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Epidemiology, Risk Factors
and Prevention of
Cardiovascular Diseases in
Saudi Arabia-1
By
Dr. Ayesha Mallick
Community Medicine Department, JU
Taken from MOH website
ILOS
• 8.1 Describe the burden of cardiovascular diseases in
terms of mortality and morbidity
• 8.2 Explain the risk factors associated with occurrence of
CHD, hypertension and atherosclerosis
• 8.3 Explain the effect of life style modification on the
prevention of atherosclerosis, CHD and hypertension.
• 8.4 State the role of screening in the prevention of
cardiovascular diseases.
2/14/2023 CVD Prevention 1 3
Contd…
• Describe the epidemiology, prevention, treatment and
control of acute rheumatic fever and RHD.
• Explain the role of genetic and environmental factors
in the development of congenital heart disease.
• Describe the role of school health program in the
early detection and secondary prevention of congenital
heart disease.
2/14/2023 CVD Prevention 1 4
What are cardiovascular diseases?
Cardiovascular diseases (CVDs) are a group of
disorders of the heart and blood vessels and
they include:
• coronary heart disease
• cerebrovascular disease
• peripheral arterial disease
• rheumatic heart disease
• congenital heart disease
• deep vein thrombosis and pulmonary
embolism
2/14/2023 CVD Prevention 1 5
Epidemiology-global
• CVDs are the number 1 cause of death
globally
• An estimated 17.9 million people died
from CVDs in 2019 (32% of global death)
• 85% death due to CVDs are due to heart
attack and stroke.
• Over three quarters of CVD deaths take
place in low- and middle-income
countries.
• (W.H.O., 2022)
2/14/2023 CVD Prevention 1 6
NCD – Fact sheet KSA
CVD in KSA
• Congenital Heart Disease: 5.4 per 1,000
live births per year
• Ventricular septal defect ranging from 29.5%
to 39.5%
• Peripheral arterial disease
• In one study by Sheikh et al, prevalence 11.7%
• In diabetic population, prevalence is 23.1%.
• CVA (Stroke):
• 50.04 deaths per 100,000 population per year
• The fourth leading cause of death, in the
kingdom
2/14/2023 CVD Prevention 1 8
Contd…
• In Saudi Arabia, published data about the
prevalence of Rheumatic Heart Disease are
limited. However, it is known that the
percentage of children with RHD in Saudi
Arabia is still higher than the global
rate .(Alqanatish et al,2019)
2/14/2023 CVD Prevention 1 9
Risk factors
Most cardiovascular diseases can be
prevented by addressing behavioral risk
factors such as
• tobacco use,
• unhealthy diet and obesity,
• physical inactivity and
• harmful use of alcohol using
2/14/2023 CVD Prevention 1 10
Metabolic risk factors
• Metabolic refers to the biochemical processes
involved in the body's normal functioning.
• Behaviors (modifiable risk factors) can lead to
metabolic/physiologic changes.
• WHO has prioritized the following four metabolic
risk factors:
• Raised blood pressure
• Raised total cholesterol
• Elevated glucose
• Overweight and obesity
2/14/2023 CVD Prevention 1 11
One of the targets is a 25% relative reduction in premature
mortality from NCDs by 2025.
Premature mortality is death before age of 70 years
2/14/2023 CVD Prevention 1 13
Risk factors for hypertension
Modifiable factors
1.Obesity: Central Obesity indicated
waist circumference (>102 cm in
men and >88 cm in women).
2. Increased Salt Intake- (> 5 gms
per day). Decreased potassium
intake
3.Saturated Fats/hyperlipidemia
4. Low dietary Fibres.
Non-modifiable factors
1.Age: BP rises with age.
2.Sex: hypertension is less prevalent
in females till menopause
3.Genetic Factors and family history:
Children of normotensive parents
chance of getting hypertensive
compared to if both parents are
hypertensive.
2/14/2023 CVD Prevention 1 14
Contd…
Modifiable
5. Alcohol: Increased intake increases BP.
6. Environmental stress , anxiety and
sympathetic over-activity increase heart rate and
BP.
7. Socio-economic Status: Low SES higher BP.
8.Others: Noise, Vibration
9. Some evidence indicate VIT-D deficiency
10. Some drugs like NSAIDS, cough medicine
• https://www.ucsfhealth.org/education/risk-
factors-for-high-blood-pressure-hypertension
Non-modifiable
4. Ethinicity- Black Americans
and Africans have higher BP
levels than whites.
