Mississippi State Plan for Heart Disease and Stroke Prevention and Control J. Clay Hays, Jr., M.D.
Purpose of the Plan <ul><li>Provide framework to reduce morbidity and mortality associated with CVD </li></ul><ul><li>Prov...
We’re Number 1! We lead the nation in heart disease and stroke
Who developed the Plan?
Partnership <ul><li>Miss. State Dept of Health </li></ul><ul><li>Miss. Chronic Illness Coalition- CVD Advisory Committee <...
Who do we plan to target? <ul><li>Everyone </li></ul><ul><li>Gender </li></ul><ul><li>Race </li></ul><ul><li>Socioeconomic...
How do we expect to accomplish our Goals? <ul><li>Policy and environmental interventions focusing on populations instead o...
Develop a Database
Why did We decide to do this?
Mississippi Stats <ul><li>CVD is leading cause of death- 41% in 2001 </li></ul><ul><li>Our CVD mortality rate is the highe...
More facts <ul><li>Mortality worse in men than in women </li></ul><ul><li>African americans> whites </li></ul><ul><li>Clai...
Coronary Artery Disease (CAD): The Diagnosis Often Comes Too Late (Adapted from Levy et al.) Levy D et al in  Textbook of ...
<ul><li>Vascular disease—and CAD in particular— is the leading cause of death in the US and other Western nations </li></u...
Atherosclerosis: A Systemic Disease <ul><ul><li>Aronow WS et al,  Am J Cardiol , 1994. </li></ul></ul>From a prospective a...
Major Risk Factors for CAD Grundy SM et al,  Circulation , 1998; Grundy SM,  Circulation , 1999.
Most Myocardial Infarctions Are Caused by Low-Grade Stenoses <ul><ul><li>Pooled data from 4 studies: Ambrose et al, 1988; ...
 
 
Coronary Remodeling (Adapted from Glagov et al.) Normal vessel Minimal CAD Progression Compensatory expansion maintains co...
Atheroma Morphology by Ultrasound “ Soft” Lipid-Laden Plaque “ Hard” Fibrous Plaque
 
 
 
Thin Cap With Lipid Core Thick Stable Fibrotic Cap Same Lumen Size: Different Atheromas
Atherosclerosis Begins in Childhood <ul><li>(Adapted from Berenson et al.) </li></ul>Berenson GS et al,  N Engl J Med , 19...
One in Six Teenagers Has Atheromas Tuzcu EM et al, in press. (Adapted from Tuzcu et al.)
CAD: Silent Disease Necessitates Aggressive Risk Factor Management <ul><li>IVUS corroborates necroscopy studies, proving t...
The Correlation Between Atherosclerosis and Risk Factors Begins Early  <ul><li>(Adapted from Berenson et al.) </li></ul><u...
Small Increases in Cholesterol Lead to Dramatic Increases in CAD Death <ul><li>(Adapted from Neaton et al.) </li></ul><ul>...
CAD: Not Just a Lipid Disease <ul><li>Half of all MIs occur in normolipidemic patients </li></ul><ul><li>Smoking Accounts ...
Systolic BP Confers Incremental Risk Even Within “Normal” Levels <ul><li>(Adapted from Neaton et al.) </li></ul>Neaton JD ...
Diabetes: Half of All Patients Are Unaware of Their Condition <ul><li>CAD is the leading cause of hospitalization and deat...
UKPDS*: The Case for Aggressive Blood Pressure Control UK Prospective Diabetes Study Group,  BMJ , 1998. *UK Prospective D...
How do we plan to address problems? <ul><li>Physical Activity </li></ul><ul><li>Address Nutritional needs </li></ul><ul><l...
CAD Risk Factors: Minimal and Optimal Grundy SM,  Circulation , 1999; American Heart Association Consensus Panel,  Circula...
Multiple Risk Factors: Additive Risk Grundy SM et al,  J Am Coll Cardiol,  1999; Data on file, Pfizer Inc., New York, NY. ...
OBESITY
Where do we Start? <ul><li>Communities </li></ul><ul><li>Schools </li></ul><ul><li>Worksites </li></ul><ul><li>Healthcare ...
Conclusions : Risk Factor Management <ul><li>Atherosclerosis  begins in childhood and is strongly associated with major CA...
<ul><li>“ Awaiting overt signs and symptoms of coronary disease before treatment is no longer justified.” </li></ul><ul><l...
Carotid Disease: A Reliable Predictor of Coronary Risk <ul><li>Carotid atherosclerosis, even when very mild, is associated...
Upcoming SlideShare
Loading in …5
×

