The 4 Horsemen in Malaysia

Alwyn Lau
3 min readDec 4, 2023

This is Peter Attia’s term for the chronic diseases which are the world’s biggest killers as people age: Heart disease, cancer, type-2 diabetes and neuro-degenerative disease (in the form of dementia, Alzheimer’s, etc.).

When I do a mental survey of family and friends who are very sick or have passed away — apart from Covid-19 or a tragic accident — practically all of the names I come up with suffer from one of these diseases.

Sad to say, the riders have already arrived in Malaysi and are already thriving.

Heart disease, our country’s #1 killer for the past two decades, is not only rising (increasing from 11.6% of all medically certified deaths in 2000 to 17% in 2020) but afflicting even younger people. Annually, there’s a 2% increase in the number of people below 40 diagnosed. Also, the number of cardiovascular disease cases increases by 5% according to the National Heart Institute and there are 10,000 cases of cardiology and hypertension and 4,000 cases of heart surgery in a year.

The Galen Center for Health & Social Policy estimates that one in seven Malaysians would be expected to get cancer before they reach 75 years of age. The National Cancer Society of Malaysia says about 20,000 cases are discovered annually, a number Galen claims is expected to rise by almost three-fold in 2030, not even including the fact that such cases are usually under-reported.

For Type 2 diabetes, about 90 million suffer from it in South-East Asia and Malaysia ranks #5 in Western Pacific with 4.4 million folks officially diabetic in 2021. Obesity, a huge predictor of T2D, are at sky-high levels in the country with the World Obesity Atlas warning that 41% of Malaysia’s adults could be seriously over-weight by 2035.

Last, but of course not at all least, the number of adults in Malaysia suffering from dementia is expected to nearly triple over the next 30 years. According to the Alzheimer’s Disease Foundation, Malaysia (ADFM) in 2020, the population of persons living with dementia that, in its end-stage, leaves them dependent on 24-hour care, is estimated to be at 204,000 to 264,000 (8.5 per cent to 11 per cent).

Whilst panic is never a good idea, it’s certainly a matter of concern when we seem to be checking some very dangerous boxes. Putting it bluntly, unless we Malaysians take some critical action asap, the nation is poised to fail terribly on the matter of health and longevity. Our healthcare system took a severe beating during the Covid crisis two years back, almost collapsing during those precarious 4–5 months in the middle of 2021. Now imagine if the projected numbers for the four horsemen kick in in about one or two decades — is it really too dramatic to suggest, even in the absence of a new pandemic, that Malaysia could be headed for an unimaginable healthcare crisis in the distant future?


CodeBlue (2022) A Look Into The Heart Of Cardiovascular Disease. 21 December. Available at:

Free Malaysia Today (2023) Heart disease on the rise in young Malaysians. 21 October. Available at:

CodeBlue (2023) Report: 41% Of Malaysia’s Adults Will Be Obese By 2035. 3 March. Available at:

Ramadas A (2022) Tackling Malaysia’s rising diabetes crisis. Available at:

Sathiabalans I (2023) Cancer cases under-reported, says oncologist. Malaysiakini, 9 April. Available at:

Sharif, Kamaruzzaman Abdul Majid A and Singh P (2023) Poor awareness of heart health. New Straits Times, 30 September. Available at:



Alwyn Lau

Edu-trainer, Žižek studies, amateur theologian, columnist.