Cardiovascular Disease prevention - Epidemiology, cardio,healt

CardioVascularDisease
1

 C di
Cardiovascular di
l diseases (CVD) are th main cause
the i
of death in the industrialized countries. But they
are d
dangerously increasing in th emerging
l i i i the i
Countries.
 The main forms of CVD are coronary heart disease
(CHD):
 Acute myocardial infarction (AMI), Angina pectoris,
sudden cardiac death (SD)
 Stroke: Ischemic and Haemorrhagic;

 Peripheral artery disease, aortic aneurysm

www.cardiovascularprevention.com

Age-standardised death rates, per 100.000, from CHD,
1968 2002,
1968-2002, selected countries, the world (1)
2

From: Steven Allender, Viv Peto,
Peter Scarborough, Asha
Kaur and Mike Rayner (2008)
Coronary heart disease
statistics. British Heart
Foundation: London.


Age-standardised death rates, per 100.000, from CHD,
1968 2002,
1968-2002, selected countries, the world (2)
3

Foundation: London.


Cardiovascular Disease in Europe
p
4

 Fi t cause of d th counting 41% of all d th
First f death ti % f ll deaths
(Eurostat 2003)
 1.2 milioni d
ili i deaths i Europe / year
h in
 1/3 of year of life expectancy lost by CVD’s
premature death


5

EUROPE 1995-2006

6

CVD in ITALY(year 2003)
(y 3)

7

 A t Coronary S d
Acute C Syndrome
 280.000 Male

 78.000 Female

 50.000 Sudden Cardiac Death

 AMI or SD as first onset of CHD
 Only 30% of persons having traditional risk factors show
signs and symptoms of CHD
 In 68% of younger patients, without traditional risk
factors there are subcritical coronary artery stenoses( <
f h b ii l (
50%).


Mortality Year - ISTAT (Ital )
(Italy)
8

Cardiovascular
Disease 237.198

Cancer 163.070

Sudden Death 54.000
54 000


9

DISEASES ASSOCIATED WITH
HIGHT Cardiovascular mortality

 Diabetes m.
 Heart Failure
 Ictus (ischemic /haemorrhagic)
( / g )


Cardiovascular Disease in United Kingdom
-2006-
2006
10
 Diseases of the heart and circulatory system (
y y (cardiovascular disease or CVD) are the main cause of
)
death in the UK and account for almost 198,000 deaths each year. More than one in three deaths
(35%) are from CVD each year. The main forms of CVD are coronary heart disease (CHD: Acute
myocardial infarction, Angina pectoris, sudden cardiac death) and stroke. About half (48%) of all
deaths from CVD are from CHD and more than a quarter (28%) are from stroke.
 CHD by itself is the most common cause of death in the UK. Around one in five men and one in seven
UK
women die from the disease. CHD causes around 94,000 deaths in the UK each year.
 Other forms of heart disease cause over 31,000 deaths in the UK each year so in total there were just
under 126,000 deaths from heart disease in the UK in 2006.
 Premature mortality(death before the age of 75).
 CVD is one of the main causes of premature death in the UK 30% of premature deaths in men and
22% of premature deaths in women were from CVD in 2006. CVD caused just over 53,000
premature deaths in the UK in 2006.
 CHD, by itself, is the most common cause of premature death in the UK About one fifth (19%) of
premature deaths in men and one in ten (10%) premature deaths in women were from CHD.
 CHD caused almost 31,000 premature deaths in the UK in 2006.
 Other forms of heart disease cause more than 7,500 premature deaths in the UK each year. In total
there were over 38,000 premature deaths from heart disease in the UK in 2006 - around one fifth
of all premature deaths.

From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008) Coronary
heart disease statistics. British Heart Foundation: London.


DEATHS BY SEX, AGE, UNITED KINGDOM
- 2006
2006-
11

Foundation: London.


