Prevention strategies Preventive Council Peshawar Heart Study Prof Mohammad Hafizullah Cardiology Department Postgraduate Medical Institute Lady Reading

Prevention strategies Preventive CouncilPeshawar Heart Study

Prof Mohammad HafizullahProf Mohammad HafizullahCardiology DepartmentCardiology Department

Postgraduate Medical InstitutePostgraduate Medical InstituteLady Reading HospitalLady Reading Hospital

PeshawarPeshawar

Country Country YearsYears Groups ContrastedGroups Contrasted AgeAge CHD CHD Mortality Mortality

Ratio Ratio

SingaporeSingapore 1980-861980-86 South Asian vs ChineseSouth Asian vs Chinese 30-69 30-69 yrsyrs 3.83.8

FijiFiji 19801980 South Asian vs South Asian vs Melanesian Melanesian

40-59 40-59 yrsyrs 3.0 3.0

TrinidadTrinidad 1977-861977-86 South Asian vs AfricanSouth Asian vs African 35-69 35-69 yrsyrs 2.42.4

South South AfricaAfrica 19851985 South Asian vs South Asian vs

EuropeanEuropean35-74 35-74

yrsyrs 1.41.4

EnglandEngland 1979-831979-83 South Asian vs South Asian vs EuropeanEuropean

20-69 20-69 yrsyrs 1.41.4

Mortality from CAD in Indians andMortality from CAD in Indians and Pakistanis OverseasPakistanis Overseas

CAD in South Asians in UK

CAD in South Asians in UK

Early onset / malignant course

First MI 5 years earlier in average

Occurrence of first MI before the age of 40, 10

times higher (UK-Hughes 1989)

40% higher death rates across all age groups with

CAD

Two fold excess of deaths in men before the years

45

Prevalence of CAD (before 40 yrs) in the young:

West (less than 2%) South Asians (12%)

Early onset / malignant course

First MI 5 years earlier in average

Occurrence of first MI before the age of 40, 10

times higher (UK-Hughes 1989)

40% higher death rates across all age groups with

CAD

Two fold excess of deaths in men before the years

45

Prevalence of CAD (before 40 yrs) in the young:

West (less than 2%) South Asians (12%) McKeigue PM. Marmot MG. BMJ 1988;297:903.

Q: But can we fight the relentless onslaught of heart diseases?

Answer : NO

We have to PREVENT Heart problems

Ray of hope!

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EuroAction -SMOKING

Over half (58%) of the patients who were smokers prior to their coronary event had stopped by the end of the hospital programme.

One in five partners also stopped smoking cigarettes.

EuroAction- improvements in the dietary habits - pts and families Saturated fat consumption levels of patients

decreased by almost 16% (12% in partners)

Patients increased their consumption of fruit and vegetables by an average of 155 grams each day (113 grams each day for partners)

Patients increased fish consumption 58% ; (71% of partners) eating oily fish three times or more each week.

EuroAction- Physical activity

25% pts regularly active (20% of partners)

Absolute increase of 11% compared to baseline (5% in partners).

86% of pts (83% of partners) highly active; an improvement of around one-fifth against baseline.

Step counter showing an increase of 1362 steps (739 for partners) equates to around an extra three quarters of a mile each day.

Yes we can do it!

Pakistan Cardiac society established council of Preventive Cardiology

-‘preventive cardiology’. most arduous but very important job of looking after the orphan

Plan for every thing from the scratch and hopefully

develop it as a vibrant body so that we can set the program for whole of the country.

Prevention and Research

Prevention through research

Risk factors detection in major cities Risk factors in Karachi AKUH Risk factors in rural areas of Peshawar Risk factors in urban areas of Peshawar INTER HEART Heart File – wealth of data Peshawar Heart Study

PESHAWAR HEART STUDY(PHS)

CARDIOVASCULAR DISEASE RISK ASSESSMENT IN

DIFFERENT POPULATIONS OF PESHAWAR

AIMS OF PHS

To identify the risk factors for coronary artery disease (CAD) in various occupational groups of Peshawar.

Risk stratification (European Task Force risk scores).

AIMS

To determine any correlation between conventional risk factors, educational level social status and CAD risk score.

To determine risk score in “High-risk” occupations

Occupational groupsSecretariat 217Lawyers 159Journalists 150Meat related professions 156Class IV workers 157Teachers 429Nurses Total 1268

Peshawar Heart Study -Civil Secretariat

age

Total no 217 All males Age mean 42 + 9.032 Range 18- 59

0

5

10

15

20

25

30

35

40

30 40 50 59

Age

Peshawar Heart Study Civil Secretariat - BMI

Total no 217

BMI mean 25.88 (5.1) > 23 overweight > 25 obese > 30 OBESE

0

10

20

30

40

50

60

70

>23 >25 >30

BMI

Peshawar Heart Study - Weight

Civil Secretariat

Total no 217

Weight (Kg) Mean 72.57 (SD 11.1) Range 48- 105 > 70 = 52 > 80 = 22 >90 = 9 >100 = 1

0

10

20

30

40

50

60

>70 >80 >90 >100

WeightKg

Peshawar Heart Study - waist

Civil Secretariat

Total no 217 Waist > 86 cm (34 inch) South Asians > 102 cm (40.8 inch) Western standard

