epidemiology of cvs (1)

7/29/2019 Epidemiology of CVS (1)

1/28

1

By


2/28

LEARNING OBJECTIVES

Describe major & minor risk factors

Enlist new emerging cardiovascular

risk factors

Describe prevention of cardiovascular

diseases in relation to risk factors

Describe prevention of HTN inaccording the level of prevention.


3/28

3

Epidemiological : NCDs overriding

infectious diseases and doubleburden of diseases in manydeveloping countries

Lifestyles:tobacco use is increasing

diets are rapidly changingphysical activity reduces

alcohol use increases

obesity, diabetes, hypertensionDemographic : population is ageing.

Globalization : increasing global influences

THE WORLD HEALTH IS IN TRANSITION

Vilius GRABAUSKAS


4/28

4

Non-communicable diseases contribute 60 % of deathsand 43 % of the global burden of disease. Already 79% ofthese NCDs are occurring in developing countries.

By 2020 these deaths will account for 73% deaths and 60%of the disease burden.

Half of these deaths are attributable to cardiovasculardiseases.

There are more CVD deaths in india or china than in alldeveloped countries added together.

THE GLOBAL NCD REALITY


5/28

5

32.5%

58.5%

9.0%

Injuries(5.1 million)

Noncommunicableconditions

(33.1 million)

WORLD, DEATHS, BY BROAD CAUSE GROUP,2001

COMMUNICABLE

DISEASES, MATERNAL

AND PERINATAL

CONDITIONS AND

NUTRITIONAL

DEFICIENCIES

(18.4 MILLION)

Total deaths: 56,554,000

Source: WHR 2002

ViliusGRABAUSKAS


6/28

6

42.0%

45.9%

12.2%

Injuries

Noncommunicable

conditions

WORLD, DALYs, BY BROAD CAUSE GROUP,

2001

COMMUNICABLE

DISEASES, MATERNAL

AND PERINATAL

CONDITIONS AND

NUTRITIONAL

DEFICIENCIES

Source: WHR 2002


7/28

7

3%

3%

5%

5%

7% 3% 6%

4%

13%

30%9%

WORLD, DISTRIBUTION OF CAUSES OF

DEATH, 2001

Total deaths: 56,554,000

Cardiovascular diseases

Diabetes

Malignant neoplasms

Digestive diseasesNeuropsychiatric disorders

Respiratory diseasesOther NCDs

InjuriesOther CD causes

Nutritional deficienciesMaternal conditions

MalariaChildhood diseases

Tuberculosis

Diarrhoeal diseasesPerinatal conditions

HIV/AIDS

Respiratory infections

Source: WHR 2002

Vilius GRABAUSKAS


8/28

8

Key risk factors: unhealthy diet (salty, fatty and sugaryfood), physical inactivity, tobacco and alcohol drinking.

The behaviouralfactors lead to high blood pressure &

hypertension, blood glucose intolerance & diabetes,elevated blood cholesterol & hypercholesterol, anaemia,overweight and obesity.

Simple changes in these lifestyles can powerfully preventchronic diseases and promote health.

Some of the changes take place relatively quickly andalso in late age.

NCDs ARE TO A GREAT EXTENT

PREVENTABLE

Vilius GRABAUSKAS

h d bl f h 4 ll d h


9/28

9

Chronic diseases are responsible for more than 24 million deaths a

year, or almost half of the global total. The leading causes are

circulatory diseases, including heart disease and stroke, cancer and

chronic obstructive pulmonary disease.

infectious diseases kill about 17 million people a year and afflict

hundreds of millions of others, particularly in the developing world. In

the industrialized world, infectious diseases are well under control. It

is noninfectious diseases - particularly cancer, circulatory diseases,

mental disorders including dementia, chronic respiratory conditions

and musculoskeletal diseases - that now pose the greatest threat to

health in developed countries. These are essentially the diseases that

strike later in life and which, as life expectancy increases, will become

more prevalent.


10/28

10

As life expectancy in developing countries also increases, so the people

will become more and more prone to diseases that are more common

among older age groups. Outlook for most individuals in the developing

world is that if they do manage to survive the killer infections of

infancy, childhood and maturity, they will become exposed in later life

to non communicable diseases.

This situation is known as the "epidemiological transition" - the

changing pattern of health in which poor countries inherit the

problems of the rich, including not merely illness but also the harmful

effects of tobacco, alcohol and drug use, and of accidents, suicide and

violence. It is also referred to as the "double burden", because of the

continuing weight of endemic infectious diseases.


11/28

11

Change from agriculture to industry takes place overa few hundred years. Effect on health is profound,

with the decline of infectious disease and the rise on

non-communicable disease.

Modern rise in population is distinguished from allprevious increases by its size, continuity and

duration.

A major contributor is the decline in death rate --increase in normal longevity -- of modern man.

Industry


12/28

12

Industrialists Risk factors:

Sedentary lifestyle

Longer life

Abundant food

Processed food

Degraded environment

Increase in medical technology

Industry


13/28

13

EPIDEMIOLOGY OF CHRONIC NON COMMUNICABLE DISEASES.

"An impairment of structure or function that necessitates a

modification of the patients normal life, and has persisted over an

extended period of time".

Chronic diseases have one or more of the following characteristics.

Are permanent.

Leave residual disability.

Are caused by non-reversible pathological alteration.

Require special training for rehabilitation.

Require long period of care and supervision.


14/28

14

NON COMMUNICABLE DISEASES INCLUDE:

Cardiovascular, Renal, Nervous, Mental, Musculo-skeletal

(Arthritis), Chronic non-specific respiratory diseases (Chronic

bronchitis, emphysema, asthma), Accidents, senility, blindness,

Cancer, Diabetes, Obesity, Chronic results of communicable

diseases.