MS State Plan for Heart Disease and Stroke Prevention and Control

721 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
721
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
7
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

MS State Plan for Heart Disease and Stroke Prevention and Control

  1. 1. Mississippi State Plan for Heart Disease and Stroke Prevention and Control J. Clay Hays, Jr., M.D.
  2. 2. Purpose of the Plan <ul><li>Provide framework to reduce morbidity and mortality associated with CVD </li></ul><ul><li>Provide education </li></ul><ul><li>Create healthy environment </li></ul><ul><li>Provide quality health services </li></ul><ul><li>Focuses on disparities between groups </li></ul>
  3. 3. We’re Number 1! We lead the nation in heart disease and stroke
  4. 4. Who developed the Plan?
  5. 5. Partnership <ul><li>Miss. State Dept of Health </li></ul><ul><li>Miss. Chronic Illness Coalition- CVD Advisory Committee </li></ul><ul><li>Miss. Task Force on Heart Disease and Stroke Prevention </li></ul>
  6. 6. Who do we plan to target? <ul><li>Everyone </li></ul><ul><li>Gender </li></ul><ul><li>Race </li></ul><ul><li>Socioeconomic status </li></ul><ul><li>Other cultural factors </li></ul>
  7. 7. How do we expect to accomplish our Goals? <ul><li>Policy and environmental interventions focusing on populations instead of individuals </li></ul><ul><li>Partnership development </li></ul><ul><li>Address specific community needs </li></ul>
  8. 8. Develop a Database
  9. 9. Why did We decide to do this?
  10. 10. Mississippi Stats <ul><li>CVD is leading cause of death- 41% in 2001 </li></ul><ul><li>Our CVD mortality rate is the highest in the country </li></ul><ul><li>One in five occurs in people <65 old </li></ul><ul><li>Prevalence- 4.3% heart disease and 2.4% stroke </li></ul><ul><li>160,000 Mississippians reported CVD </li></ul>
  11. 11. More facts <ul><li>Mortality worse in men than in women </li></ul><ul><li>African americans> whites </li></ul><ul><li>Claiborne county has the highest (675 per 100,000) </li></ul><ul><li>Three fourths of Miss. have one risk factor </li></ul><ul><li>Cost 3.7 billion </li></ul>
  12. 12. Coronary Artery Disease (CAD): The Diagnosis Often Comes Too Late (Adapted from Levy et al.) Levy D et al in Textbook of Cardiovascular Medicine , 1998.
  13. 13. <ul><li>Vascular disease—and CAD in particular— is the leading cause of death in the US and other Western nations </li></ul><ul><li>By 2020, cardiovascular disease will become the most common cause of death worldwide </li></ul><ul><li>Due to the high initial mortality of vascular disease, the target of clinical practice must be aggressive risk factor management </li></ul><ul><ul><li>American Heart Association  , 2000 Heart and Stroke Statistical Update , 1999; Braunwald E, N Engl J Med , 1997; Kannel WB in Atherosclerosis and Coronary Artery Disease , 1996. </li></ul></ul>Vascular Disease: Scope of the Problem
  14. 14. Atherosclerosis: A Systemic Disease <ul><ul><li>Aronow WS et al, Am J Cardiol , 1994. </li></ul></ul>From a prospective analysis of 1886 patients aged  62 years, 810 patients were diagnosed with CAD as defined by a documented clinical history of MI, ECG evidence of Q-wave MI, or typical angina without previous MI. (Adapted from Aronow et al.)
  15. 15. Major Risk Factors for CAD Grundy SM et al, Circulation , 1998; Grundy SM, Circulation , 1999.
