The document provides an overview of ischemic heart disease (IHD), the leading cause of death globally. It discusses IHD in detail, including its symptoms, risk factors, global and national burden, economic costs, and approaches for prevention and control. Key points are: IHD accounts for over 9 million deaths annually worldwide; prevalence is highest in Eastern Europe but increasing in Western countries; Nepal faces a growing IHD burden responsible for 16.4% of deaths; and prevention relies on controlling major risk factors like smoking, diet, activity levels, and treating conditions like diabetes and hypertension.

1. Prepared by: Pratikshya Kisiju MPH 1st Sem, 2021
Pokhara University
1
6/01/2021

2. Outline
 Introduction to NCDs
 List of the major NCDs of 21st Century
 ISCHEMIC HEART DISEASE
 Introduction
 Problem Statement
 Risk Factors
 Prevention/Control
 Major policies/programs at Global & National Level
NCDs : Non Communicable
Diseases
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3. What are NCDs?
- Impairment of bodily structure or functions that necessitates a
modification of the patients normal life and has persisted over
extended life period of time.
- EURO Symposium, 1997
Key Features:
- Non-infectious
- No known causative agent; Result of multiple factors
- Have a long latent period between exposure & outcome
- Leave residual disability
- Requires a long term systemic approach to treatment
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4. Rationale
 Accounts for almost 70% of all deaths worldwide.
 The LMICs share of NCDs:
o Almost three quarters of all NCD deaths
o 82% of the 16 million worldwide premature deaths occur in
LMIC
 Nepal, facing the double burden of disease; most recent data
suggests NCDs account for 60% of all deaths & 80% of
Outpatient care.
COPD-43%; CVD-40%; Diabetes Mellitus-12% & Cancer 5%
 Devastating health consequences for individuals, families &
communities
 High Socioeconomic costs associated with NCDs
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5. List of Emerging Non-Communicable Diseases
• Cardiovascular diseases
- Ischemic Heart Disease
- Stroke
- Rheumatic Heart Disease
• Diabetes
• Cancer
- Lung
- Breast
- Stomach
• Chronic Respiratory Diseases
- Asthma
- COPD
- Occupational Lung disease
• Mental & Behavioral Disorders
- Alzheimer’s , Depression &
- Other dementias
• Musculo-skeletal & Connective
tissue diseases
• Nervous system Disorders
• Endocrine, Nutritional & Metabolic
Disorders
• Chronic Kidney Disease
• Cataract & Blindness
• Hearing Impairment
• Oral Health Problems
• Genetic and Autoimmune disorders
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6. 6

