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Global Burden of Coronary
Heart Diseases
Rochmad Romdoni
President of Inaheart
Rochmad Romdoni
President of Inaheart
Depar...
Cardiovascular Diseases
CVDs due to
Atherosclerosis:
• Coronary Artery
Disease (Heart Attack,
AMI)
• Cerebrovascular
Disea...
Risk Factors
(Factors that Promote The Process of Atherosclerosis)
Behavioural risk
factors:
• Tobacco use
• Physical inac...
Global Map Risk Factors of Cardiovascular
Diseases
WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Con...
Surveillance Map and Monitor
The Epidemic of CVDs
WHO 2011: Cause of Death
Distribution of major causes of death including CVDs
WHO/WHF/WSO : Global Atlas on Cardiovascular...
WHO 2011: Cause of Death
Distribution of CVD deaths due to heart
attacks, strokes and other types of
cardiovascular diseas...
World Map Showing The Global Distribution of CVD Mortality
Rates in Males (Age Standardized, per 100.000)
WHO/WHF/WSO : Gl...
World Map Showing The Global Distribution of CVD Mortality
Rates in Females (Age Standardized, per 100.000)
WHO/WHF/WSO : ...
Global Burden Hidden of
Cardiovascular Diseases
WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Contro...
WHO (2009):
“CHD is now the leading cause of death worldwide; it is on the rise
and has become a true pandemic that respec...
CAD is Leading Cause of
Premature Death
CAD is Leading Cause of
Premature Death
Calls for a different approach
on handling...
Cardiovascular Diseases
in Indonesia
Riset Kesehatan dasar (RisKesDas) 2007:
• Prevalence of Heart Diseases 7.2 %
• Preval...
Cardiovascular Diseases
in Indonesia
Riset Kesehatan dasar (RisKesDas) 2007:
• Mortality of Various Diseases:
• Ischemic H...
Reducing Cardiovascular Risk
to Prevent Heart Attacks and
Strokes
Cardiovascular Continuum
InterventionIntervention
Focusing on high risk people
To prevent one from having a
CHD or CVD event
People with established disease
To reduce morbi...
Population-Based
Strategy
High Risk
Strategy
Ideal Cardiovascular Health
Targetting on modifiable
risk factors
Introductio...
Risk Assessment
Individu
Level of Risk
Low RiskLow Risk
Moderate RiskModerate Risk
High RiskHigh Risk
Very High RiskVery H...
How To Apply CVD Prevention
Starts with Behaviour ChangeStarts with Behaviour Change
Key to succesful lifestyle changes
Sh...
Cardiovascular Risk Prediction Chart
WHO and International Society of Hypertension (ISH)
Cardiovascular Risk Prediction Ch...
10 Year Risk Predictor Charts of Fatal CVD
10 Year CVD Risk Predictor Chart in Indonesia
WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control....
10 Year CVD Risk Predictor Chart in Indonesia
WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control....
Recommendation for CVD Prevention
WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : Wo...
General Practitioner Cardiologist
Serve as consultant
Further diagnostic tools :
ECG, echocardiography,
vascular ultrasoun...
SUMMARY
Cardiovascular Disease (CVD), especially Coronary Artery Disease is the
leading cause of morbidity and mortality w...
“The doctor of the future will give“The doctor of the future will give“The doctor of the future will give“The doctor of th...
CVD Prevention and Control:
Why It should not be Ignored any Longer?
International efforts in poverty reduction will be de...
CVD Prevention and Control:
Why It should not be Ignored any Longer?
CVD s are eminently preventable.
Investment in preven...
SUMMARY
• During the last century, Cardiovascular Disease (CVD) has burgeoned from a
relatively minor disease worldwide to...
