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    Cardio Vascular Diseases

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    voruganty_vvs
    1. Cardiovascular diseases are projected to remain the leading cause of death worldwide, with deaths increasing from 17.5 million in 2005 to over 23 million by 2030. 2. The top risk factors contributing to the global burden of cardiovascular disease are high blood pressure, tobacco use, high cholesterol, high BMI, low fruit and vegetable intake, and physical inactivity. 3. As countries develop economically, they typically experience an epidemiological transition where non-communicable or chronic diseases like cardiovascular disease replace infectious diseases as the major causes of death.

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    Cardio Vascular Diseases

    Uploaded by

    voruganty_vvs
    272 views21 pages
    1. Cardiovascular diseases are projected to remain the leading cause of death worldwide, with deaths increasing from 17.5 million in 2005 to over 23 million by 2030. 2. The top risk factors contributing to the global burden of cardiovascular disease are high blood pressure, tobacco use, high cholesterol, high BMI, low fruit and vegetable intake, and physical inactivity. 3. As countries develop economically, they typically experience an epidemiological transition where non-communicable or chronic diseases like cardiovascular disease replace infectious diseases as the major causes of death.

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    1. Cardiovascular diseases are projected to remain the leading cause of death worldwide, with deaths increasing from 17.5 million in 2005 to over 23 million by 2030. 2. The top risk factors contributing to the global burden of cardiovascular disease are high blood pressure, tobacco use, high cholesterol, high BMI, low fruit and vegetable intake, and physical inactivity. 3. As countries develop economically, they typically experience an epidemiological transition where non-communicable or chronic diseases like cardiovascular disease replace infectious diseases as the major causes of death.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    272 views21 pages

    Cardio Vascular Diseases

    Uploaded by

    voruganty_vvs
    1. Cardiovascular diseases are projected to remain the leading cause of death worldwide, with deaths increasing from 17.5 million in 2005 to over 23 million by 2030. 2. The top risk factors contributing to the global burden of cardiovascular disease are high blood pressure, tobacco use, high cholesterol, high BMI, low fruit and vegetable intake, and physical inactivity. 3. As countries develop economically, they typically experience an epidemiological transition where non-communicable or chronic diseases like cardiovascular disease replace infectious diseases as the major causes of death.

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    of 21

    Global burden of

    Cardiovascular Diseases

    Andrew M Tonkin, MD
    PROJECTED GLOBAL BURDEN OF CVD
    30
    CVD Deaths (millions)

    25
    Established market
    6 economies and
    20 former socialist
    economies of
    15 Europe
    5
    10 19 Demographically
    developing countries
    5 9

    0
    1990 2020
    Deaths
    Global CVD B. Neal et al. Eur. Heart J 2002
    GLOBAL BURDEN OF DISEASE:
    COMMON CVD RISK FACTORS
    Risk factor Exposure Variable Theoretical Contribution
    Minimum to GBD
    High BP Usual SBP 115mmHg (SD6) 4.4%
    Tobacco Smoking impact ratio; No use 4.1%
    oral tobacco use
    High cholesterol Usual TC 3.8mmol/L (SD0.6) 2.8%
    High BMI BMI 21kg/m2 (SD1) 2.3%
    Low fruit and Intake daily 600g (SD50) 1.8%
    veg. Intake
    Inactivity Categories >2.5h/week, mod. 1.3%

    M. Ezzati et al. Lancet 2003;362:271-80


    Global CVD
    EPIDEMIOLOGIC TRANSTION

    •Age •Pestilence •Receding •Degenerative •Delayed


    and famine pandemics “man-made” degenerative
    diseases diseases

    •Predominant •Rheumatic •Hypertension- •CHD, stroke, •CHD, stroke at


    CVD •heart disease •related diabetes at young older ages
    •diseases ages

    •% of deaths •5-10 •10-35 •35-65 •<50


    due to CVD

    •Current examples •Sub-Saharan •Rural China •Urban India •North America,


    •Africa Australasia

    Global CVD From S Yusuf et al. Circulation 2001;104:2746-53


    DRIVERS OF THE CVD EPIDEMIC

    • Urbanisation
    • Global trade and marketing developments
    • Tobacco industry
    • Physical inactivity
    Tobacco use, inappropriate diet and physical
    inactivity (expressed through unfavourable lipid
    profiles, overweight and raised BP) explain at
    least 75% of new CHD cases
    Global CVD
    CHD TRENDS IN BEIJING 1984 TO 1999

