In USA, 1920’s, 1930’s in Britain.
WHO has completed a project known as MONICA.
Multinational Monitoring of Trends and Determinants
in Cardiovascular Diseases.
Is to elucidate CHD issue.
41 centres in 26 countries were participating in this
Ended in 1994.
INDICES URBAN RURAL
Prevalence rate/1000 64.37 25.27
Death rate/1000 0.8 0.4
DALY/100,000 2703.4 986.2
Non Modifiable Modifiable
Elevated Serum Cholesterol
PREVENTION OF CHD
• Prevention in Whole Population
• Primordial Prevention
High Risk Strategy
CHD is primarily a mass disease.
So, the strategy should be therefore mass approach.
Should focus mainly on control of risk factors.
• Reduction in
• MUFA &
• No safer
• So, smok
It involves preventing the emergence and spread of
CHD risk factors and life styles that have not yet
appeared or become endemic.
Prevention should be multifactorial because the
aetiology is multifactorial.
The aim should be to change the community as a
whole, not the individual subjects living in it.
HIGH RISK STRATEGY
Can be started only when
those high risk
BP, Increased serum
levels, Family history of
Bring them under
preventive care. Motivate
them to take positive
action against all the
An elevated BP should
Nicotine chewing gum to
wean from smoking.
Intervention is effective
in reducing the disease
only in high risk group.
Might not reduce to same
extent in general
More than half of the
CHD cases occurs in
those who are not at high
Forms an important part of an overall strategy.
Aim is to prevent the recurrence and progression of
Rapidly expanding field with much of research in
progress. [ E.g. drug trials, coronary surgery, pace
Principles Governing Secondary
Rapidly developed clinical signs of focal disturbance
of cerebral function ; lasting more than 24 hours or
leading to death, with no apparent cause other than
Cerebral Thrombosis or Embolism
Occlusion of Pre-Cerebral arteries
TIA ( more than 24 hrs )
Ill defined cardiovascular disease.
Prevalence rate of Stroke : 1.54/1000
Death Rate : 0.6/1000
DALY’s lost : 597.6/1,00,000
RHEUMATIC HEART DISEASE
Rheumatic fever (RH) and RHD cannot be separated
from an epidemiological point of view.
Lancefield Group A β Haemolytic Streptococci.
Starts as a pharyngitis.
Not a communicable disease.
RHD is prevalent in the range of 5-7/1000 in 5-15yrs
age group and about 1 million cases of RHD in our
Duckett Jones Criteria’s
MAJOR MANIFESTATIONS MINOR MANIFESTATIONS
POLYARTHRITIS Previous RF
SYDENHAM’s CHOREA Raised ESR/CRP
ERYTHEMA MARGINATUM First degree AV block
SUBCUTANEOUS NODULES Leucocytosis
JONES criteria :
2 major criteria & 1 minor criteria
Non – Medical Measures
Improving living conditions, Socio-
economic status etc.
Breaking the poverty-disease-poverty
Prevention of recurrences of RF
Persons with RF – IM Inj. of Benzathine
Prevent first attack of RF by identifying
patients with streptococcal throat.
Concentrate on high risk groups such as
NATIONAL PROGRAMME FOR PREVENTION
AND CONTROL OF
DIABETES, CARDIOVASCULAR DISESES AND
In India, 53% of deaths are due to NCD’s (2005)
Pilot programme for prevention and control of
cardiovascular diseases, diabetes and stroke.
Launched on Jan 4th 2008 in 7 states with one district
Assam – Kamrup
Punjab – Jalandhar
Rajasthan – Bhilwara
Karnataka – Shimoga
Tamil Nadu – Kancheepuram
Kerala – Thiruvananthapuram
Andhra Pradesh – Nellore
Financial outlay for the pilot phase is 5 crores.
Health Promotion for the General Population
• Targeted to healthy, Risk free population.
• Community based, Work based and School based Interventions.
Disease Prevention for the High Risk Group
• Early diagnosis and appropriate management.
Assessment of Prevalance of Risk Factors – through