epidemiology and overview of cardiac disease. introduction the 20th century saw unparalleled...
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EPIDEMIOLOGY and overview of cardiac DISEASE
EPIDEMIOLOGY and overview of cardiac DISEASE
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INTRODUCTION
The 20th century saw unparalleled increase in life expectancy & major shift in the cause of illness throughout the world
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GLOBAL BURDEN OF CVD.
A century ago, CVD death <10% Today, approximately 30% of deaths
worldwide including nearly 40% in high income countries and about 28% in low and middle income countries
-Braunwald’s Heart Disease 2008
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EPIDEMIOLOGICALTRANSITIONS
Stage Typical proportion of deaths caused by CVD %
Predominant types of CVD
Pestilence and
Famine
<10 Rheumatic heart disease, cardiomyopathies
Receding
Pandemics
10-35 Rheumatic valvular disease, HT,CHD, Stroke
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Contd…
Degenerative &
Manmade diseases
35 – 65 CHD, Stroke
Delayed degenerative
Diseases
40 – 50 CHD, Stroke, CHF.
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PREVALENCE OF CHD-US
Age in years Male
%
Female
%
40-49 07 05
50-59 13 08
60-69 16 11
70-79 22 14
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PREVALENCE
The prevalence of CHD is about 7.4% in men and 4.5% in women.
The prevalence is higher in lower socio-economic groups.
Of note, mortality from CHD is falling but morbidity appears to be rising.
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EPIDEMIOLOGY OF IHD MORTALITY RATES-UK
CHD is the most common cause of death (and premature death) in the UK
1 in 5 men and 1 in 6 women die from CHD
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Contd…
There are 101,000 deaths from CHD in the UK each year.
Death rates from CHD have fallen by 46% for people under 65 years in the last 10 years in UK, Australia (48%) and Norway (54%).
Death from CHD is more likely during winter.
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MORBIDITY RATES IN UK
The average incidence of Myocardial Infarction is 600 per 100,000 in men aged 30-69 and 200 per 100,000 in women. The incidence increases with age
There are about 52,000 new cases of Angina per year in all men living in the UK and about 43,000 new cases in women
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PREVALENCE OF CVD-UK
Disease Age %
Heart attack Men
Women
04 %
02%
Angina
Men
55-64yrs
Women
08%
05 %
Men
65-74 yrs
Women
17%
08%
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NEWS ALERT
Aug 13, 2009 The heart of the matter Premature heart attack is common in Indians
compared to the Western population
Beyond the age of 50, the risk of heart attack per year approximately 2-3 per 1000
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Contd…
Aug 13, 2009.The Hindu one in 200 deaths of adults over age 40
occurs due to Sudden Cardiac Arrest
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Contd…
November 4 , 2006 The Hindu MYSORE: Incidence of heart disease
has doubled in India during the last 20 years on account of changes in lifestyle and economic development.
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Contd…
Dr Rajesh Pande (Cardiovascular disease in India and the impact of lifestyle and food habits)
80 % of global CVD related deaths now occur in low and middle-income nations, which covers most countries in Asia
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INCIDENCE OF MI IN URBAN INDIA
Gender Incidence Prevalence Mortality
Male 06/1000 Urban -35–90/1000
Rural -17–45/1000
40 % in
Urban
Female 02/1000 Urban -28–93/1000
Rural -13–43/1000
30 % in
Rural.
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PREVALENCE IN CHENNAI
Year Urban
%
Rural
%
1960 2
1970 6.5 2
1980 7.0 2.5
1990 9.7 4
2000 10.5 4.5
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OUR FUTURE
The World Health Organization estimated that 60 % of the world's cardiac patients will be Indian by 2010
50 % of CVD-related deaths in India occur below the age of 70, compared with just 22 % in the West
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Contd…
CVD will increase rapidly in India and this country will be host to more than half the cases of heart disease in the world within the next 15 years
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RESEARCH EXCERPTS
South Asians have elevated levels of LDL cholesterol and triglycerides, while also suffering from a deficiency in HDL cholesterol
South Asians seem more naturally vulnerable to heart disease than other ethnic groups
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Contd…
The disease occurs at a much younger age in Indians as compared to those in North America and Western Europe
In general, the incidence of all rhythm problems is 8-10 per 1000 people
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VITAL STATISTICS-WHO
2 million people die of CVD in India every year
32 % are in the age group 35-44. Four Indians die of a heart ailment every
minute
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prevalence of major risk factors for CVD.
Diabetes 11.9% hypertension 25.4% dyslipidaemia 40.2% hypertriglyceridaemia 28.3% overweight 60.2% and metabolic syndrome 34.1%.
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Contd…
Use of tobacco in any form was present in 22.9% of men and 0.5% of women
79% of the subjects followed a sedentary lifestyle.
--Natl Med J India. 2008 Jan-Feb
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CURRENT WORLDWIDE VARIATIONS
Currently 85 % of the world’s population lives in low and middle income countries.
About 30 % of the world’s population lives in East Asia and the pacific islands and another 22 % live in south Asia.
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CORONARY ARTERY DISEASEIN WOMEN
Stroke and MI- Number one killer of women with 500,000 deaths per year
First myocardial infarction in women is more severe and more lethal than they are in men.
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Contd…
Women’s mortality rate at 6 months post myocardial infarction double that of men
Coronary artery bypass surgery operative mortality 4.5% women, 2.6% men
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Contd…
Menopause often cause increase in total cholesterol and LDL
Framingham Study: Risk of CAD doubles with onset of menopause
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Heart disease or cardiopathy is an umbrella term for a variety of different diseases affecting the heart
Cardiovascular disease is any of a number of specific diseases that affect the heart itself and/or the blood vessel system, especially the veins and arteries leading to and from the heart.
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Types of cardiovascular disease
Atherosclerosis Ischaemic heart disease Heart failure Hypertensive heart disease Include:Left ventricular hypertrophy Coronary heart disease (Congestive) heart failure Hypertensive cardiomyopathy Cardiac arrhythmias
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Inflammatory heart disease Valvular heart disease
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Risk factors hypertension, diabetes, high cholesterol
(hypercholesterolemia, hyperlipidemia), obesity, sedentary lifestyle, male gender, increasing age, drinking excessive amounts of alcohol, long-term stress, smoking and heredity
high C-protein levels & high
homocysteine levels
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Signs and symptoms · chest pain or abdominal distress · cough · cyanosis · enlarged veins in the neck · fainting · loss of appetite · palpitations · shortness of breath · swelling in the legs · weakness and fatigue
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Diagnosis
History
Physical examination blood and urine tests · cardiac catheterization, a special X-ray done with a
contrast agent to look at the heart and its blood supply · chest X-ray · echocardiogram, which uses sound waves to view the
beating heart · electrocardiogram, or EKG, which shows the electrical
activity of the heart · stress EKG tests, in which the person either walks on
a treadmill or receives a medicine while the effects on the heart are examined with an EKG or imaging test
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CONCLUSION
It is possible that the efficient transfer of low-cost preventive and therapeutic strategies may alter the natural course of the epidemiological transition in every part of the world and thus reduce the excess global burden of preventable CVD
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