Cardiovascular Disease prevention - Epidemiology, cardio,healt

CardioVascularDisease1

C di l di (CVD) th i Cardiovascular diseases (CVD) are the main cause of death in the industrialized countries. But they

d l i i i th i are dangerously increasing in the emerging Countries.

The main forms of CVD are coronary heart disease (CHD): Acute myocardial infarction (AMI), Angina pectoris,

sudden cardiac death (SD)

Stroke: Ischemic and Haemorrhagic;

Peripheral artery disease, aortic aneurysm

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Age-standardised death rates, per 100.000, from CHD, 1968-2002, selected countries, the world (1)1968 2002, selected countries, the world (1)

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From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008) Coronary heart diseaseCoronary heart disease statistics. British Heart Foundation: London.


Age-standardised death rates, per 100.000, from CHD, 1968-2002, selected countries, the world (2)1968 2002, selected countries, the world (2)

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Cardiovascular Disease in Europep4

Fi t f d th ti % f ll d th First cause of death counting 41% of all deaths (Eurostat 2003)

ili i d h i / 1.2 milioni deaths in Europe / year

1/3 of year of life expectancy lost by CVD’s premature death


5www.cardiovascularprevention.com

EUROPE 1995-2006


CVD in ITALY(year 2003)(y 3)

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A t C S d Acute Coronary Syndrome 280.000 Male

78.000 Female

50.000 Sudden Cardiac Death

AMI or SD as first onset of CHD Only 30% of persons having traditional risk factors show

signs and symptoms of CHD

In 68% of younger patients, without traditional risk f h b i i l (factors there are subcritical coronary artery stenoses( < 50%).


Mortality Year - ISTAT (Ital )Mortality Year - ISTAT (Italy)8

CardiovascularDisease 237.198

Cancer 163.070

Sudden Death 54 000Sudden Death 54.000


DISEASES ASSOCIATED WITH 9

DISEASES ASSOCIATED WITH HIGHT Cardiovascular mortality

Diabetes m.

Heart Failure

Ictus (ischemic /haemorrhagic)( / g )


Cardiovascular Disease in United Kingdom -2006-2006

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Diseases of the heart and circulatory system (cardiovascular disease or CVD) are the main cause of y y ( )death in the UK and account for almost 198,000 deaths each year. More than one in three deaths (35%) are from CVD each year. The main forms of CVD are coronary heart disease (CHD: Acute myocardial infarction, Angina pectoris, sudden cardiac death) and stroke. About half (48%) of all deaths from CVD are from CHD and more than a quarter (28%) are from stroke.

CHD by itself is the most common cause of death in the UK Around one in five men and one in seven CHD by itself is the most common cause of death in the UK. Around one in five men and one in seven women die from the disease. CHD causes around 94,000 deaths in the UK each year.

Other forms of heart disease cause over 31,000 deaths in the UK each year so in total there were just under 126,000 deaths from heart disease in the UK in 2006.

Premature mortality(death before the age of 75). CVD is one of the main causes of premature death in the UK 30% of premature deaths in men and

22% of premature deaths in women were from CVD in 2006. CVD caused just over 53,000premature deaths in the UK in 2006.

CHD, by itself, is the most common cause of premature death in the UK About one fifth (19%) of premature deaths in men and one in ten (10%) premature deaths in women were from CHD.premature deaths in men and one in ten (10%) premature deaths in women were from CHD.

CHD caused almost 31,000 premature deaths in the UK in 2006. Other forms of heart disease cause more than 7,500 premature deaths in the UK each year. In total

there were over 38,000 premature deaths from heart disease in the UK in 2006 - around one fifth of all premature deaths.

From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008) Coronary heart disease statistics. British Heart Foundation: London.


DEATHS BY SEX, AGE, UNITED KINGDOM 2006- 2006-

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USA Death rate in 2003USA Death rate in 2003Th 2003 li i CVD d th t 364 2 f l• The 2003 preliminary CVD death rates were 364.2 for males and 262.5 for females.

• Cancer death rates were 232.3 for males and 160.2 for f lfemales.