2/14/2023 CVD Prevention 1 15
Contd…
• All CVDs risk factors overlap
• The risk factor for hypertension and coronary artery disease
are same like obesity, lack of physical activity,
• Other less well-established risk factors for various CVD
include:
• High serum Homocysteine levels
• Elevated serum C-reactive protein
• Infectious agents: as Chlamydia Pneumoniae, Herpesvirus,
Cytomegalovirus) in atheromatous lesions has been
demonstrated by immunocytochemistry, but no cause-and-effect
relationship has been established.
2/14/2023 CVD Prevention 1 16
Facts about hypertension
• An estimated 1.28 billion adults aged 30-79 years
worldwide have hypertension, most (two-thirds) living
in low- and middle-income countries
• An estimated 46% of adults with hypertension are
unaware that they have the condition.
• Less than half of adults (42%) with hypertension are
diagnosed and treated.
• Approximately 1 in 5 adults (21%) with hypertension
have it under control.
• Hypertension is a major cause of premature death
worldwide.
• One of the global targets for noncommunicable
diseases is to reduce the prevalence of hypertension
by 33% between 2010 and 2030.
• https://www.who.int/news-room/fact-
sheets/detail/hypertension
2/14/2023 CVD Prevention 1 17
SCREENING TESTS
2/14/2023 CVD Prevention 1 18
American Heart Association
classification of hypertension
2/14/2023 CVD Prevention 1 19
Management of risks
Reducing hypertension prevents heart attack, stroke, and kidney
damage, as well as other health problems.
Prevention
• Reducing salt intake (to less than 5g daily).
• Eating more fruit and vegetables.
• Being physically active on a regular basis.
• Avoiding use of tobacco.
• Reducing alcohol consumption.
• Limiting the intake of foods high in saturated fats.
• Eliminating/reducing trans fats in diet.
Management
Reducing and managing stress.
• Regularly checking blood pressure.
• Treating high blood pressure.
• Managing other medical conditions
2/14/2023 CVD Prevention 1 20
Risk factors for cerebrovascular
disease –KSA perspective
• Age: Being over the age of 55.
• High blood pressure (hypertension): The systolic pressure level
being 140 mmHg or higher, or diastolic pressure level being 90
mmHg or higher.
• High cholesterol: The blood cholesterol level being 200 mg/dL or
higher.
• Smoking
• Diabetes
• Obesity The BMI being 30 or more.
• Cardiovascular diseases, including heart failure, a heart defect,
heart inflammation or an irregular heartbeat.
• A previous stroke or a transient ischemic attack.
• Elevated levels of homocysteine, a type of amino acid.
• Using birth control pills or other forms of hormonal therapy.
2/14/2023 CVD Prevention 1 21
Contd…
• Other factors can also increase the risk of
a stroke. They include: Alcohol and drug
use.
• Even though stroke rates are equal among
women and men, women are more likely
than men to die from a stroke. People with
darker skin are more likely to have a
stroke than people of other ethnic groups.
2/14/2023 CVD Prevention 1 22
Risk factors for Rheumatic
Heart Disease RHD
• Young age <23 years
• Repeated episodes of Rheumatic Fever
• Non compliance with antibiotic therapy
• Crowded homes
• Low socioeconomic status
• Others at risk parents of young children,
teachers, physicians, nurses and allied health
personnel in contact with children, military
recruits, and others living in crowded
situations (eg, college dormitories).
2/14/2023 CVD Prevention 1 23
Risk Factors of Congenital Heart
Disease
• Congenital heart disease includes major structural
malformations of the heart and/or major vessels.
• Risk factors include
• First-cousin consanguinity : significantly associated with ventricular
septal defect (VSD), atrial septal defect (ASD), atrioventricular septal
defect (AVSD), pulmonary stenosis (PS), and pulmonary atresia (PA).
• Presence of congenital heart lesion in in a first degree relative
specially h/o maternal congenital heart disease
• Use of teratogenic drugs in the first trimester of pregnancy
(thalidomide)
• Maternal diabetes
2/14/2023 CVD Prevention 1 24
School based screening -MOH
It is a school-based health screening for
students for early detection of potential
health disorders or diseases.
