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RISK FACTORS OF CARDIOVASCULAR
DISEASES
DR. Vaibhav Gupta
MPH 2nd
year
Dept. of community
medicine
JSSMC
07/09/2013
MODERA...
2
Introduction
CHD (IHD) is a group of closely related syndromes
resulting from myocardial ischemia – an imbalance
between t...
Pál Kertai:“Cardiovascular disease has the same meaning
for health care today as the epidemics of centuries had for
medici...
Problem statement
World:
• In today's world , most deaths are attributable to non
communicable diseases 35million and just...
Cont.......
Fact sheet on CVDs
• An estimated 17.3 million people died from CVDs in
2008.
• Over 80% of CVD deaths take pl...
Cont..
India:
 29.8million patients with cardiovascular disease
2003.An estimated 1.5million people die of CVD
every year...
International variations
 CHD is now considered as our “Modern Epidemic”. Not an
unavoidable consequence of aging.
 Epid...
Mortality and morbidity due to CHD,
global estimates for 2004
9
CHD IN INDIA
There is a steep increase in prevalence of IHD in urban areas in
India (considerable increase in the last dec...
CHD in the United States
• CHD is the single largest killer of men and women
• 13.9 million have history of MI and angina
...
Cont...
• AHA. 1998 Heart and Stroke Statistical Update;
1997.
• National Center for Health Statistics.
• National Health ...
World Health Day Theme
• 27 March 2013 -- The theme for this year's, 7 April, is
hypertension. Also known as high or raise...
Gaps In Natural History
• There are many gaps in our Knowledge about the the
natural history of chronic diseases. These ga...
cont,...
2. Multifactorial causation: Most chronic diseases are
the result of multiple causes –one –to- one cause –
effect...
Cont..
3. Long latent period : chronic diseases is the long
latent period the first exposure to “suspected cause”
and the ...
Non Communicable Disease Risks Factors
• Six key of risks factors
1. Cigarette use and other form of smoking.
2. Alcohol a...
Cardiovascular disease (CVD)
• Cardio- = The Heart
• Vascular= Blood Vessels
• Cardiovascular diseases = disease of The He...
Cardiovascular Disease
Cardiovascular diseases (CVD) comprise of group of disease of
the heart and the vascular system.
Th...
MEASURING THE BURDEN OF THE DISEASE
1. Proportional mortality ratio
2. Loss of life expectancy
3. CHD incidence rate
4. Ag...
Major Risks Factors of CVD
• Tobacco use
• Inappropriate diet
• Physical inactivity
• 75- 85% new cases of coronary health...
CHD can manifest itself in any of the following ways
Angina Pectoris
Myocardial Infarction  Heart Attack
Irregularities...
Age specific Prevalence Rates
AGE
GROUP
Urban (PR/1000) Rural(PR/1000)
M F M F
20-24 8 6 17 10
25-29 19 26 13 15
30-34 17 ...
CHD RISK FACTORES
24
Modifiable
o Cigarette smoking
o High blood pressure
o Elevated serum
cholesterol
o Diabetes
o Obesity
o Sedentary Habits
...
Non Modifiable
1.Age
• Aging strongly associated with atherosclerosis due to:
– Cumulative exposure to risk factors
– Dege...
2.Gender
• Gender difference in age of coronary heart
disease onset has been attributed to:
– A protective effect of estro...
3.Family History
• Family history of early coronary heart disease in one’s
immediate family members is an independent risk...
Modifiable
1.SMOKING
• Mechanism by which cigarette smoking
contribute to CHD are Carbon monoxide induced
atherogenesis
 ...
30
2.Blood Pressure
• For people over 50 years of age, a high systolic blood
pressure is more predictive of coronary heart di...
2.Diabetes
• High blood glucose can attach (glycate) to proteins
forming glycoprotein
– These proteins can damage blood ve...
3.Obesity
• Overweight = BMI 25.0-29.9
• Obese = BMI ≥ 30
• Recommended BMI = 18.5 – 24.9
33
Others Risks Factors
1. Genetic Factors
2. Physical activity
3. Hormones
4. Type A personality
5. Alcohol
6. Oral contrace...
Cardiovascular Prevention
 Primordial: Social, legal and other (often
nonmedical) activities which may lead to a
lowering...
