EPIDEMIOLOGY and overview of cardiac DISEASE

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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 lt10
• Today, approximately 30 of deaths worldwide
  including nearly 40 in high income countries and
  about 28 in low and middle income countries
• -Braunwalds Heart Disease 2008

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EPIDEMIOLOGICALTRANSITIONS
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Contd
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PREVALENCE OF CHD-US
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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
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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
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PREVALENCE IN CHENNAI
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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 worlds population lives in
  low and middle income countries.
• About 30 of the worlds 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

• Womens 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
• IncludeLeft 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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THANK YOU