The program includes
• the investigation of student medical record
history (especially for chronic diseases and
disabilities),
• completion of vaccinations,
• obesity early detection,
• Depression ADHD and other issues
2/14/2023 CVD Prevention 1 25
IPO approach to problem
solving
Programmatic approach or IPO (Input
Process Outcome approach )to problem
resolution has 5 steps
• Problem statement
• Input
• Process/ activity
• Output
• Outcome
• Impact
14/02/2023 Second CVD presentation 26
.
• Inputs: the raw materials that provide a basis for
programs. Inputs can include money, technical
expertise, relationships and personnel.
• Activities/ process: the actions that are designed to
meet a project’s objectives. Example activities include
hiring staff, purchasing equipment, constructing
prisons or other facilities, commissioning guidelines,
and providing other forms of technical assistance.
• Outputs: the tangible and intangible products that
result from project activities.
• Outcomes: the benefits that a project or intervention
is designed to deliver..
• Impacts: the higher level goals to which you hope your
project will contribute, such as increased access to
health for the poor or improvements in public safety.
14/02/2023 Second CVD presentation 27
EXAMPLE
14/02/2023 Second CVD presentation 28
• Problem statement: High burden of CVD in
women and low levels of compliance with
exercise.
• Input: Green areas covered and exclusive for
ladies. Open air gyms in these areas.
• Activities: talking to the incharge of municipality
(baldiah) about suitable space. Get investors,
involve M.O.H. , involve advertising companies for
promotion
• Outcome: Increased number of parks for ladies
only
• Output: Increase in exercise compliance with
more women exercising and walking
• Impact: decrease in CVD burden of society
Prevention (in next lecture)
• Evidence shows such interventions are
excellent economic investments because, if
provided early to patients, they can reduce the
need for more expensive treatment (Best buys)
REFERENCES:
• https://www.moh.gov.sa/en/Ministry/Pro
jects/HEC/Pages/default.aspx
• https://www.who.int/en/news-room/fact-
sheets/detail/cardiovascular-diseases-
(cvds)
• https://www.who.int/news-room/fact-
sheets/detail/salt-reduction
• https://www.moh.gov.sa/en/HealthAware
ness/EducationalContent/Diseases/NonC
ommunicable/Pages/010.aspx
2/14/2023 CVD Prevention 1 30
Thank you
2/14/2023 CVD Prevention 1 31

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CVD PREVENTION 1 2022-23.pptx

  • 1. Epidemiology, Risk Factors and Prevention of Cardiovascular Diseases in Saudi Arabia-1 By Dr. Ayesha Mallick Community Medicine Department, JU
  • 2. Taken from MOH website
  • 3. ILOS • 8.1 Describe the burden of cardiovascular diseases in terms of mortality and morbidity • 8.2 Explain the risk factors associated with occurrence of CHD, hypertension and atherosclerosis • 8.3 Explain the effect of life style modification on the prevention of atherosclerosis, CHD and hypertension. • 8.4 State the role of screening in the prevention of cardiovascular diseases. 2/14/2023 CVD Prevention 1 3
  • 4. Contd… • Describe the epidemiology, prevention, treatment and control of acute rheumatic fever and RHD. • Explain the role of genetic and environmental factors in the development of congenital heart disease. • Describe the role of school health program in the early detection and secondary prevention of congenital heart disease. 2/14/2023 CVD Prevention 1 4
  • 5. What are cardiovascular diseases? Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and they include: • coronary heart disease • cerebrovascular disease • peripheral arterial disease • rheumatic heart disease • congenital heart disease • deep vein thrombosis and pulmonary embolism 2/14/2023 CVD Prevention 1 5
  • 6. Epidemiology-global • CVDs are the number 1 cause of death globally • An estimated 17.9 million people died from CVDs in 2019 (32% of global death) • 85% death due to CVDs are due to heart attack and stroke. • Over three quarters of CVD deaths take place in low- and middle-income countries. • (W.H.O., 2022) 2/14/2023 CVD Prevention 1 6
  • 7. NCD – Fact sheet KSA
  • 8. CVD in KSA • Congenital Heart Disease: 5.4 per 1,000 live births per year • Ventricular septal defect ranging from 29.5% to 39.5% • Peripheral arterial disease • In one study by Sheikh et al, prevalence 11.7% • In diabetic population, prevalence is 23.1%. • CVA (Stroke): • 50.04 deaths per 100,000 population per year • The fourth leading cause of death, in the kingdom 2/14/2023 CVD Prevention 1 8