Cont...
• Primary: Controlling risk factors contributing to
CVD (health education programs, anti-smoking
campaign, sports ...
Cont……….
 Secondary: Screening and treatment of symptomatic
patients, set up personal risk profile
 Tertiary: Cardiovasc...
PREVENTION OF CHD
The WHO expert committee has recommended the
following strategy :
I. Population strategy
 Prevention in...
POPULATION STRATEGY
• Control of underlying causes (risk factors) in whole
population.
• Strategy based on mass approach
•...
Specific interventions
1.Dietary Changes
 Low saturated and trans fat (as low as possible below 10%
of calories).
 Dieta...
• Intake of less than 2 gm sodium (5 gm salt)/day.
• 0.4 mg of late (diet and/or supplement)
• B12, B6 from diet or multiv...
2.Smoking
• As far as CHD is concerned, present evidence does
not support promotion of the so- called “safer
cigarette”.
•...
3.Blood Pressure
• Involves a multifactorial approach based on:
• Prudent diet
• Regular physical activity
• Weight contro...
Prudent diet
• Fat intake to limited to 15 to 30 percent of total cal.
• Saturated fat to limited to 10%
• Carbohydrate ri...
3.Weight Control
• Obesity is the major risk for NIDDM and therefore CHD.
• On average, 1/2 to 1mm decrease in blood press...
Health Benefits of Weight Loss
• Decreased cardiovascular risk
• Decreased glucose and insulin levels
• Decreased blood pr...
Whenever possible, weight loss therapy should
employ the combination of
• Low-calorie/low-fat diets
• Increased physical a...
4.Physical Activity
• Helps prevent obesity and required for long term
weight control
• Raises HDL- and lowers LDL-cholest...
cont..
• Unfit men who become fit may reduce cardiovascular
disease mortality by 52% compared to those who remain
unfit.
•...
HIGH RISK STRATEGY
I. Identifying risk
– Detection by screening tests
– Individuals include those who smoke, with a
strong...
• Cont…
(ii) Specific advice
– Prevention and motivation to approach positively
against all identified risk factors.
Eg: T...
SECONDARY PREVENTION
• AIM : To prevent the recurrence and
progression of CHD.
Eg:
Coronary surgery
Use of Pacemakers
52
RISKS FACTORS INTERVENTION TRIALS
1) The North Kerelia Project (1972-) Finland
2) The Stanford -Three – Community Study (1...
Secondary prevention trials
• At preventing a subsequent coronary attack or
sudden death. A wide range of clinical trial h...
55
Women Making a Change
Wish you all a healthy heart
THANK YOU ; )
58
Risk factors of cardiovascular
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Risk factors of cardiovascular

  1. 1. RISK FACTORS OF CARDIOVASCULAR DISEASES DR. Vaibhav Gupta MPH 2nd year Dept. of community medicine JSSMC 07/09/2013 MODERATOR: DR. N.C ASHOK 1
  2. 2. 2
  3. 3. Introduction CHD (IHD) is a group of closely related syndromes resulting from myocardial ischemia – an imbalance between the supply or perfusion and demand of heart for oxygenated blood. Definition: “ Impairment of heart function due to inadequate blood flow to the heart compared to its needs, caused by obstructive change in the coronary circulation to the heart”. • 25- 30% deaths in most industrialized countries. 3
  4. 4. Pál Kertai:“Cardiovascular disease has the same meaning for health care today as the epidemics of centuries had for medicine in earlier times: 50% of the population in developed countries die of cardiovascular disease” British Heart Foundation:“Someone has a heart attack every two minutes” 4
  5. 5. Problem statement World: • In today's world , most deaths are attributable to non communicable diseases 35million and just over half of these 17 million are as a result of CVD. • more then one third of these deaths occur in middle-aged adults. • Developed countries heart disease and stroke are the second leading cause of death for adults men & women . 5
  6. 6. Cont....... Fact sheet on CVDs • An estimated 17.3 million people died from CVDs in 2008. • Over 80% of CVD deaths take place in low- and middle-income countries. • By 2030 more than 23 million people will die annually from CVDs 6
