NON Communicable Disease

1. Coronary Heart Disease
Hawler Medical University
College of Medicine
Community Health
Prepared by:
Hawraz Faris Saadi
BSN, MD Student
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2. Coronary Heart Disease
(ischaemic heart disease) has been defined as
".impairment of heart function due to inadequate
blood flow to the heart compared to its needs,
caused by obstructive changes in the coronary
circulation to the heart"
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3. Coronary Heart Disease Cont.
 It’s the most common form of heart disease and
the single most important cause of premature
death in Europe, Russia, North and South America,
Australia and New Zealand.
 It’s the cause of 25-30% of deaths in most
industrialized countries.
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4. Clinical Problems of CHD :
1. Stable angina
2. Unstable angina
3. Myocardial infarction
4. Heart failure
5. Arrhythmia
6. Sudden death
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5. Risk Factors :
Not Modifiable Modifiable
Age Cigarette smoking
Sex High blood pressure
Family History Elevated serum cholesterol
Genetic Factors
Others (Diabetes, Obesity,
Sedentary habits ,Stress)
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6. 1. Smoking
 Smoking damages the lining of arteries, leading to
a build up of fatty material (atheroma) which
narrows the artery.
 The carbon monoxide induced atherogenesis and
in tobacco smoke reduces the amount of oxygen
in the blood. This means the heart has to pump
harder to supply the body with the oxygen it
needs.
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7. 1. Smoking Cont.
 The nicotine in cigarettes stimulates the body to
produce adrenaline, which makes the heart beat
faster and raising the blood pressure, making the
heart work harder and raising myocardial oxygen
demand.
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8. 1. Smoking Cont.
 The degree of risk developing CHD is directly related
to the number of cigarettes smoked per day.
 Filter cigarettes are probably not protective .
 There is evidence that the influence of smoking is not
only independent of, but also synergistic with other
risk factors such as hypertension and elevated serum
cholesterol.
 This means that the effects are more than additive.
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9. 1. Smoking Cont.
 The risk declines quite substantially within one
year of stopping smoking and more gradually
thereafter until, after 10-20 years, it is the same
as that of nonsmokers
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10. 2. Hypertension
 The blood pressure is the single most useful test
for identifying individuals at a high risk of
developing CHD.
 Hypertension accelerates the atherosclerotic
process, especially if hyperlipidaemia is also
present and contributes importantly to CHD.
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11. 3. Elevated Serum cholesterol
 The elevation of serum cholesterol was one of the
factors which carried an increased risk for the
myocardial infraction.
 the level of low-density lipoprotein (LDL)
cholesterol that is most directly associated with
coronary heart disease.
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12. 4. Other risk factor(Diabetes)
 The risk of coronary heart disease is 2-3 times
higher in diabetics than in non-diabetics.
 Coronary heart disease is responsible for 30-50%
of deaths in diabetics over the age of 40 years in
industrialized countries
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13. Epidemiology
 "Epidemics" of coronary heart disease began at
different times in different countries.
 In United States, epidemics began in the early
1920s ,in Britain in the 1930s.
 Countries where the epidemic began earlier are
now showing a decline. For example, in United
States, where the epidemic began in early 1920s,
a steady decline was evident by 1968, and a 25%
fall in mortality
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14. Epidemiology cont.
 Coronary heart disease (CHD) is a major cause of
death and disability in developed countries.
 Although CHD mortality rates worldwide have
declined over the past four decades, CHD remains
responsible for about one-third or more of all deaths
in individuals over age 35.
 It has been estimated that nearly one-half of all
middle-aged men and one-third of middle-aged
women in the United States will develop some
manifestation of CHD.
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15. Prevention of CHD
1. Primordial prevention.
2. Primary prevention.
A. Population strategy.
B. High risk strategy.
3.Secondary prevention.
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16. 1. Primordial prevention
 It involves preventing the emergence and spread
of CHD risk factors and life-styles that have not
yet appeared or become endemic.
 This applies to developing countries in particular
because these countries should seek to preserve
their traditional eating patterns and lifestyles
associated with low levels of CHD risk factors.
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17. 1. Primordial prevention Cont.
 Since the etiology of CHD is multifactorial the
approach to prevention should be multifactorial
aimed at controlling or modifying as many risk
factors as possible.
 The aim should be to change the community as a
whole, not the individual subjects living in it
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18. 2. Primary prevention
a. Population strategy:
The strategy should therefore be based on mass
approach focusing mainly on the control of risk factors
in whole populations, not merely in individuals.
This approach is based on the principle that small
changes in risk factor levels in total populations can
achieve the biggest reduction in mortality
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19. 2. Primary prevention Cont.
a. Population strategy: The population strategy
include the following key areas
1. Dietary changes.
2. Smoking.
3. Blood pressure.
4. Physical activity.
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20. 1. Dietary changes
Dietary modification is the principal preventive
strategy in the prevention of CHD by :
1. Reduction of fat intake to 20-30% of total energy
intake.
2. consumption of saturated fats must be limited to
less than 10 per cent of total energy intake.
3. Reduction of dietary cholesterol to below 100 mg
per 1000 kcal per day.
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21. 1. Dietary changes Cont.
4. increase in complex carbohydrate consumption
(vegetables, fruits, whole grains and legumes).
5. avoidance of alcohol consumption.
6. Reduction of salt intake to 5 g daily or less.
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22. 2. Smoking
 The goal should be to achieve a smoke-free
society, and several countries are progressing
towards this goal.
 To achieve the goal of a smoke-free society, a
comprehensive health program would be required
which includes effective information and
education activities
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23. 3. Blood pressure
The goal of the population approach to high blood
pressure would thus be to reduce mean population
blood pressure levels. This involves a multifactorial
approach based on a "prudent diet"
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24. 4. Physical activity
Regular physical activity should be a part of normal
daily life. It is particularly important to encourage
children to take up physical activities that they can
continue throughout their lives.
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25. B. High risk strategy
1) Identifying risk
2) Specific advice
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26. 1) Identifying risk
 High-risk intervention can only start once those at
high risk have been identified.
 By means of simple tests such as blood pressure
and serum cholesterol measurement it is possible
to identify individuals at special risk.
 Individuals at special risk also include those who
smoke, those with a strong family history of CHD,
diabetes and obesity and young women using oral
contraceptives
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27. 2) Specific advice
Having identified those at high risk, the next step
will be to bring them under preventive care and
motivate them to take positive action against all
the identified risk factors.
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28. 3. Secondary prevention
 Secondary prevention must be seen as a
continuation of primordial prevention and primary
prevention, It forms an important part of an
overall strategy.
 The aim of secondary prevention is to prevent the
recurrence and progression of CHD.
 Despite advances in treatment
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29. References
1. Nicki R., Brian R., Stuart H., (2010) Davidson’s Principles and Practice of
Medicine.
2. Park K. (2015) Park’s textbook of preventive and social medicine.
3. https://www.bhf.org.uk/heart-health/risk-factors/smoking
4. https://www.uptodate.com/contents/epidemiology-of-coronary-heart-
disease
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