La Malattia Cardiovascolare in Europa (CVD) E’ la principale causa di morte contando per il 41% di tutti i decessi (Eurostat 2003) 1.2 milioni di decessi in Europa / anno 1 / 3 degli anni di vita perduti per morte precoce secondaria a CVD www.cardiovascularprevention.com

E’ la principale causa di morte contando per il 41% di tutti i decessi (Eurostat 2003)

1.2 milioni di decessi in Europa / anno

1 / 3 degli anni di vita perduti per morte precoce secondaria a CVD

Maggiori cause di morte in EU anno 2003 per gruppi di 5 anni di età www.cardiovascularprevention.com

Age-standardised death rates, per 100.000, from CHD, 1968-2002, selected countries, the world (1) www.cardiovascularprevention.com From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008) Coronary heart disease statistics . British Heart Foundation: London.

Age-standardised death rates, per 100.000, from CHD, 1968-2002, selected countries, the world (2) www.cardiovascularprevention.com From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008) Coronary heart disease statistics . British Heart Foundation: London.

EUROPE 1995-2006 www.cardiovascularprevention.com

Cardiovascular Disease in United Kingdom -2006- Diseases of the heart and circulatory system (cardiovascular disease or CVD) are the main cause of 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 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 53,000 premature 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. 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. www.cardiovascularprevention.com

Diseases of the heart and circulatory system (cardiovascular disease or CVD) are the main cause of 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 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 53,000 premature 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.

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

Incidenza in Italia per anno Sindromi coronariche acute 280.000 M 78.000 F + 50.000 morti improvvise Solo il 30% dei soggetti con fattori di rischio tradizionali manifesta segni di CAD Studio: Pz giovani, 50 aa. senza FRC : nel 50% M, 25% F , IMA o Morte come prima manifestazione di CAD , di questi Il 68% ha stenosi coronariche subcritiche, < 50% www.cardiovascularprevention.com

Sindromi coronariche acute 280.000 M

78.000 F + 50.000 morti improvvise

Solo il 30% dei soggetti con fattori di rischio tradizionali manifesta segni di CAD

Studio: Pz giovani, 50 aa. senza FRC : nel

50% M, 25% F , IMA o Morte come prima manifestazione di CAD , di questi

Il 68% ha stenosi coronariche subcritiche, < 50%

Mortalità Per Grandi Gruppi anno 2002 - ISTAT (Italy) Malattie Cardiovascolari 237.198 Tumori 163.070 Morte improvvisa 54.000 www.cardiovascularprevention.com

Malattie

Cardiovascolari 237.198

Tumori 163.070

Morte improvvisa 54.000

Numero dimessi 2004 - Ricoveri per acuti. (ISTAT – Italy) Tumori 761.582 Malattie cardiovascolari 1.413.082 www.cardiovascularprevention.com

Tumori 761.582

Malattie cardiovascolari 1.413.082

www.cardiovascularprevention.com ITALY CONSUMO DI FARMACI

Particolari condizioni associate ad elevata mortalità cardiovascolare Diabete mellito Scompenso cardiaco Ictus ischemico/emorragico www.cardiovascularprevention.com

Diabete mellito

Scompenso cardiaco

Ictus ischemico/emorragico

U.S.A. Data 1999-2002 Of the 71 300 000 American adults with 1 or more types of cardiovascular disease (CVD), 27 400 000 are estimated to be age 65 or older High blood pressure 65 000 000. Coronary heart disease 13 200 000. – 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. www.cardiovascularprevention.com

Of the 71 300 000 American adults with 1 or more types of cardiovascular disease (CVD), 27 400 000

are estimated to be age 65 or older

High blood pressure 65 000 000.

Coronary heart disease 13 200 000.

– 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.

USA Death rate in 2003 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 females. Breast cancer claimed the lives of 41 566 females in 2003. Lung cancer claimed 67 894. 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 2.6 are from CVD . Based on preliminary 2003 mortality, CVD caused about a death a minute among females over 480 000 female lives every year. www.cardiovascularprevention.com

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 females.

Breast cancer claimed the lives of 41 566 females in 2003.

Lung cancer claimed 67 894.

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 2.6 are from CVD .

Based on preliminary 2003 mortality, CVD caused about a death a minute among females over

480 000 female lives every year.