  7. 7. Cont.. India:  29.8million patients with cardiovascular disease 2003.An estimated 1.5million people die of CVD every year.  The burden of common CVD are, about 0.93 million stroke cases every year. 7
  8. 8. International variations  CHD is now considered as our “Modern Epidemic”. Not an unavoidable consequence of aging.  Epidemics of CHD began at different times in different countries. Developed countries were the first to be affected  At present, CHD is decreasing in many developed countries, but is increasing in developing and transitional countries, partly as a result of increased longevity, urbanization and lifestyle changes  Highest mortality is found in European countries followed by SEAR countries. 8
  9. 9. Mortality and morbidity due to CHD, global estimates for 2004 9
  10. 10. CHD IN INDIA There is a steep increase in prevalence of IHD in urban areas in India (considerable increase in the last decade). Although there is an increased prevalence in the rural areas, the lifestyle changes have affected people more in urban areas than that in rural areas. Expected to be the single most important cause of death in India by 2015. Prevalence in URBAN -6.4%/1000, RURAL-2.5%/1000 Death rate in URBAN-0.8%/1000, RURAL-0.4% /1000 10
  11. 11. CHD in the United States • CHD is the single largest killer of men and women • 13.9 million have history of MI and angina • Each year 1.1 million people have MI MI- 3,70,000 die & 2,50,000 die within 1 hr • By age 60, every 5th man and 17th woman develops CHD • 1998 estimated direct and indirect costs of heart disease are $95.6 billion • 53.3 million adults have elevated LDL-C and warrant intervention (1994 NHANES data) 22.3 million qualify for drug therapy, 5.5 million receive therapy 11
  12. 12. Cont... • AHA. 1998 Heart and Stroke Statistical Update; 1997. • National Center for Health Statistics. • National Health and Nutrition Examination Survey (III); 1994. (Data collected 1991-1994.) 12
  13. 13. World Health Day Theme • 27 March 2013 -- The theme for this year's, 7 April, is hypertension. Also known as high or raised blood pressure, hypertension increases the risk of heart attacks, strokes and kidney failure. Uncontrolled hypertension can also cause blindness, irregularities of the heartbeat and heart failure. However, high blood pressure is preventable and treatable. Early detection is key: all adults should know their blood pressure. 13
  14. 14. Gaps In Natural History • There are many gaps in our Knowledge about the the natural history of chronic diseases. These gaps cause difficulties in aetiological investigation and research. Theses are- 1. Absence of a know agent: some of chronic disease the cause is known silica in silicosis. For many chronic disease the causative agent is not known. The absence of known agent makes both diagnosis & specific prevention difficult. 14
  15. 15. cont,... 2. Multifactorial causation: Most chronic diseases are the result of multiple causes –one –to- one cause – effect relationship. The concept of disease “agent”& stress multiplicity of interactions between host & environment. 15
  16. 16. Cont.. 3. Long latent period : chronic diseases is the long latent period the first exposure to “suspected cause” and the eventual development of disease (cervical cancer) 4 Indefinite onset: Most chronic disease are slow in onset and development and may be difficult to establish.(diabetes and hypertension) 16
  17. 17. Non Communicable Disease Risks Factors • Six key of risks factors 1. Cigarette use and other form of smoking. 2. Alcohol abuse 3. Failure or inability to obtain preventive health services.(hypertension control, cancer detection, management of diabetes) 4. Life- style changes( dietary patterns, physical activity) 5. Environmental risks factors ( occupation hazards, air and water pollution and possession of destructive weapons in case of injuries) 6. Stress factors 17
  18. 18. Cardiovascular disease (CVD) • Cardio- = The Heart • Vascular= Blood Vessels • Cardiovascular diseases = disease of The Heart + Blood vessels 18
