????? Cardiovascular Disease

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?????Cardiovascular Disease
?????????????? Department of epidemiology
,Harbin Medical University
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? ? Content

• CVD Epidemic outline
• Hypertension
• Stroke
• Coronary heart disease
• strategies and measurement for CVD

• ??????????
• ???
• ???
• ???
• ?????????????

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??? ?? overview

• ????????(CVD)????????????????????,???????????????
  ????????

• Generalized cardiovascular disease (CVD) is a
  group of circulatory diseases mainly focusing on
  cardiac and vascular anomalies, which includes
  the heart and vascular disease, pulmonary
  circulation disease, and cerebral vascular
  disease

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• Among them, high blood pressure, stroke and
  coronary heart disease badly hazards human health
  hazards

• ?????????????????????????????

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• ???? Epidemic situation
• ????CVD??????????Four stages of CVD prevalence
  in developed countries

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• ????(???)
• ??????????????????????,???????5-10,???????????
  ?????

• The first stage (plague stage)
• The main health problems was infectious
  diseases, famine and nutritional deficiencies.
  Cardiovascular disease accounted for only 5
  -10, which were mainly Rheumatic heart disease
  and pulmonary heart disease

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• ????
• ???????????????????????????????,????????,???????
  ?????,????????????????????????

• The second stage
• Hypertension, hypertensive heart disease and
  hemorrhagic stroke prevalence rate increased with
  economic development, and improvement of
  production and living standards.

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• ????
• ??????,????,???????????????55-60????,???????????
  ???35-65,???????????

• The third stage
• People intake more and more fat and calories
  with the economic development. coronary heart
  disease and cerebral ischemic stroke are early
  onset .As a result Population decline in the
  average life expectancy.

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• ????
• ????????????????
• ?????????????,???????????
• ????????????50???

• The forth stage
• Realizing to the severity of CVD,
• the whole society actively take prevention and
  cure measures and the medical standards improve
  continuously.
• The mortality of CVD is declining more than 50.

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???????????

• Epidemic situation of cardiovascular disease
• in China

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• Stroke morbidity and mortality rates of our
  country is the second highest in the world .
• The CVD count for the primary cause of death in
  city.

• ??????????????????,??,????????????????

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???????????Epidemiological Characteristics of
CVD in China

• ??????,?????????????????

• Age of onset earlier, and the incidence
  and prevalence of young adults population is
  increasing.

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• The incidence, prevalence, mortality, of
  cardiovascular disease significantly increased
  not only in city but also in rural.

• ???????????????????????????,???????????????
  ????????????????

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• ?????????,????????????????????????

• Different form western developed countries,
  the incidence, prevalence and mortality of
  cerebrovascular disease are higher than coronary
  heart disease.

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• ??????????????????,????????????????????,????????
  ?????????????????

• Because of need life long treatment, fast
  rising of medical care fees, the treatment and
  control rate are lower in china, the disability
  and handicap leaded by CVD is very severity

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??? ???(Hypertension)

• ????????????????????????

• Hypertension is a kind of cardiovascular disease
  with arterial blood pressure increasing as the
  main manifestations.

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?????? types

• ??????
• ????????,?????????,?????95???

• primary hypertension
• Blood increasing are special sign and an
  independent disease with unclear cause, account
  95 of total hypertension.

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• ??????
• ???????????????,???????70???

• secondary hypertension
• Blood increase is the express of some disease,
  70 of them are kidney disease

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????????????(epidemiological characteristics of
Hypertension )

• ?????????????
• The status and prevalence trend of hypertension
  in our country
• ????????????????????????????????????????????
  ????????

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2001???????????The prevalence of hypertension in
China in 2001

• ??? (prevalence)27.2
• ???(awareness rate)44.7
• ???(medication rate)28.2
• ???(control rate)8.1

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???????????? epidemiological characteristics of
Hypertension
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• (?)????(endemic distribution)
• ????(general tendency)
• ???????????????, ??????,??????,???????????
  ??,????????????
• Prevalence of hypertension in various
  regions of China are significant differences, it
  is higher in the north than the south, the east
  than the west, and there is decreasing trend from
  northeast to southwest, urban is higher than
  rural in the same area.

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• (?)????(time distribution)
• ??1959?-1991????32???15???????????????????
  ?????????????
• Sample surveys of hypertension prevalence
  among age 15 and above population were carried
  out 32 times in China from 1959 to 1991. The
  results showed that prevalence of hypertension is
  on the rise.

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• (?)????
• (population distribution)
• 1??????(age and sex )
• 2??? (occupation)
• 3???(race)
• 4?????(education)

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• (?)???????
• (conformed risk factor)
• ??(obesity)
• ???????
• (sodium and potassium in the food )
• ? ?(alcohol)
• ????(hereditary factor)

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• (?)????????
• (uncertain risk factors)
• ???(Dietary Calcium)
• ???(contraceptives)
• ??(smoking)
• ????(physical activity)
• ???????(stress)

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??? ???(Stroke)

• ??????????????,?????????????????????
• A stroke (sometimes called a cerebrovascular
  accident (CVA)) is the rapidly developing loss of
  brain functions due to disturbance in the blood
  supply to the brain, caused by a blocked or burst
  blood vessel.

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????????

• ??/????
• ?????????1,500,000?
• ?????????1,000,000?
• ??????6,000,000?
• ?????????
• ?????????????
• ??????100????