U.S.A. Data 2003 & cost 2006 www.cardiovascularprevention.com

Other causes of death in 2003 in USA (preliminary data) Cancer 554 643 Accidents 105 695 Alzheimer’s disease 63 343 HIV (AIDS) 13 544. www.cardiovascularprevention.com

Cancer 554 643

Accidents 105 695

Alzheimer’s disease 63 343

HIV (AIDS) 13 544.

CARDIOVASCULAR DISEASE IN CANADA (2) These statistics are based on 2004 data (from Statistics Canada) Cardiac arrest About 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 congestive heart failure (CHF). Stroke More than 50,000 strokes occur in Canada each year. That’s one stroke every 10 minutes. 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. www.cardiovascularprevention.com

ACUTE CORONARY SINDROME IN INDIA India has the largest percentage of heart disease in the world 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 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 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 whites. 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 and PCI/CABG were all far lower than rates seen in the West. www.cardiovascularprevention.com

India has the largest percentage of heart disease in the world

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 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 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 whites.

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 and PCI/CABG were all far lower than rates seen in the West.

India: Mortality rates and socioeconomic status From: Xavier D. et al. Lancet 2008; 371:1435-1442 . www.cardiovascularprevention.com Mortality Rich (%) Lower middle class (%) Poor (%) p Unadjusted mortality 5.5 6.5 8.2 <0.0001 Mortality adjusted for risk factors, location of infarct, and treatments 7.2 6.4 6.6 0.97

Ten-year risk of CVD event (%) in 60-year-olds British minority Ethnic groups From: P Brindle, M May, et Al: Heart 2006;92:1595–1602. doi: 10.1136/hrt.2006.092346 www.cardiovascularprevention.com Ethnic group Male nonsmoker Male smoker Female nonsmoker Female smoker Indian 22.4 36.7 8.7 15.1 Pakistani 24.7 40.0 13.4 22.8 Bangladeshi 24.9 40.4 7.4 13.0 All South Asians 23.6 38.5 9.7 16.9 Chinese 11.1 19.1 2.5 4.4 Caribbean 13.3 22.7 9.7 16.9 Black African 20.1 33.3 10.8 18.7 Irish 16.0 27.0 9.1 15.8 Framingham score 14.1 22.3 8.7 14.7

Health care costs of CVD, CHD and stroke by EU country, 2006, Europe From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008) Coronary heart disease statistics . British Heart Foundation: London. www.cardiovascularprevention.com CVD CHD Stroke Cost per % of total Cost per % of total Cost per % of total capita health capita health capita health Country (€) expenditure (€) expenditure (€) expenditure Austria 198 6 43 1 35 1 Belgium 193 6 46 1 27 1 Bulgaria Ì5 14 6 2 7 3 Cyprus 59 5 18 2 7 l Czech Republic 107 13 25 3 16 2 Denmark 182 5 44 1 37 l Estonia 77 15 22 4 14 3 Finland 237 10 52 2 65 3 France 207 7 32 ! 2; 1 Germany 413 14 96 3 58 1 Greece 173 10 46 3 44 2 Hungary 75 111 15 2 10 1 Ireland 183 6 46 1 26 1 Italy 235 in 45 2 45 2 Latvia 47 9 13 3 8 2 Lithuania 59 13 14 3 14 3 Luxembourg 252 5 60 1 24 0 Malta 72 6 IS 1 5 0 Netherlands 271 9 73 2 78 3 Poland 74 17 18 4 10 2 Portugal 151 LO 33 2 27 2 Romania 14 15 6 3 6 2 Slovakia 74 13 21 4 11 2 Slovenia 91 7 19 1 12 1 Spain 130 7 31 2 17 1 Sweden 308 10 62 2 52 2 UK 313 12 71 3 69 3 Total EU 223 10 49 2 38 2

Sproporzione tra la domanda crescente di prestazioni e le risorse economiche scarse Ciò richiede fondamentali modifiche nella strategia diagnostica e terapeutica Problemi cardiologici attuali e futuri www.cardiovascularprevention.com

Sproporzione tra la domanda crescente di prestazioni e le risorse economiche scarse

Ciò richiede fondamentali modifiche nella strategia diagnostica e terapeutica

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

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

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