  19. 19. Cardiovascular Disease Cardiovascular diseases (CVD) comprise of group of disease of the heart and the vascular system. The major conditions are:  Ischemic heart disease  Hypertension  Cerebrovascular disease (stroke)  Congenital heart disease  Rheumatic heart disease 19
  20. 20. MEASURING THE BURDEN OF THE DISEASE 1. Proportional mortality ratio 2. Loss of life expectancy 3. CHD incidence rate 4. Age specific death rates 5. Prevalence rate 6. Case Fatality rates 7. Measuring the risk factors levels 8. Medical care 20
  21. 21. Major Risks Factors of CVD • Tobacco use • Inappropriate diet • Physical inactivity • 75- 85% new cases of coronary health disease 21
  22. 22. CHD can manifest itself in any of the following ways Angina Pectoris Myocardial Infarction Heart Attack Irregularities of the Heart Cardiac failure Sudden Death 22
  23. 23. Age specific Prevalence Rates AGE GROUP Urban (PR/1000) Rural(PR/1000) M F M F 20-24 8 6 17 10 25-29 19 26 13 15 30-34 17 22 12 10 35-39 43 48 18 15 40-44 47 65 17 23 45-49 83 105 20 38 50-54 93 112 30 50 55-59 162 152 26 50 60+ 174 175 70 67 23
  24. 24. CHD RISK FACTORES 24
  25. 25. Modifiable o Cigarette smoking o High blood pressure o Elevated serum cholesterol o Diabetes o Obesity o Sedentary Habits o Stress Non Modifiable o Age o Sex o Family history o Genetic Factors o Personality 25
  26. 26. Non Modifiable 1.Age • Aging strongly associated with atherosclerosis due to: – Cumulative exposure to risk factors – Degeneration of blood vessels with age • Aging becomes a significant risk factor for: – Men at age 45 or older, – Women at age 55 or older as they reach menopause 26
  27. 27. 2.Gender • Gender difference in age of coronary heart disease onset has been attributed to: – A protective effect of estrogen in women – Men also tend to have other possible risk factors: • Higher homocysteine levels • Higher risk of iron overload • Ultimately, coronary heart disease kills as many women as men 27
  28. 28. 3.Family History • Family history of early coronary heart disease in one’s immediate family members is an independent risk factor, independent of other risk factors 28
  29. 29. Modifiable 1.SMOKING • Mechanism by which cigarette smoking contribute to CHD are Carbon monoxide induced atherogenesis  Nicotinic stimulation of adrenergic drive  Lipid metabolism with fall in protective high density lipoproteins 29
  30. 30. 30
  31. 31. 2.Blood Pressure • For people over 50 years of age, a high systolic blood pressure is more predictive of coronary heart disease risk than diastolic blood pressure • High blood pressure is ≥140/ ≥90 mm Hg 31
  32. 32. 2.Diabetes • High blood glucose can attach (glycate) to proteins forming glycoprotein – These proteins can damage blood vessels and worsen atherosclerosis • Other effects of diabetes promote blood clot formation 32
  33. 33. 3.Obesity • Overweight = BMI 25.0-29.9 • Obese = BMI ≥ 30 • Recommended BMI = 18.5 – 24.9 33
  34. 34. Others Risks Factors 1. Genetic Factors 2. Physical activity 3. Hormones 4. Type A personality 5. Alcohol 6. Oral contraceptives 7. Miscellaneous 34
  35. 35. Cardiovascular Prevention  Primordial: Social, legal and other (often nonmedical) activities which may lead to a lowering of risk factors (e.g., socioeconomic development, smoke-free restaurants)  A novel approach to primary prevention of CHD is primordial prevention. Its involves preventing the emergence and spread of CHD risk factors and life styles that have not appeared or become endemic 35
  36. 36. Cont... • Primary: Controlling risk factors contributing to CVD (health education programs, anti-smoking campaign, sports programs, nutrition counselling, regular check of blood pressure and certain blood parameters, e.g., cholesterol, blood lipids, glucose) 36
  37. 37. Cont……….  Secondary: Screening and treatment of symptomatic patients, set up personal risk profile  Tertiary: Cardiovascular rehabilitation, prevention of recurrence of CVD (new heart attack: 5-7 times higher risk among CVD patients) 37