  16. 16. Most Myocardial Infarctions Are Caused by Low-Grade Stenoses <ul><ul><li>Pooled data from 4 studies: Ambrose et al, 1988; Little et al, 1988; Nobuyoshi et al, 1991; and Giroud et al, 1992. (Adapted from Falk et al.) </li></ul></ul><ul><ul><li>Falk E et al, Circulation , 1995. </li></ul></ul>
  17. 19. Coronary Remodeling (Adapted from Glagov et al.) Normal vessel Minimal CAD Progression Compensatory expansion maintains constant lumen Expansion overcome: lumen narrows Severe CAD Moderate CAD Glagov et al, N Engl J Med , 1987.
  18. 20. Atheroma Morphology by Ultrasound “ Soft” Lipid-Laden Plaque “ Hard” Fibrous Plaque
  19. 24. Thin Cap With Lipid Core Thick Stable Fibrotic Cap Same Lumen Size: Different Atheromas
  20. 25. Atherosclerosis Begins in Childhood <ul><li>(Adapted from Berenson et al.) </li></ul>Berenson GS et al, N Engl J Med , 1998.
  21. 26. One in Six Teenagers Has Atheromas Tuzcu EM et al, in press. (Adapted from Tuzcu et al.)
  22. 27. CAD: Silent Disease Necessitates Aggressive Risk Factor Management <ul><li>IVUS corroborates necroscopy studies, proving that atherosclerosis begins in youth </li></ul><ul><li>CAD progresses silently; the initial presentation is usually MI or sudden death </li></ul><ul><li>Most atheromas are extraluminal, rendering them angiographically silent </li></ul><ul><li>The only reasonable approach is early and aggressive risk factor management </li></ul>Berenson GS et al, N Engl J Med, 1998; Tuzcu EM et al, in press; Levy D et al in Textbook of Cardiovascular Medicine , 1998 ; Yamashita T et al, Progress in Cardiovascular Diseases , 1999; Topol EJ et al, Circulation , 1995. Kannel WB in Atherosclerosis and Coronary Artery Disease , 1996.
  23. 28. The Correlation Between Atherosclerosis and Risk Factors Begins Early <ul><li>(Adapted from Berenson et al.) </li></ul><ul><ul><li>Berenson GS et al, N Engl J Med , 1998. </li></ul></ul>
  24. 29. Small Increases in Cholesterol Lead to Dramatic Increases in CAD Death <ul><li>(Adapted from Neaton et al.) </li></ul><ul><ul><li>Neaton JD et al, Arch Intern Med , 1992. </li></ul></ul>
  25. 30. CAD: Not Just a Lipid Disease <ul><li>Half of all MIs occur in normolipidemic patients </li></ul><ul><li>Smoking Accounts for 200,000 cardiovascular deaths annually </li></ul><ul><li>Diabetes Affects 16 million Americans—and is growing </li></ul><ul><li>Hypertension Confers as much risk for MI as smoking or dyslipidemia </li></ul><ul><ul><li>Systolic hypertension is an even greater indicator of CAD risk than diastolic hypertension </li></ul></ul>Braunwald E, N Engl J Med, 1997; Grundy SM et al, Circulation , 1998; The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Coordinating Committee, Arch Intern Med , 1997.
  26. 31. Systolic BP Confers Incremental Risk Even Within “Normal” Levels <ul><li>(Adapted from Neaton et al.) </li></ul>Neaton JD et al, Arch Intern Med , 1992.
  27. 32. Diabetes: Half of All Patients Are Unaware of Their Condition <ul><li>CAD is the leading cause of hospitalization and death among patients with type 2 diabetes (NIDDM) </li></ul><ul><li>Patients with both type 1 and type 2 diabetes are at a high short-term risk of CAD-related end points </li></ul><ul><li>Insulin resistance increases risk and may exist for 25 years or more before diabetes is diagnosed </li></ul><ul><li>Patients with diabetes tend to cluster other risk factors (such as hypertension and dyslipidemia) while diabetes confers risk unto itself </li></ul><ul><ul><li>Aronson D et al in Atherosclerosis and Coronary Artery Disease , 1996; Grundy SM et al, J Am Coll Cardiol , 1999. </li></ul></ul>