• Breast cancer claimed the lives of 41 566 females in 2003.• Lung cancer claimed 67 894.g• Death rates for females were 25.2 for breast cancer and 41.1

for lung cancer. • One in 30 female deaths are from breast cancer while 1 in• One in 30 female deaths are from breast cancer, while 1 in

2.6 are from CVD. • Based on preliminary 2003 mortality, CVD caused about a

death a minute among females overdeath a minute among females over • 480 000 female lives every year.


Other causes of death in 2003 in USA (preliminary data)

Cancer 554 643• Cancer 554 643• Accidents 105 695• Alzheimer’s disease 63 343

HIV (AIDS) 13 544• HIV (AIDS) 13 544.


U.S.A. Data 1999-200299914

Of the 71 300 000 American adults with 1 or more types of Of the 71 300 000 American adults with 1 or more types of cardiovascular disease (CVD), 27 400 000are estimated to be age 65 or olderg 5

High blood pressure 65 000 000. Coronary heart disease 13 200 000.y

– Myocardial infarction (MI, or heart attack)7 200 000.

– Angina pectoris (AP, or chest pain) 6 500 000.• Heart failure 5 000 000. Stroke 5 500 000. Congenital cardiovascular defects 1 000 000.


U.S.A. Data 2003 & cost 2006


CARDIOVASCULAR DISEASE IN CANADA (1)Th t ti ti b d 2004 d t (f St ti ti C d )These statistics are based on 2004 data (from Statistics Canada)

Cardiovascular disease (heart disease, diseases of the blood vessels and stroke) acco nts for the death of more Canadians than an otherand stroke) accounts for the death of more Canadians than any other disease. Every 7 minutes in Canada, someone dies from heart disease or strokestroke.

Cardiovascular disease accounted for 72,338 deaths:32% of all deaths in Canada32% of all deaths in Canada 31% of all male deaths 33% of all female deaths In 2004, of all cardiovascular deaths:In 2004, of all cardiovascular deaths:54% were due to ischemic heart disease20% to stroke25% to heart attack

Cost of cardiovascular diseasesHeart disease and stroke costs the Canadian economy more than $18 billion every year in physician services, hospital costs, lost wages and

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decreased productivity. www.cardiovascularprevention.com

CARDIOVASCULAR DISEASE IN CANADA (2)These statistics are based on 2004 data (from Statistics Canada)These statistics are based on 2004 data (from Statistics Canada)

Cardiac arrest

Ab t 40 000 C di i di tAbout 40,000 Canadians experience cardiac arrest every year.Less than 5% of those who have a cardiac arrest outside of a hospital

survive.

Congestive heart failure

It is estimated that there are 400 000 Canadians living with congestiveIt is estimated that there are 400,000 Canadians living with congestive heart failure (CHF).

StrokeStroke

More than 50,000 strokes occur in Canada each year. That’s one stroke every 10 minutes.y

Stroke is the third leading cause of death in Canada. Each year, more than 14,000 Canadians die from stroke.

Each year, more women than men die from stroke.

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y


ACUTE CORONARY SINDROME IN INDIA

18 India has the largest percentage of heart disease in the world

X i t l' i d th i id f STEMI d STEMI Xavier et al's, examined the incidence of STEMI and non-STEMI among almost 21 000 patients from 89 centers in 50 Indian cities. They found that more than 60% of these patients were diagnosed with STEMI, mean age was 57.5 years (although STEMI patients tended to be even younger), and the

j i f l iddl i f ili vast majority were from lower-middle-income or poor families.

The Indians were, on average, 57,5 years of age compared with 70.7 years for the European whitesthe European whites.

Reinfarction, and stroke rates and 30-day death, were higher for STEMI patients than non-STEMI, and mortality, notably, was significantly higher in poor patients than in rich patients.

They also had significantly increased prevalence of diabetes, hypertension, history of CAD compared with European whites.

And triple-vessel disease was more common in the Indian Asians than in the whiteswhites.

Almost all STEMI and non-STEMI patients were treated with antiplatelet drugs (primarily aspirin), but use of thrombolytics, ACE inhibitors or Angiotensin-Receptor Blockers, beta blockers, statins, omega 3 fatty-acids

d PCI/CABG ll f l th t i th W tand PCI/CABG were all far lower than rates seen in the West.