  38. 38. PREVENTION OF CHD The WHO expert committee has recommended the following strategy : I. Population strategy  Prevention in whole populations  Primordial prevention in whole population II. High risk strategy III. Secondary prevention 38
  39. 39. POPULATION STRATEGY • Control of underlying causes (risk factors) in whole population. • Strategy based on mass approach • Approach based on the principle that small changes in risk factor level in total population can achieve the biggest reduction in mortality. 39
  40. 40. Specific interventions 1.Dietary Changes  Low saturated and trans fat (as low as possible below 10% of calories).  Dietary cholesterol to below 100 mg/1000kcal/day  At least 5 fruits and vegetables/day 40
  41. 41. • Intake of less than 2 gm sodium (5 gm salt)/day. • 0.4 mg of late (diet and/or supplement) • B12, B6 from diet or multivitamin • At least 1000 mg of calcium/day and the RDA for magnesium 41
  42. 42. 2.Smoking • As far as CHD is concerned, present evidence does not support promotion of the so- called “safer cigarette”. • The goal should be to achieve a smoke- free society an several countries are progressing towards this goal. 42
  43. 43. 3.Blood Pressure • Involves a multifactorial approach based on: • Prudent diet • Regular physical activity • Weight control 43
  44. 44. Prudent diet • Fat intake to limited to 15 to 30 percent of total cal. • Saturated fat to limited to 10% • Carbohydrate rich in fiber to be consumed • Alcohol to be restricted • Salt intake to less than 5gms • Proteins to be 10 to 15 percent of total cal • Junk food to be avoided. 44
  45. 45. 3.Weight Control • Obesity is the major risk for NIDDM and therefore CHD. • On average, 1/2 to 1mm decrease in blood pressure for each pound weight loss in obese hypertensive's. • Weight reduction can raise HDL-cholesterol 45
  46. 46. Health Benefits of Weight Loss • Decreased cardiovascular risk • Decreased glucose and insulin levels • Decreased blood pressure • Decreased LDL and triglycerides, increased HDL • Reduced symptoms of degenerative joint disease • Improved gynecological conditions 46
  47. 47. Whenever possible, weight loss therapy should employ the combination of • Low-calorie/low-fat diets • Increased physical activity • Behavior modification Weight Loss Therapy 47
  48. 48. 4.Physical Activity • Helps prevent obesity and required for long term weight control • Raises HDL- and lowers LDL-cholesterol • Reduces blood pressure up to 10/8 mm Hg in hypertensive patients (moderate activity >30 minutes most days) 48
  49. 49. cont.. • Unfit men who become fit may reduce cardiovascular disease mortality by 52% compared to those who remain unfit. • Recommendation is for 30 minutes of moderate activity most days 49
  50. 50. HIGH RISK STRATEGY I. Identifying risk – Detection by screening tests – Individuals include those who smoke, with a strong family history of CHD, diabetes, obesity and young women using oral contraceptives. 50
  51. 51. • Cont… (ii) Specific advice – Prevention and motivation to approach positively against all identified risk factors. Eg: Treatment of elevated BP Breaking the smoking habit Reduction of serum cholesterol levels 51
  52. 52. SECONDARY PREVENTION • AIM : To prevent the recurrence and progression of CHD. Eg: Coronary surgery Use of Pacemakers 52
  53. 53. RISKS FACTORS INTERVENTION TRIALS 1) The North Kerelia Project (1972-) Finland 2) The Stanford -Three – Community Study (1972-75, 1980-86) USA 3) Multiple Risk factor Intervention Trial (1972-79) USA 4) Oslow diet & smoking Intervention Study(1973) 5) Lipid Research Clinics study 53
  54. 54. Secondary prevention trials • At preventing a subsequent coronary attack or sudden death. A wide range of clinical trial have been performed with four main groups of drugs anti coagulants , lipid lowering agents (clofibrate), anti- thrombotic agents ( aspirin) and beta- blockers. 54
  55. 55. 55
  56. 56. Women Making a Change
  57. 57. Wish you all a healthy heart THANK YOU ; ) 58

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