7. Group of disorders of the heart &
blood vessels.
• Coronary Heart Disease – disease of
the blood vessels supplying the heart
muscle.
• Stroke/Cerebrovascular Disease –
disease of the blood vessels supplying
the brain.
Cardiovascular Diseases(CVDs)
•Peripheral Arterial Disease – disease of
blood vessels supplying the arms & legs.
•Rheumatic Heart Disease – damage to
the heart muscle & heart valves from
rheumatic fever, caused by streptococci.
•Congenital Heart Disease –
malformations of heart structure existing
at birth.
•Deep Vein Thrombosis & Pulmonary
Embolism – blood clots in the leg veins,
can dislodge & move to the heart and lungs.
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8. Silent Epidemic of CVDs
• Most common NCD, over 17.8 million CVD deaths globally; of which
more than three quarters are in LMICs.
• In the SEAR, CVDs estimated to cause almost 44% of all the NCD-
related deaths nearly 8.6 million; with almost half of them occurring in
economically productive years 30-69 yrs.
• From 1990 to 2019,
 Prevalence of CVDs nearly doubled from 271 million to 523 million
 CVD deaths steadily increased from 12.1 million, reaching 18.6 million
 Global trends for DALYs & YLL also increased significantly, & years lived with
disability doubled from 17.7 million to 34.4 million. 1
1 - Roth, G.A. et al. Global Burden of CVD and Risk Factors, 1990-2019
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9. Roth, G.A. et al. Global Burden of CVD and Risk Factors, 1990-2019
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10. Ischemic Heart Disease: ‘The leading cause
of death globally since two decades’
• Ischemia - inadequate blood supply (circulation) to a local area
due to blockage of the blood vessels supplying the area.
• Ischemic Heart Disease/IHD: heart problems caused by narrowed
heart (coronary) arteries that supply blood to the heart muscle.
• Narrowing by a blood clot or by constriction of the blood vessel,
most often caused by buildup of plaque, called atherosclerosis.
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11. Major Symptoms
• Chest Pain
• Pain in neck or jaw
• Shoulder or arm pain
• Arrythmia
• Nausea with or without vomiting
• Tachypnea or Dyspnea
• Clammy Skin
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12. • Hypertension
• Increased
Blood
Cholesterol
• Obesity
>70% of at-risk
individuals have
multiple risk
factors for IHD,
& only 2 - 7%
have no risk
factors.
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13. Problem Statement
o 126 million prevalent cases of IHD in 2017. 2
o 197 million prevalent cases of IHD in 2019. 1
o Retained the position of ‘leading of cause
of death’ since more than 2 decades.
o Around 9 million IHD death in 2017 2
o 9.14 million IHD deaths in the year 2019.1
o Since 1990-2019, DALYs due
to IHD rose steadily,
reaching 182 million.1
1 - Roth, G.A. et al. Global Burden of CVD and Risk Factors, 1990-2019
2 - Khan, M.A. et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease, 2017
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14. o Highest IHD
Prevalence in eastern
& central Europe
o Several Eastern
European countries
moved up the ranks of
highest prevalence.
o Western Europe
continues increasing
IHD prevalence,
substantially higher
than SEAR & the rest
of the world.
o High-income countries
like the UK, Finland
moved down the
ranks.
2- Khan, M. A. et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study,2017
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15. Burden of IHD in Nepal
oIn Nepal, CVD = 26·9% of total deaths & 12·8% of total DALYS, 2017
oIncidence of CVD for Nepal
• lower than the global rate; higher than rates in South Asia, while
• the death rate higher than the global rate, yet lower than South Asia.
oIHD, the predominant CVD = 16·4% to total deaths & 7·5% to total DALYs.
• 5% IHD prevalence reported in a study conducted in six hospitals of
Kathmandu in 2003, &
• 5.7% IHD prevalence in a population-based study in eastern Nepal in 2009
NCD STEPs Survey 2019- Key Findings
o1.1 % adults 15-69 yrs (1.4% women; 0.8% men) & 1.7% 40-69 yrs adults reported
ever having heart attack or chest pain from CAD or Stroke
oPredicted 10 yr CVD risk:
3.3 % adults 40-69 yrs have a predicted 30% or more chance of having a fatal or
non fatal major CVD, in the next 10 years based on WHO /ISH risk prediction
charts.
3- Bhattarai S. et al. Cardiovascular disease trends in Nepal – An analysis of global burden of disease data 2017.
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16. Percentage of total deaths and DALYs due to CVDs by gender in Nepal
(all ages, 2017)
Percentage of total deaths Percentage of total DALYs
Both Male Female Both Male Female
Ischemic heart
disease 16.4 20.5 11.1 7.6 10.3 4.5
o Burden of IHD in terms of DALYs, YLDs and YLLs in Nepal 2017 -
- higher among older age groups &
- higher in males compared to females
3- Bhattarai, S. et al. Cardiovascular disease trends in Nepal – An analysis of global burden of disease data 2017.
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17. Economic Burden of CVD/IHD
• In LMICs, both the direct cost of annual care & the cost
for seeking care for an acute episode of CVD exceeds
the per capita health expenditure.
• Estimated costs per episode for IHD: between $500 and
$1500.
• Estimated monthly cost for hypertension treatment:
around $22.
• Majority of Nepali popn can’t afford the exorbitant cost
of managing CVDs as 52% of total health care
expenditure is out-of-pocket.
• Investment on CVD management - Only 8.9% of the total
health care expenditures (both government &private)
3- Bhattarai S. et al. Cardiovascular disease trends in Nepal – An analysis of global burden of disease data 2017, 2020
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18. Risk factors contributing to DALYs for Specific CVD disease in Nepal
(all ages 2017)
3- Bhattarai S. et al. Cardiovascular disease trends in Nepal – An analysis of global burden of disease data 2017.
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19. Prevention/Control of IHD
Legislation & regulation for the effective implementation of WHO
FCTC
Taxation on junk food and insurance for NCD patients.
Re-orient health services for mobilizing existing health network
for NCD at various levels
Establish surveillance system of NCDs and their risk factors
Incorporate major NCDs & their risk factors in HMIS reporting
formats
Build capacity for developing & organizing standard curricula for
in service training of health workers, for specialists and super
specialists for secondary and tertiary care and for ancillary
paramedics about NCDs and their major risk factors
Advocacy, communication & community mobilization for the
inclusion of NCD in School Curricula, development &
dissemination of NCD messages in current NHEICC activities &
NCD interaction program in social institutions and secondary &
tertiary care hospitals of both public and private sectors
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20. Prevention/Control of IHD
Primary Prevention (Controlling major CVD risk factors)
• Smoking and alcohol Cessation
• Dietary Changes
• Physical Activity and weight control
• Promoting Mental wellbeing
• Effectively treating medical conditions such as type 2
diabetes and high blood pressure
• Maintaining healthy blood cholesterol levels
• Being aware of risk factors
• Focusing on primary prevention tackling the social
determinants of health as well as policy & individual
interventions for risk factor control, supported by use of
technology.
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21. Prevention/Control of IHD
Secondary Prevention (Early Diagnosis and Treatment)
• Access to early diagnostic services
• Ensuring Quality of care
• Evidence based drug therapy
• Treatment of Hypertension and Dyslipidemia
• Surgical Revascularization
• Exercise based cardiac rehabilitation
• Greater availability, access & affordability for acute
coronary syndrome management
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22. Global/National Actions to fight CVDs
 Global Strategy for the Prevention and Control of Non-Communicable
Diseases (2000)
 WHO Framework Convention on Tobacco Control (2003): Multisectoral
Action Plan on the Prevention and Control of NCD in Nepal 2014-2020
 Global Strategy on Diet, Physical Activity and Health (2004)
 Resolution WHA60.23 on Prevention and control of Non-Communicable
Diseases: Implementation of the Global Strategy (2007)
 2008-2013 Action Plan for the Global Strategy for the Prevention and
Control of Non communicable Diseases (2008)
 Global Strategy to Reduce the Harmful Use of Alcohol in 2010 (WHA63.13)
 Global action plan, including indicators and voluntary targets, through
resolution WHA66.10
 Action Plan for the prevention and control of NCDs in South-east Asia, 2013-
2020 (2013)
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23. References
1. Roth, G.A. et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–
2019. Journal of the American College of Cardiology. 9 December 2020.
2. Khan, M.A. et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global
Burden of Disease Study, 2017
3. Bhattarai, S. et al. Cardiovascular disease trends in Nepal – An analysis of global burden of
disease data 2017. Int J Cardiol Heart Vasc. 2020 Oct; 30
4. NHRC, Noncommunicable Disease Risk Factors: STEPS Survey Nepal, 2019
5. Schlabach A, Guragain B, Marx B, et al. Non-communicable disease risk factors and
prevalence within Thaha, Makwanpur, Nepal: a cross-sectional study. Journal of Global
Health Reports. 2021
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