NON COMMUNICABLE DISEASES RISK FACTORS:

1. Cigarette smoking

2. Alcohol abuse

3. Inability to obtain preventive health services for hypertension control, cancer

detection, and Diabetes management.

4. Life style changes (dietary patterns, physical activity)

5. Environmental Risk Factors (occupational hazards, air, water pollution, Destructive

weapons)

6. Stress factors.


15/28

15

WHY IT IS DIFFICULT TO CONTROL NON

COMMUNICABLE DISEASES.

Absence of a known agent: absence of a known agent makes both

diagnosis and prevention difficult.

Multifactorial Causation: Chronic diseases appear to result from the

cumulative effects of multiple risk factors. Many of the risk factors are yet to beidentified and evaluated.

Long Latent Period: This makes difficult to link suspected causes with

outcomes.

Indefinite onset: slow in onset & development, Distinction between diseasedand non-diseased is difficult to establish (diabetes, hypertension).


16/28

16

PREVENTION OF NON COMMUNICABLE

DISEASES:

1. Case finding through screening and Health examinations

2. Application ofimproved methods of diagnosis, treatment

3. Control of food, water, & air pollution4. Reducing accidents

5. Changing life style

6. Comprehensive Medical care

7. Political approaches


17/28

17

What is Cardiovascular Disease?

CVD is the name for the group of disorders of the heart and

blood vessels and include:

Hypertension (high blood pressure)

Coronary heart disease (heart attack)

Cerebro-vascular disease (stroke)

Peripheral vascular disease

Heart failure

Rheumatic heart disease

Congenital heart disease

Cardiomyopathies


18/28

18

Facts:

Heart disease has no geographic, gender or socio-economic boundariesIn1999 CVD contributed to a third of global deaths.

In 1999, low and middle income countries contributed to 78% of CVD deaths.

By 2010 CVD is estimated to be the leading cause of death in developing countries

CORONARY HEART DISEASE (IHD):

"Impairmentof heart function due to inadequate blood flow to the heart

compared to its needs, caused by obstructive changes in the coronary

circulation to the heart".

CHD may present itself as

Angina pectoris

Myocardial infarction

Irregularities of the heart

Cardiac failure

Sudden death


19/28

19

MEASUREMENT OF DISEASE BURDEN:

Proportional mortality Ratio (Proportion to all deaths)

Loss of life expectancy

CHD incidence Rate

Age specific death Rates

Prevalence Rate by cross sectional surveysCase fatality rate

Measurement of risk factor level Cigarettes smoking, alcohol

serum cholesterol in the community.

Medical care.


20/28

20

EPIDEMIOLOGY:

Epidemics

USA 1920

Britain 1930

CHD is worldwide in distribution

Incubation period 10 years or more

CHD IN PAKISTAN: 12% of all deaths or (100,000)deaths per year


21/28

21

RISK FACTORS

Non Modifiable Modifiable

Age Cigarette

smoking

Sex High blood

pressure

Family History Elevated serum

cholesterol

Genetic factors Diabetes

Personality ObesitySedentary habits

Stress


22/28

22

PREVENTION OF CHD: Population strategy

Primordial prevention

Prevention in whole populations

High Risk strategy

Secondary prevention

Newly emerging CVD risk factors in low and middle-income countries.

Low birth weight

Folate deficiency

Certain infectionsHypercoagulability

Water hardness

hypercalcemia

HYPERTENSION


23/28

23

HYPERTENSION

(The level of blood pressure at which action is warranted)

"A systolic pressure equal to or greater than 140mm Hg o

a diastolic pressure equal to or greater than 95mm Hg".

Classification:Primary (Essential):when the causes are unknown is the most prevalen

form accounting for 90% of all cases.

Secondary:When some other disease process is involved in its causatio

(Kidney disease, tumors of adrenal gland, congenital narrowing of aorta

Toxemia's of pregnancy

MORTALITY


24/28

24

MORTALITY:

Major risk factor for stroke,CHD, Kidney failure.

Death rate per 100,000 population from hypertensive disease

Country Total Male Female

USA 14.4 12.6 16

Japan 11.6 9.5 13.6

Eng & wales 10.4 9.4 11.3

France 9.9 7.7 12.1

New Zealand 9.2 8.3 10.1

Scotland 8.3 7 9.6

Canada 6.1 5 7.2

Netherland 4.8 3.9 5.7

TRACKING OF BLOOD PRESSURE: Low blood pressure levels

tend to remain low and high levels tend to become higher as individuals

grow elder, by this children and adolescents at risk can be identified.


25/28

25

RISK FACTORS FOR HYPERTENSION

Non-Modifiable Modifiable

Age Obesity

Genetic factors Salt intake

Family history Saturated fat

Alcohol

Physical inactivity

Tension & stress

Oral contraception

Noise, vibration, temperature.

PREVENTION OF HYPERTENSION


26/28

26

PREVENTION OF HYPERTENSION:

1. Primary Prevention

(Population Strategy):

Nutrition: Salt intake less than 5 grams/day, Low fat,Avoidance of alcohal, energy intake according to bodyrequirement. Weight Reduction

Exercise

Behavioral changes (reduction of stress, smoking)

Health education & Self care

High Risk Strategy (Tracking of blood pressure from

childhood).

2. Secondary Prevention (Screening, treatment)


27/28

27

HYPERTENSION

Rule of Halves:

1. Whole community

2. Normotensive subjects

3. Hypertensive subjects

4. Un-Diagnosed Hypertension

5. Diagnosed Hypertension

6. Diagnosed but untreated

7. Diagnosed & treated

1

3

2

4

5

6

7

8

9


28/28

28

epidemiology of cvs (1)

Documents