  • 9. Contd… • In Saudi Arabia, published data about the prevalence of Rheumatic Heart Disease are limited. However, it is known that the percentage of children with RHD in Saudi Arabia is still higher than the global rate .(Alqanatish et al,2019) 2/14/2023 CVD Prevention 1 9
  • 10. Risk factors Most cardiovascular diseases can be prevented by addressing behavioral risk factors such as • tobacco use, • unhealthy diet and obesity, • physical inactivity and • harmful use of alcohol using 2/14/2023 CVD Prevention 1 10
  • 11. Metabolic risk factors • Metabolic refers to the biochemical processes involved in the body's normal functioning. • Behaviors (modifiable risk factors) can lead to metabolic/physiologic changes. • WHO has prioritized the following four metabolic risk factors: • Raised blood pressure • Raised total cholesterol • Elevated glucose • Overweight and obesity 2/14/2023 CVD Prevention 1 11
  • 12. One of the targets is a 25% relative reduction in premature mortality from NCDs by 2025. Premature mortality is death before age of 70 years
  • 14. Risk factors for hypertension Modifiable factors 1.Obesity: Central Obesity indicated waist circumference (>102 cm in men and >88 cm in women). 2. Increased Salt Intake- (> 5 gms per day). Decreased potassium intake 3.Saturated Fats/hyperlipidemia 4. Low dietary Fibres. Non-modifiable factors 1.Age: BP rises with age. 2.Sex: hypertension is less prevalent in females till menopause 3.Genetic Factors and family history: Children of normotensive parents chance of getting hypertensive compared to if both parents are hypertensive. 2/14/2023 CVD Prevention 1 14
  • 15. Contd… Modifiable 5. Alcohol: Increased intake increases BP. 6. Environmental stress , anxiety and sympathetic over-activity increase heart rate and BP. 7. Socio-economic Status: Low SES higher BP. 8.Others: Noise, Vibration 9. Some evidence indicate VIT-D deficiency 10. Some drugs like NSAIDS, cough medicine • https://www.ucsfhealth.org/education/risk- factors-for-high-blood-pressure-hypertension Non-modifiable 4. Ethinicity- Black Americans and Africans have higher BP levels than whites. 2/14/2023 CVD Prevention 1 15
  • 16. Contd… • All CVDs risk factors overlap • The risk factor for hypertension and coronary artery disease are same like obesity, lack of physical activity, • Other less well-established risk factors for various CVD include: • High serum Homocysteine levels • Elevated serum C-reactive protein • Infectious agents: as Chlamydia Pneumoniae, Herpesvirus, Cytomegalovirus) in atheromatous lesions has been demonstrated by immunocytochemistry, but no cause-and-effect relationship has been established. 2/14/2023 CVD Prevention 1 16
  • 17. Facts about hypertension • An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries • An estimated 46% of adults with hypertension are unaware that they have the condition. • Less than half of adults (42%) with hypertension are diagnosed and treated. • Approximately 1 in 5 adults (21%) with hypertension have it under control. • Hypertension is a major cause of premature death worldwide. • One of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030. • https://www.who.int/news-room/fact- sheets/detail/hypertension 2/14/2023 CVD Prevention 1 17
  • 18. SCREENING TESTS 2/14/2023 CVD Prevention 1 18
  • 19. American Heart Association classification of hypertension 2/14/2023 CVD Prevention 1 19
  • 20. Management of risks Reducing hypertension prevents heart attack, stroke, and kidney damage, as well as other health problems. Prevention • Reducing salt intake (to less than 5g daily). • Eating more fruit and vegetables. • Being physically active on a regular basis. • Avoiding use of tobacco. • Reducing alcohol consumption. • Limiting the intake of foods high in saturated fats. • Eliminating/reducing trans fats in diet. Management Reducing and managing stress. • Regularly checking blood pressure. • Treating high blood pressure. • Managing other medical conditions 2/14/2023 CVD Prevention 1 20