India: Mortality rates and i i t tsocioeconomic status

M t lit Ri h L P (%)

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Mortality Rich (%)

Lower middle class

Poor (%) p

class (%)

Unadjusted mortality 5.5 6.5 8.2 <0.0001Mortality adjusted for i k f t l ti

7.2 6.4 6.6 0.97risk factors, location of infarct, and treatmentstreatmentsFrom: Xavier D. et al. Lancet 2008; 371:1435-1442.


Ten-year risk of CHD event (%) in 60-year-y ( ) yolds British minority Ethnic groups

Eth i M l M l F l F l

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Ethnic group Male nonsmoker

Male smoker

Female nonsmoker

Female smoker

Indian 18.5 27.9 6.4 10.0Pakistani 21.3 31.8 9.8 15.3Bangladeshi 21.2 31.7 5.3 8.3All South Asians

19.5 29.3 7.1 11.1

Chinese 6 1 9 6 1 1 1 8Chinese 6.1 9.6 1.1 1.8Caribbean 5.4 8.5 8.6 13.4Black African 8.9 13.9 3.6 5.7Black African 8.9 13.9 3.6 5.7Irish 13.7 20.9 6.8 10.6Framingham 11.8 18.2 7.1 11.7score

From: P Brindle, M May, et Al: Heart 2006;92:1595–1602. doi: 10.1136/hrt.2006.092346


Ten-year risk of CVD event (%) in 60-year-y ( ) yolds British minority Ethnic groups21

Ethnic group Male nonsmoker

Male smoker

Female nonsmoker

Female smoker

Indian 22.4 36.7 8.7 15.122.4 36.7 8.7 15.1Pakistani 24.7 40.0 13.4 22.8Bangladeshi 24.9 40.4 7.4 13.0All South Asians

23.6 38.5 9.7 16.9

Chinese 11 1 19 1 2 5 4 4Chinese 11.1 19.1 2.5 4.4Caribbean 13.3 22.7 9.7 16.9Black African 20 1 33 3 10 8 18 7Black African 20.1 33.3 10.8 18.7Irish 16.0 27.0 9.1 15.8Framingham 14.1 22.3 8.7 14.7gscore

From: P Brindle, M May, et Al: Heart 2006;92:1595–1602. doi: 10.1136/hrt.2006.092346www.cardiovascularprevention.com

Health care costs of CVD, CHD and stroke f ,by EU country, 2006, Europe

CVD CHD Stroke

Cost per % of total Cost per % of total Cost per % of total

From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008)

capita health capita health capita health

Country (€) expenditure (€) expenditure (€) expenditure

Austria 198 6 43 1 35 1Belgium 193 6 46 1 27 1Bulgaria Ì5 14 6 2 7 3 Kaur and Mike Rayner (2008)

Coronary heart disease statistics. British Heart Foundation: London.

Cyprus 59 5 18 2 7 lCzech Republic 107 13 25 3 16 2

Denmark 182 5 44 1 37 lEstonia 77 15 22 4 14 3Finland 237 10 52 2 65 3France 207 7 32 ! 2; 1Germany 413 14 96 3 58 1Greece 173 10 46 3 44 2Hungary 75 111 15 2 10 1Ireland 183 6 46 1 26 1Italy 235 in 45 2 45 2L t i 47 9 13 3 8 2Latvia 47 9 13 3 8 2Lithuania 59 13 14 3 14 3Luxembourg 252 5 60 1 24 0Malta 72 6 IS 1 5 0Netherlands 271 9 73 2 78 3Poland 74 17 18 4 10 2Portugal 151 LO 33 2 27 2Portugal 151 LO 33 2 27 2Romania 14 15 6 3 6 2Slovakia 74 13 21 4 11 2Slovenia 91 7 19 1 12 1Spain 130 7 31 2 17 1

Sweden 308 10 62 2 52 2

222222 www.cardiovascularprevention.com

UK 313 12 71 3 69 3

Total EU 223 10 49 2 38 2

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Circulation January 24, 2006Alter et al The Proliferation of Cardiac TechnologyIn Canada www.cardiovascularprevention.com

Lucas et al Temporal Trends in Cardiac Testing and Treatment- USA- Circulation January 24, 2006

24 www.cardiovascularprevention.com

www CardioVascularPrevention comwww.CardioVascularPrevention.com

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Cardiovascular Disease prevention - Epidemiology, cardio,healt