  28. 33. UKPDS*: The Case for Aggressive Blood Pressure Control UK Prospective Diabetes Study Group, BMJ , 1998. *UK Prospective Diabetes Study Group. <ul><li>Mean final BP: More-aggressive control, 144/82 mm Hg Less-aggressive control, 154/87 mm Hg </li></ul>
  29. 34. How do we plan to address problems? <ul><li>Physical Activity </li></ul><ul><li>Address Nutritional needs </li></ul><ul><li>Tobacco cessation </li></ul><ul><li>Identify Sociocultural Factors (Jackson Heart Study) </li></ul>
  30. 35. CAD Risk Factors: Minimal and Optimal Grundy SM, Circulation , 1999; American Heart Association Consensus Panel, Circulation , 1995; The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Coordinating Committee, Arch Intern Med , 1997.
  31. 36. Multiple Risk Factors: Additive Risk Grundy SM et al, J Am Coll Cardiol, 1999; Data on file, Pfizer Inc., New York, NY. Risk of developing CAD over 10 years according to specified BP levels and other risk factors. Calculations are based on a Framingham Heart Study computer program, which includes variables for systolic BP, diastolic BP, TC, HDL-C, LVH by ECG, cigarette smoking, and glucose intolerance. The following remained constant unless otherwise indicated: male, age 45 years, TC 180 mg/dL, HDL 45, and nonsmoker. Elevated LDL-C estimated based on TC 250 mg/dL with triglycerides 200 mg/dL. (Data on file, Pfizer Inc.)
  32. 37. OBESITY
  33. 38. Where do we Start? <ul><li>Communities </li></ul><ul><li>Schools </li></ul><ul><li>Worksites </li></ul><ul><li>Healthcare centers </li></ul>
  34. 39. Conclusions : Risk Factor Management <ul><li>Atherosclerosis begins in childhood and is strongly associated with major CAD risk factors from the youngest ages </li></ul><ul><li>Hypertension (particularly systolic), diabetes, and smoking—in addition to dyslipidemia—confer comparable risks </li></ul><ul><li>The effect of these risk factors is continuous , extending even into the “normal” range </li></ul><ul><li>Therefore, aggressive risk factor modification is the most effective strategy for reducing the consequences of CAD </li></ul>Berenson GS et al, N Engl J Med, 1998; Braunwald E, N Engl J Med, 1997; Neaton JD et al, Arch Intern Med , 1992; Kannel WB in Atherosclerosis and Coronary Artery Disease, 1996.
  35. 40. <ul><li>“ Awaiting overt signs and symptoms of coronary disease before treatment is no longer justified.” </li></ul><ul><li>“ In some respects, the occurrence of symptoms may be regarded more properly as a medical failure than as the initial indication for treatment.” </li></ul><ul><ul><li>— William B. Kannel, MD Department of Medicine Boston University Medical Center </li></ul></ul>Kannel WB in Atherosclerosis and Coronary Artery Disease, 1996.
  36. 41. Carotid Disease: A Reliable Predictor of Coronary Risk <ul><li>Carotid atherosclerosis, even when very mild, is associated with MI and sudden cardiac death </li></ul><ul><li>Ultrasound-derived carotid intimal-medial thickness (IMT) has been shown to predict the risk of MI </li></ul><ul><li>The same risk factors predispose patients to atherosclerosis in both the coronary and carotid arterial systems </li></ul><ul><ul><li>Salonen R in Risk Factors for Ultrasonographically Assessed Common Carotid Atherosclerosis , 1991; O’Leary DH et al, N Engl J Med , 1999; Androulakis AE et al, Eur Heart J , 2000. </li></ul></ul>

×