USA Death rate in 2003
• Th 2003 preliminary CVD d th rates were 364 2 f males
The li i death t 364.2 for l
and 262.5 for females.
• Cancer death rates were 232.3 for males and 160.2 for
females.
f l
• Breast cancer claimed the lives of 41 566 females in 2003.
• Lung cancer claimed 67 894.
g
• Death rates for females were 25.2 for breast cancer and 41.1
for lung cancer.
• One in 30 female deaths are from breast cancer, while 1 in
cancer
2.6 are from CVD.
• Based on preliminary 2003 mortality, CVD caused about a
death a minute among females over
• 480 000 female lives every year.

12

Other causes of death in 2003 in
USA (preliminary data)

• Cancer 554 643
• Accidents 105 695
• Alzheimer’s disease 63 343
• HIV (AIDS) 13 544
544.

13

U.S.A. Data 1999-2002
999
14

 Of the 71 300 000 American adults with 1 or more types of
cardiovascular disease (CVD), 27 400 000
are estimated to be age 65 or older
g 5
 High blood pressure 65 000 000.
 Coronary heart disease
y 13 200 000.
– Myocardial infarction (MI, or heart attack)
7 200 000.
– Angina pectoris (AP, or chest pain) 6 500 000.
• Heart failure 5 000 000.
 Stroke 5 500 000.
 Congenital cardiovascular defects 1 000 000.

U.S.A. Data 2003 & cost 2006

15

CARDIOVASCULAR DISEASE IN CANADA (1)
These statistics are based on 2004 d t (f
Th t ti ti b d data (from St ti ti C
Statistics Canada)
d )

Cardiovascular disease (heart disease, diseases of the blood vessels
and stroke) acco nts for the death of more Canadians than an other
accounts any
disease.
Every 7 minutes in Canada, someone dies from heart disease or
stroke.
stroke

Cardiovascular disease accounted for 72,338 deaths:
32% of all deaths in Canada
31% of all male deaths
33% of all female deaths
In 2004, of all cardiovascular deaths:
54% were due to ischemic heart disease
20% to stroke
25% to heart attack
Cost of cardiovascular diseases
Heart disease and stroke costs the Canadian economy more than $18
billion every year in physician services, hospital costs, lost wages and
decreased productivity.
16

CARDIOVASCULAR DISEASE IN CANADA (2)
These statistics are based on 2004 data (from Statistics Canada)
Cardiac arrest

About 40,000 Canadians experience cardiac arrest every year.
Ab t 40 000 C di i di t
Less than 5% of those who have a cardiac arrest outside of a hospital
survive.

Congestive heart failure

It is estimated that there are 400 000 Canadians living with congestive
400,000
heart failure (CHF).

Stroke

More than 50,000 strokes occur in Canada each year. That’s one stroke
every 10 minutes.
y
Stroke is the third leading cause of death in Canada.
Each year, more than 14,000 Canadians die from stroke.
Each year, more women than men die from stroke.
y

17

ACUTE CORONARY SINDROME IN INDIA

18
 India has the largest percentage of heart disease in the world
 X i et al's, examined th i id
Xavier t l' i d the incidence of STEMI and non-STEMI among
f d STEMI
almost 21 000 patients from 89 centers in 50 Indian cities. They found that
more than 60% of these patients were diagnosed with STEMI, mean age was
57.5 years (although STEMI patients tended to be even younger), and the
vast majority were f
j i from l
lower-middle-income or poor f ili
iddl i families.

 The Indians were, on average, 57,5 years of age compared with 70.7 years for
the European whites
whites.
 Reinfarction, and stroke rates and 30-day death, were higher for STEMI
patients than non-STEMI, and mortality, notably, was significantly higher in
poor patients than in rich patients.
 They also had significantly increased prevalence of diabetes, hypertension,
history of CAD compared with European whites.
 And triple-vessel disease was more common in the Indian Asians than in the
whites.
whites
 Almost all STEMI and non-STEMI patients were treated with antiplatelet
drugs (primarily aspirin), but use of thrombolytics, ACE inhibitors or
Angiotensin-Receptor Blockers, beta blockers, statins, omega 3 fatty-acids
and PCI/CABG were all far lower than rates seen in the West.
d ll f l th t i th W t

India: Mortality rates and
socioeconomic status
i 19
i t t
Mortality
M t lit Rich
Ri h Lower P
L Poor (%) p
(%) middle
class
(%)

Unadjusted mortality 5.5 6.5 8.2 <0.0001
Mortality adjusted for 7.2 6.4 6.6 0.97
risk f t
i k factors, location
l ti
of infarct, and
treatments
From: Xavier D. et al. Lancet 2008; 371:1435-1442.


