epidemiology of cvs (1)
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By
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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.
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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
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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
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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
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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
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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
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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
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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.
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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.
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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
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Industrialists Risk factors:
Sedentary lifestyle
Longer life
Abundant food
Processed food
Degraded environment
Increase in medical technology
Industry
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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.
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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.
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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).
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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
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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
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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
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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.
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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
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RISK FACTORS
Non Modifiable Modifiable
Age Cigarette
smoking
Sex High blood
pressure
Family History Elevated serum
cholesterol
Genetic factors Diabetes
Personality ObesitySedentary habits
Stress
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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
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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
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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.
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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
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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)
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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
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