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????????????epidemic characteristic of stroke

• (?)????(geographic distribution)
• ?????????????,???????????,???????????????.
• There is difference in the geographical
  distribution of stroke, such differences exist
  not only among countries, but also in different
  parts of the same country.

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• (?)????(time distribution)
• ??????,??????????????????,???40????????????.
• The mortality rate of stroke continued to decline
  in Britain, France, United States, Canada,
  Australia, Japan and other industrialized
  countries during the past 40 years, except for
  the Eastern European countries,

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• (?)????(population distribution)
• ???????(sex and age)
• ?????????????????????,??????????????????,?50??????
  ???
• Population morbidity and mortality rates of
  stroke were higher in male than female, morbidity
  and mortality rates were increased with age in
  both male and female, showing a substantial
  upward trend after age 50 .

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• (?)????(population distribution)
• ???????(sex and age)
• ???????????????1.3-2.01
• ?????????????1.3-1.51
• The ratio of male to female for incidence of the
  most countries in the world is 1.3-2.01
• The ratio of male to female for incidence of
  stroke in China is 1.3-1.51

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• ????(race)
• ???????????????????
• ????????????????
• The prevalence rate of stroke is higher in black
  persons than whites in the same area of United
  States
• The prevalence rate of stroke is higher in Han
  ethnic than the minorities of China

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• ? ?(occupation)
• ??????????????
• ?????????????????
• Heavy manual workers have a higher prevalence
  of stroke
•   The incidence rate is significantly higher
  among the persons with regular night shift work
  than those with day shift work

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??????????Risk factors of stroke

• ???(hypertension)
• ??? (heart disease)
• ???(diabetes mellitus)
• ????????(transient ischemic attack)
• ? ?(smoking)
• ? ?(alcohol)

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??? ???(Coronary heart disease)

• ???(CHD)????????????????,?????????????????????????
  ?????????????????????
• Coronary disease (or coronary heart disease)
  refers to the failure of coronary circulation to
  supply adequate circulation to cardiac muscle and
  surrounding tissue.

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????????????epidemic characteristic of coronary
heart disease

• (?)????(endemic distribution )
• ????????????????????,????????????????????????
• There is difference in the geographical
  distribution of incidence an mortality rate of
  CHD, such differences exist not only among
  countries, but also in different parts of the
  same country.

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• (?)????(time distribution)
• ???????,???????????????????,???????????????30?????
  ??
• The morbidity and mortality rates of coronary
  heart disease are in low levels in China compared
  with developed countries, but they are increased
  gradually in nearly 30 years.

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• (?)????
• (population distribution)
• ?? (age)
• ?????????????????
• Incidence rates of coronary heart disease
  increased with age for both men and women

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• (?)????
• (population distribution)
• ??(sex)
• ????????????????????????
• Morbidity and mortality rates of coronary heart
  disease are higher in male than female in all age
  groups

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• (?)????
• (population distribution)
• ??(race)
• ?MONICA??,???????????,??????(????),?????????????
  ?
• According to MONICA data, the mortality of
  coronary heart disease, apart from several
  countries (e.g. Singapore), is lower in Asian
  yellow race than white race in general.

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• (?)????
• (population distribution)
• ??(occupation)
• ???????????????????
• Prevalence of coronary heart disease is
  higher in mental workers than in manual workers.

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??????????the risk factor of coronary heart
disease

• ??????? (Pathogenic risk factors)
• ???? (Plaque burden)
• ??????? (Conditional risk factors)
• ??????? (Perpetuating risk factors)
• ??????? (Susceptibility risk factors)

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??????????the risk factor of coronary heart
disease

• ??? (hypertension)
• ?????? (hypercholesterolemia)
• ?? (smoking)
• ??? (diabetes mellitus)
• ?? (obesity)

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??????????the risk factor of coronary heart
disease

• ???? (physical activity)
• ?? (heredity)
• A??????????
• (A-type personality and social factor)

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??? ?????????????(prevention and care strategy
and measure)
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• ????????????
• prevention and care Strategies of CVD
• ?????????????,???????????????????????
• Primary prevention
• Secondary prevention
• Tertiary prevention

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• (?)??????????
• population policy
• (?)??????
• high risk group policy

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??????????????(tertiary prevention of CVD)
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??????????????(tertiary prevention OF CVD)

• (?)????(Primary prevention)

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• ????(Reasonable diet )
• ????
• (limit of salt and addition of potassium)
• ??????
• (reduce fat intake )

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• ????(limit of smoking and alcohol)
• ???????????
• Health education
• ????(Appropriate movement)

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• ???? (control weight)
• ??????????????????
• Overweight and obesity are important risk factors
  for cardiovascular disease
• ???? (psychological equilibrium)
• ??????????????????
• Should pay attention to the harm of social and
  psychological factors on cardiovascular system

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(?)???? (secondary prevention)

• ????????????????????????????????????
• Secondary prevention of cardiovascular disease is
  to detect and diagnose cardiovascular disease,
  such as high blood pressure, earlier through
  various ways

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(?)???? (tertiary prevention)

• ??????????????????????????????,??????,???????,???
  ????,??????????????
• Reasonable and appropriate rehabilitation
  measures to prevent disease progression, prevent
  serious complications, prevent disability, try to
  extend the dynamic healthy life expectancy.

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??????????????community integrate control of CVD

• ?? (concept)
• ????????????????,???????,?????????????,???????????
  ?
• Comprehensive prevention and treatment of CVD in
  population based on community, aiming at
  community groups and mobilizing various resources
  within and outside the community.

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