0

10

20

30

40

50

60

70

80

>86 >102

waist

Peshawar Heart Study –Blood Pressure

Civil Secretariat

Total no 217

Systolic Blood pressure > 120 mmHg =53.9% >140 mmHg =14.3% >160 mmHg = 3%

0

10

20

30

40

50

60

>120 >140 >160

Sys BP

Peshawar Heart Study –Blood Pressure

Civil Secretariat

Total no 217

Diastolic Blood pressure > 80 mmHg =47.5% >85 mmHg =41.6% >90 mmHg = 17.1%

0

5

10

15

20

25

30

35

40

45

50

>80 >85 >90

Dias BP

Peshawar Heart Study –Cholesterol

Civil Secretariat

Total no 217

Cholesterol > 150 mg/dl= 63 % > 180 mg/dl= 36.9% > 200 mg/dl= 22.6%

0

10

20

30

40

50

60

70

>150 >180 >200

Cholesterol

Peshawar Heart Study – Glucose

Civil Secretariat

Total no 217

Random Glucose Mean 112.6 (SD 40.36) Range 63-375 > 150 mg/dl= 11% 50% new cases 0

2

4

6

8

10

12

>150

Glucose

CURRENT MEDICALSTATUS

Lawyers

n=159

Teachers n=429

MRP*n=156

Sweepersn=157

Journalistn=150

Sectt**n=217

DIAB 10% 5% 4% 3% 0.6% 3%HTN 17% 4% 3.2% 6% 10% 5%

CAD 1.9% 3.4% 1.2% 0.6% 0.6% 1.3%

PESHAWAR HEART STUDYPESHAWAR HEART STUDY

*MRP: Meat Related Professions **Sectt: secretariat*MRP: Meat Related Professions **Sectt: secretariat


FAMILY HISTORY OF CAD

Lawyers

N= 159

Teachers

n=429

MRP

n=156

Sweepers

n=157

Journalists

n=150

Sectt

n=217

30 7.3 10 30 223737


CURRENT SMOKERS

Lawyers

n=159

Teachers

n=429

MRP

n=156

Sweepers

n=157

Journalist

n=150

Sectt.

n=217

13% 4% 25% 26% 36% 21%


BODY MASS INDEX

Lawyers

N=159

Teachers

n=429

MRP

n=156

Sweepers

n=157

Journalist

n=150

Sectt:

n=217

Mean BMI 28 4 274 255 255 255 254

BMI > 25 77% 66% 36% 58% 44% 59%


SYSTOLIC BP

Lawyers

N=159

Teachersn=429

MRP n=156

Sweepersn=157

Journalistsn=150

Sectt:n=217

Mean 132 18

13120

11919

12215

11418

12716

> 140 mmHg

59% 58% 28% 42% 20% 46%


DIASTOLIC BP

Lawyers

N=159

Teachers

n=429

MRP

n=156

Sweepers

n=157

Journalists

n=150

Sectt:

n=217

Mean 85 11

8612

7711

8110

7612

8312

>90mmHg

49% 50% 17% 37% 14% 40%


CHOLESTEROL

Lawyers

n=159

Teachersn=429

MRP n=156

Sweepersn=157

Journalistsn=150

Sectt:n=217

Mean 183 26

17120

16017

16720

15820

15850

>200mg/dl

28% 11% 5% 5% 12.8% 24%


RANDOM BLOOD SUGAR

Lawyers Teachers MRP Sweepers Journalists Sectt:

Mean 113 52

10344

10546

10856

9832

11240

>180mg/dl

8% 5% 4.4% 6.3% 3% 5%


EXERCISEDAILY FOR ≥ 20 MINS

Lawyers

n=159

Teachers

n=429

MRP

n=156

Sweepers

n=157

Journalist

n=150

Sectt.

n=217

31% 36% 33% 37% 26% 78%

Lessons to be learnt!

Redefine our enemiesStudy correlationsSet new goalsDevelop new strategiesAdherence to guidelines

Guidelines GPs/House staff/

doctors working in the periphery

Primordial Primary Secondary

prevention

Topics Diabetes Dyslipidaemia Hypertension Obesity Smoking Lack of exercise Metabolic syndrome

Guidelines

To disseminate the guidelines more effectively Symposia Workshops Media Print material

General population

Posters Translation in

local languages Pictorial Bill boards

0 Tolerance for Smoking 30 minutes of exercise

every day 120 systolic blood pressure

less than that 34 inch waist & no more 150 cholesterol less than

that 5 times fruits & vegetables

Preventive CouncilPakistan Cardiac society

Prevent a Heart attack Heart Mobile 0-30-120-34-150-5

Healthy Healthy HeartHeart

1. Awareness 2. Knowledge data base3. Capacity building

Undergraduate Medical training Projects for Community Medicine Curriculum/ Final year examination

Part of FCPS training program and examination

Preventive cardiology departments at Institutes/ departments

Recommendations

Foster healthy lifestyles and behaviors in schools.

● Improve education in prevention and nutrition in schools.

● Increase opportunities for physical activity in community, school, and work settings

Recommendations - food policy

● Change food policy to foster the reduction of sodium in the food

supply leading to a 5% per year decline the labeling of the nutritional

content

awareness about caloric value and cholesterol content of diet

Recommendations

● Increase the visibility of preventive cardiology at national meetings attended by cardiologists and/or primary care providers.

● Encourage coordination between professional organizations

Message-Ways to healthy life

1.Search your house for enemies

2.Refuse to inhale nicotine3.Watch what you eat4.Take a walk!

Prevention of CVD

the challenge is huge, the path is arduous, resources are meager persistence is in demand,

BUT fruits are sweet

PCS –Preventive Council

Documents

Prevention strategies Preventive Council Peshawar Heart Study Prof Mohammad Hafizullah Cardiology Department Postgraduate Medical Institute Lady Reading