    Global CVD Critchley J et al. Circulation 2004;110:1236-1244


    CURRENT AND PROJECTED POPULATION
    PERCENTAGES FOR 2000, 2020 AND 2040
    30

    25
    % population 65+

    20

    15

    10

    0
    S. Africa India Brazil China Russia Portugal U.S.

    2000 2020 2040 S. Leeder 2003


    CVD IN AUSTRALIA:
    11% TOTAL HEALTH SPENDING
    Total
    $6,563.7m Outpatients
    5%
    Inpatients 41% 5% Aged care
    10%

    6%
    3% GPs
    4%
    Research 26% 4% Imaging &
    OHPs 1% pathology

    Out-of-hospital
    Pharmaceuticals specialists
    USE OF MEDICATION IN STROKE AND CHD

    Aspirin Statins
    95 96
    % 100
    89
    90 83 81
    79 78 78
    80
    70 66 66
    58
    60
    50
    38 38
    40
    29 31 28 28
    30 23
    20 16
    9
    10
    0
    Brazil Egypt India Indonesia Iran, Pakistan Sri Lanka Turkey Russian Tunisia
    Islamic Federation
    Republic of

    Global CVD WHO PREMISE project,


    ANTIHYPERTENSIVE DRUGS
    Available Affordable
    Locally manufactured
    57%
    67% 30%
    48%
    45%
    91% 89%
    74% 64% 83%
    7%

    46%
    92% 100% 96%
    88%
    70% 71%

    Africa Americas Eastern Europe South-EastWestern


    Mediterranean Asia Pacific
    entage of countries in each region where drugs are availabl
    rdable to low income groups, or manufactured locally
    Global CVD WHO 2001
    POLYPILL: EFFECTS AFTER TWO YEARS,
    AGE 55-64
    RRR (95% CI) (%)
    Factor Agent Reduction IHD Stroke
    LDL-C Statin 1.8 mmol/L 61 (51,71) 17 (9-25)
    BP Three agents, 11 mmHg 46 (39-68) 63 (55-70)
    half dose DBP
    Platelet funct. ASA (75mg) Not quant. 32 (23-40) 16 (7-25)
    Homocysteine Folic acid, 3 μmol/L 16 (11-20) 24 (15-33)
    (0.5mg)
    Combined All 88 (84-91) 80 (71-87)

    BMJ, 28 June 2003


    Polypill
    FIVE-YEAR HARD CHD EVENTS
    HHP Japanese American Men

    Deciles based on Framingham function


    Absolute risk D'Agostino, Sr, R. B. et al. JAMA 2001;286:180-187
    FRAMEWORK CONVENTION ON TOBACCO CONTROL

    Key provisions encourage countries to:


    • Enact comprehensive bans on tobacco advertising,
    promotion and sponsorship;
    • Obligate placement of rotating health warnings on tobacco
    packaging that cover at least 30% (but ideally ≥ 50%) of
    principal display areas;
    • Ban use of deceptive terms such as “light” and “mild”;
    • Protect citizens from exposure to tobacco smoke in
    workplaces, public transport and indoor public places;
    • Combat smuggling, including placing of final destination
    markings on packs;
    • Increase tobacco taxes
    Tobacco
    PUBLIC HEALTH POLICY
    • Comprehensive health programs led by primary care
    • Appropriate balance between primary and secondary
    prevention
    • Particularly population approaches (Only 5% in
    wealthy countries at ideal cholesterol, BP, weight)
    • Also high-risk approaches to primary prevention
    (although latter may increase inequalities)
    • Acute management and secondary prevention
    • Surveillance and monitoring
    Global CVD
    NCD PREVENTION AND CONTROL
    94%
    88% 88%
    76%
    65%

    39%

    Africa Americas Eastern Europe South-East Western


    Mediterranean Asia Pacific
    ountries with integration of components of NCD prevention
    rammes in primary health care
    Global CVD WHO 2001
    PRIORITIES FOR DEVELOPING COUNTRIES

    • Control strategies, initially based on extrapolation


    from knowledge from other population, e.g.
    tobacco control: whole population initiatives

    • Cross-sectional surveys (ecological comparisons),


    case-control studies and prospective longitudinal
    studies for incidence data

    • Workforce training and capacity building

    • Low cost, high yield interventions


    CHD prevention
    PRIORITIES FOR DEVELOPED COUNTRIES

    • Prevention including implementation of


    proven strategies

    • Chronic disease strategies

    • Health inequalities

    • Primary care strategies

    • Strategies to combat overweight


    CHD prevention

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