  • 21. Risk factors for cerebrovascular disease –KSA perspective • Age: Being over the age of 55. • High blood pressure (hypertension): The systolic pressure level being 140 mmHg or higher, or diastolic pressure level being 90 mmHg or higher. • High cholesterol: The blood cholesterol level being 200 mg/dL or higher. • Smoking • Diabetes • Obesity The BMI being 30 or more. • Cardiovascular diseases, including heart failure, a heart defect, heart inflammation or an irregular heartbeat. • A previous stroke or a transient ischemic attack. • Elevated levels of homocysteine, a type of amino acid. • Using birth control pills or other forms of hormonal therapy. 2/14/2023 CVD Prevention 1 21
  • 22. Contd… • Other factors can also increase the risk of a stroke. They include: Alcohol and drug use. • Even though stroke rates are equal among women and men, women are more likely than men to die from a stroke. People with darker skin are more likely to have a stroke than people of other ethnic groups. 2/14/2023 CVD Prevention 1 22
  • 23. Risk factors for Rheumatic Heart Disease RHD • Young age <23 years • Repeated episodes of Rheumatic Fever • Non compliance with antibiotic therapy • Crowded homes • Low socioeconomic status • Others at risk parents of young children, teachers, physicians, nurses and allied health personnel in contact with children, military recruits, and others living in crowded situations (eg, college dormitories). 2/14/2023 CVD Prevention 1 23
  • 24. Risk Factors of Congenital Heart Disease • Congenital heart disease includes major structural malformations of the heart and/or major vessels. • Risk factors include • First-cousin consanguinity : significantly associated with ventricular septal defect (VSD), atrial septal defect (ASD), atrioventricular septal defect (AVSD), pulmonary stenosis (PS), and pulmonary atresia (PA). • Presence of congenital heart lesion in in a first degree relative specially h/o maternal congenital heart disease • Use of teratogenic drugs in the first trimester of pregnancy (thalidomide) • Maternal diabetes 2/14/2023 CVD Prevention 1 24
  • 25. School based screening -MOH It is a school-based health screening for students for early detection of potential health disorders or diseases. The program includes • the investigation of student medical record history (especially for chronic diseases and disabilities), • completion of vaccinations, • obesity early detection, • Depression ADHD and other issues 2/14/2023 CVD Prevention 1 25
  • 26. IPO approach to problem solving Programmatic approach or IPO (Input Process Outcome approach )to problem resolution has 5 steps • Problem statement • Input • Process/ activity • Output • Outcome • Impact 14/02/2023 Second CVD presentation 26
  • 27. . • Inputs: the raw materials that provide a basis for programs. Inputs can include money, technical expertise, relationships and personnel. • Activities/ process: the actions that are designed to meet a project’s objectives. Example activities include hiring staff, purchasing equipment, constructing prisons or other facilities, commissioning guidelines, and providing other forms of technical assistance. • Outputs: the tangible and intangible products that result from project activities. • Outcomes: the benefits that a project or intervention is designed to deliver.. • Impacts: the higher level goals to which you hope your project will contribute, such as increased access to health for the poor or improvements in public safety. 14/02/2023 Second CVD presentation 27
  • 28. EXAMPLE 14/02/2023 Second CVD presentation 28 • Problem statement: High burden of CVD in women and low levels of compliance with exercise. • Input: Green areas covered and exclusive for ladies. Open air gyms in these areas. • Activities: talking to the incharge of municipality (baldiah) about suitable space. Get investors, involve M.O.H. , involve advertising companies for promotion • Outcome: Increased number of parks for ladies only • Output: Increase in exercise compliance with more women exercising and walking • Impact: decrease in CVD burden of society
  • 29. Prevention (in next lecture) • Evidence shows such interventions are excellent economic investments because, if provided early to patients, they can reduce the need for more expensive treatment (Best buys)
  • 30. REFERENCES: • https://www.moh.gov.sa/en/Ministry/Pro jects/HEC/Pages/default.aspx • https://www.who.int/en/news-room/fact- sheets/detail/cardiovascular-diseases- (cvds) • https://www.who.int/news-room/fact- sheets/detail/salt-reduction • https://www.moh.gov.sa/en/HealthAware ness/EducationalContent/Diseases/NonC ommunicable/Pages/010.aspx 2/14/2023 CVD Prevention 1 30
  • 31. Thank you 2/14/2023 CVD Prevention 1 31

Editor's Notes

  1. 2012 WHO global targets: reducing risk factors