Global Burden of Coronary Heart Disease
Global Burden of Coronary Heart Disease
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Global Burden of Coronary Heart Disease

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Prof. DR. Dr. Rochmad Romdoni, SpJP(K), FINASIM, FIHA, FAsCC. 3rd Pekanbaru Cardiology Update, August 24th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com

Published in: Health & Medicine
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Global Burden of Coronary Heart Disease

  1. 1. Global Burden of Coronary Heart Diseases Rochmad Romdoni President of Inaheart Rochmad Romdoni President of Inaheart Department of Cardiology and Vascular Medicine Airlangga School of Medicine - Dr. Soetomo Hospital Surabaya
  2. 2. Cardiovascular Diseases CVDs due to Atherosclerosis: • Coronary Artery Disease (Heart Attack, AMI) • Cerebrovascular Disease (Stroke) • Aorta & Artery Diseases : • Hypertension & PAD Other CVDs: • Congenital Heart Disease • Rheumatic Heart Diseases • Cardiomyopathies • Cardiac Arrhythmias WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  3. 3. Risk Factors (Factors that Promote The Process of Atherosclerosis) Behavioural risk factors: • Tobacco use • Physical inactivity • Unhealthy diet (rich in salt, fat, and calories) • Harmful use of alcohol Metabolic risk factors: • Raised blood pressure (hypertension) • Raised blood sugar (diabetes) • Raised blood lipids (cholesterol) • Overweight and obesity Other risk factors: • Poverty and low educational status • Advancing age • Gender • Inherited (genetic) disposition • Psychological factors (stress, depression) • Other risk factors (e.g. excess homocysteine) WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  4. 4. Global Map Risk Factors of Cardiovascular Diseases WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  5. 5. Surveillance Map and Monitor The Epidemic of CVDs
  6. 6. WHO 2011: Cause of Death Distribution of major causes of death including CVDs WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011 Cardiovascular diseases 31% Injuries 9% Communicable, maternal, perinatal and nutriotional conditions 27% Other NCOs 33%
  7. 7. WHO 2011: Cause of Death Distribution of CVD deaths due to heart attacks, strokes and other types of cardiovascular diseases (MALES) Distribution of CVD deaths due to heart attacks, strokes and other types of cardiovascular diseases (FEMALES) WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011 Other cardiovascular diseases 11% Inflamatory heart diseases 2% Cerebrovascular diseases 34% Rheumatic heart diseases 1% Hypertensive heart diseases 6% Ischemic heart disease 46% Other cardiovascular diseases 14% Inflamatory heart diseases 2% Cerebrovascular diseases 37% Ischemic heart disease 33% Hypertensive heart diseases 7% Rheumatic heart diseases 1%
  8. 8. World Map Showing The Global Distribution of CVD Mortality Rates in Males (Age Standardized, per 100.000) WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  9. 9. World Map Showing The Global Distribution of CVD Mortality Rates in Females (Age Standardized, per 100.000) WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  10. 10. Global Burden Hidden of Cardiovascular Diseases WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  11. 11. WHO (2009): “CHD is now the leading cause of death worldwide; it is on the rise and has become a true pandemic that respects no borders Coronary Artery Disease Leading cause of mortality Happened globallyHappened globally Leading cause of loss of productivity Increase new cases
  12. 12. CAD is Leading Cause of Premature Death CAD is Leading Cause of Premature Death Calls for a different approach on handling CAD Calls for a different approach on handling CAD
  13. 13. Cardiovascular Diseases in Indonesia Riset Kesehatan dasar (RisKesDas) 2007: • Prevalence of Heart Diseases 7.2 % • Prevalence of Coronary Risk Factors : • Smoking 35.4 % (65.3 % men & 5.6 % women) • Hipertension 31.7 % • Diabetes Mellitus 1.1 % (Urban 5.7 %) DepKes RI: RisKesDas. 2007
  14. 14. Cardiovascular Diseases in Indonesia Riset Kesehatan dasar (RisKesDas) 2007: • Mortality of Various Diseases: • Ischemic Heart diseases (5.1 %) • Stroke (15.4 %) • Hipertension (6.8 %) • Other Heart Diseases (4.6 %) • Diabetes Mellitus (5.7 %) • Accidence (6.5 %) • Cancer (5.7 %) • Chronic Lower Respiratory Tract Diseases (5.1 %) DepKes RI: RisKesDas. 2007
  15. 15. Reducing Cardiovascular Risk to Prevent Heart Attacks and Strokes
  16. 16. Cardiovascular Continuum InterventionIntervention
  17. 17. Focusing on high risk people To prevent one from having a CHD or CVD event People with established disease To reduce morbidity and mortality Primary Prevention Primary Prevention Secondary Prevention Secondary Prevention To prevent one from having a first time or repeated CVD event
  18. 18. Population-Based Strategy High Risk Strategy Ideal Cardiovascular Health Targetting on modifiable risk factors Introduction of pharmacotherapy How To Apply CVD Prevention No Smoking Healthy diet Sufficient physical activity Low blood pressure Low cholesterol
