and hip implants can reduce the burden for the uninsured (which is a large majority of those who need such care) – and thus ensuring they have good mobility and thus independence even as they age.


The government should consider encouraging the adoption of such technologies especially in healthcare.

Grants or even personal subsidies to access such health technologies where appropriate can propel the adoption and perhaps even development of such tech.

For example, 3-D printed casts or prosthesis will improve recovery and long-term quality of life. The regulatory framework also needs to support the faster adoption of such health technologies, to ensure Malaysia is able to maintain its advantage as a healthcare travel destination.


Competitive and facilitative immigration policies, for healthcare travellers especially, will allow Malaysia to be serve a greater no of patients, which in turn lowers the cost of investment in health-related technologies and equipment, thus enabling more Malaysians to access it as well.

Some of our neighbouring countries continue to attract patients from a number of different countries, despite being less competitive overall than Malaysia, primarily due to the ease of arriving into the country.

Thus, they are able to invest in technologies such as thehealthy  Proton beam, as fee paying foreign patients ensure there is a sufficient volume of patients for these advanced and latest modalities.