Ten-year risk of CHD event (%) in 60-year-
y ( ) y
olds British minority Ethnic groups
20

Ethnic
Eth i group Male
M l Male
M l Female
F l Female
F l
nonsmoker smoker nonsmoker smoker
Indian 18.5 27.9 6.4 10.0
Pakistani 21.3 31.8 9.8 15.3
Bangladeshi 21.2 31.7 5.3 8.3
All South 19.5 29.3 7.1 11.1
Asians
Chinese 6.1
61 9.6
96 1.1
11 1.8
18
Caribbean 5.4 8.5 8.6 13.4
Black African 8.9 13.9 3.6 5.7
Irish 13.7 20.9 6.8 10.6
Framingham 11.8 18.2 7.1 11.7
score
From: P Brindle, M May, et Al: Heart 2006;92:1595–1602. www.cardiovascularprevention.com
doi: 10.1136/hrt.2006.092346

Ten-year risk of CVD event (%) in 60-year-
y ( ) y
olds British minority Ethnic groups
21

Ethnic group Male Male Female Female
nonsmoker smoker nonsmoker smoker
Indian 22.4 36.7 8.7 15.1
Pakistani 24.7 40.0 13.4 22.8
Bangladeshi 24.9 40.4 7.4 13.0
All South 23.6 38.5 9.7 16.9
Asians
Chinese 11.1
11 1 19.1
19 1 2.5
25 4.4
44
Caribbean 13.3 22.7 9.7 16.9
Black African 20.1
20 1 33.3
33 3 10.8
10 8 18.7
18 7
Irish 16.0 27.0 9.1 15.8
g
Framingham 14.1 22.3 8.7 14.7
score
From: P Brindle, M May, et Al: Heart 2006;92:1595–1602. doi: 10.1136/hrt.2006.092346

Health care costs of CVD, CHD and stroke
f ,
by EU country, 2006, Europe
CVD CHD Stroke
Cost per % of total Cost per % of total Cost per % of total
capita health capita health capita health
Country (€) expenditure (€) expenditure (€) expenditure

Austria 198 6 43 1 35 1
Belgium 193 6 46 1 27 1 Peter Scarborough, Asha
Bulgaria Ì5 14 6 2 7 3
Cyprus 59 5 18 2 7 l Kaur and Mike Rayner (2008)
Czech Republic 107 13 25 3 16 2
Denmark
Estonia
182
77
5
15
44
22
1
4
37
14
l
3
Finland 237 10 52 2 65 3 Foundation: London.
France 207 7 32 ! 2; 1
Germany 413 14 96 3 58 1
Greece 173 10 46 3 44 2
Hungary 75 111 15 2 10 1
Ireland 183 6 46 1 26 1
Italy 235 in 45 2 45 2
Latvia
L t i 47 9 13 3 8 2
Lithuania 59 13 14 3 14 3
Luxembourg 252 5 60 1 24 0
Malta 72 6 IS 1 5 0
Netherlands 271 9 73 2 78 3
Poland 74 17 18 4 10 2
Portugal 151 LO 33 2 27 2
Romania 14 15 6 3 6 2
Slovakia 74 13 21 4 11 2
Slovenia 91 7 19 1 12 1
Spain 130 7 31 2 17 1

Sweden 308 10 62 2 52 2
UK 313 12 71 3 69 3
Total EU 223 10 49 2 38 2

22 www.cardiovascularprevention.com

Alter et al The Proliferation of Cardiac Technology Circulation January 24, 2006
In Canada 23 www.cardiovascularprevention.com

Lucas et al Temporal Trends in Cardiac Testing and Treatment- USA- Circulation January 24, 2006

24 www.cardiovascularprevention.com

www.CardioVascularPrevention.com
www CardioVascularPrevention com

E-mail: info@cardiovascularprevention.com
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