  19. 19. Risk Assessment Individu Level of Risk Low RiskLow Risk Moderate RiskModerate Risk High RiskHigh Risk Very High RiskVery High Risk
  20. 20. How To Apply CVD Prevention Starts with Behaviour ChangeStarts with Behaviour Change Key to succesful lifestyle changes Should involved patients, family dan physician altogether Communication plays vital role
  21. 21. Cardiovascular Risk Prediction Chart WHO and International Society of Hypertension (ISH) Cardiovascular Risk Prediction Chart (shows the 10 year risk of a fatal or nonfatal cardiovascular event by gender, age, smoking status, systolic blood pressure, blood cholesterol and presence or absence of diabetes). Different charts are available for all WHO subregions. WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  22. 22. 10 Year Risk Predictor Charts of Fatal CVD
  23. 23. 10 Year CVD Risk Predictor Chart in Indonesia WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  24. 24. 10 Year CVD Risk Predictor Chart in Indonesia WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  25. 25. Recommendation for CVD Prevention WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  26. 26. General Practitioner Cardiologist Serve as consultant Further diagnostic tools : ECG, echocardiography, vascular ultrasound Pivotal Role Screening Ability to do risk assesment Primary care Role of General Practitioner and Cardiologist Motivating, counseling the patient Implementation of evidence-based Communication to patient regarding severity of disease, therapeutic options and target
  27. 27. SUMMARY Cardiovascular Disease (CVD), especially Coronary Artery Disease is the leading cause of morbidity and mortality worldwide. CVD Prevention is the cornerstone of reducing global burden of cardiovascular disease. The implementation of CVD prevention by Population-based strategy and High Risk strategy should give a more benefit in achieving prevention target. General practitioner and Cardiologist has a different yet vital role in CVD prevention with synergistic effect one to the other.
  28. 28. “The doctor of the future will give“The doctor of the future will give“The doctor of the future will give“The doctor of the future will give no medicine, but will interest hisno medicine, but will interest hisno medicine, but will interest hisno medicine, but will interest his patients in the care of humanpatients in the care of humanpatients in the care of humanpatients in the care of human frame, in diet and in the cause andframe, in diet and in the cause andframe, in diet and in the cause andframe, in diet and in the cause and prevention of disease”prevention of disease”prevention of disease”prevention of disease” (Thomas Edison)(Thomas Edison)(Thomas Edison)(Thomas Edison)
  29. 29. CVD Prevention and Control: Why It should not be Ignored any Longer? International efforts in poverty reduction will be derailed if the global challenge of CVD is not addressed. If no action is taken, increasing numbers of people will slip into highrisk categories or develop CVD due to continuing exposure to risk factors. Millions of deaths due to CVD can be prevented by scaling up implementation of high- impact interventions that already exist. High-impact interventions include policies that promote governmentwide action: stronger anti-tobacco controls; promotion of healthier diets and physical activity; reducing the harmful use of alcohol; improving people's access to essential health care. WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  30. 30. CVD Prevention and Control: Why It should not be Ignored any Longer? CVD s are eminently preventable. Investment in prevention is the most sustainable solution for the CVD epidemic. Over the last two decades, CVD mortality has declined in developed countries due to a combination of prevention and control measures. Prevention of CVD by reducing the total cardiovascular risk is cost effective. WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
  31. 31. SUMMARY • During the last century, Cardiovascular Disease (CVD) has burgeoned from a relatively minor disease worldwide to a leading cause of morbidity and mortality. • A substantial portion of the increasing global impact of CVD is attributable to economic, social, and cultural changes that have led to increases in risk factors for CVD. • CVD Prevention is the cornerstone of reducing global mortality and morbidity worldwide. • Risk factor screening should be considered in adult men >40 years old and in women >50 years of age or post menopausal. • The physician in general practice is the key person to initiate, coordinate, and provide long term follow-up for CVD prevention. • The practising cardiologist should be the advisor in cases where there is uncertainty over the use of preventive medication or when usual preventive options are difficult to apply.

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