Cardiovascular diseases are now the leading cause of death worldwide, responsible for over 17 million deaths in 2016. The epidemiological transition driven by industrialization and urbanization has led to lifestyle changes that promote cardiovascular risks like obesity, physical inactivity and smoking. In India, cardiovascular diseases account for 27% of all deaths, with over 2.5 million deaths in 2016. The major cardiovascular diseases - coronary heart disease, cerebrovascular disease, rheumatic heart disease and hypertension - and their risk factors are discussed. Modifiable behavioral and metabolic risk factors provide opportunities for prevention and management of cardiovascular mortality on a global scale.

1. Epidemiology Of
Cardiovascular Diseases
Made By : Niteesh Kumar

2. Introduction
Cardiovascular disease (CVD) is now the most common cause of death
worldwide. Before 1900, infectious diseases and malnutrition were the
most common causes, and CVD was responsible for <10% of all deaths.
In 2015, CVD accounted for ~17.9 million deaths worldwide (32%),
including nearly 34% of deaths in high-income countries and about
32% in low- and middle-income countries.

3. Epidemiological Transition
The epidemiologic transition, the shift is driven by industrialization,
urbanization, and associated lifestyle changes and is taking place in
every part of the world among all races, ethnic groups, and cultures.
Basic stages of transition are :-
 Pestilence and famine,
 Receding pandemics,
 Degenerative and man-made diseases,
 Delayed degenerative diseases
 Inactivity and obesity

5. Proportional mortality in India (% of total deaths, all ages) 2016
Total deaths 9 ,569,000
Diabetes
3%
Chronic Respiratory Disease
11%
Cancers
9%
Cardiovascular Disease
27%
Injuries
11%
Other NCDs
13%
Communicable, maternal,
perinatal and nutritional
conditions
26%

7. Key Facts
CVDs are most common cause of death globally: more people die annually
from CVDs than from any other cause.
An estimated 17.9 million people died from CVDs in 2016, representing
31% of all global deaths. Of these deaths, 85% are due to heart attack and
stroke.
More than 75% of CVD deaths take place in low- and middle-income
countries.
Out of the 17 million premature deaths (under the age of 70) due to
noncommunicable diseases in 2015, 82% are in low- and middle-income
countries, and 37% are caused by CVDs.

8. Most cardiovascular diseases can be prevented by addressing
behavioural risk factors such as tobacco use, unhealthy diet and obesity,
physical inactivity and harmful use of alcohol using population-wide
strategies.
People with cardiovascular disease or who are at high cardiovascular
risk (due to the presence of one or more risk factors such as
hypertension, diabetes, hyperlipidaemia or already established disease)
need early detection and management using counselling and medicines,
as appropriate.

10. INDIA
2.59 Million deaths due to CVD in 2016.
 India suffers highest loss due to death of patients of productive age
(35 – 64 years).
Prevalence of CVD is 2-3 times higher in urban population than rural
population.
Prevalence of IHD among adults was estimated at 96.7/1000
population in urban and 27.1/1000 in rural areas.

11. Common Risk Factors
1) Inappropriate nutrition – Increased saturated fat ,salt, refined
carbohydrates and decreased vegetables and fruits consumption.
2) Lack of physical activity
3) Tobacco consumption
4) High blood pressure
5) Overweight
6) Central obesity
7) Dyslipidaemia
8) Diabetes

12. Coronary ( Ischaemic ) Heart Disease
 It is cause of 25-30 % of deaths in most industrialised countries.
 Epidemics of CHD –
1) United State – 1920
2) Britain – 1930
 About 7.4 Million deaths due to coronary heart disease in 2016.
IHD is the most common, serious, chronic, life-threatening illness in the
United States, where 15.5 million persons have IHD, and 3.4 million
people aged ≥40 years have angina pectoris.

13. IHD in India
According to studies 1990-2002 on IHD , Prevalence of IHD in urban
areas was 6.4% and in rural areas 2.5%.
It is estimated that 1,608,700 people died of CHD during2016,
of which 1,000,800 were men and 607,800 women. The crude death
rate was 121.5/100,000 population.

14. Risk Factors
Non Modifiable Modifiable
Age
Sex
Family History
Genetic Factors
Personality
Cigarette smoking
High Blood Pressure
Elevated serum cholesterol
Diabetes mellitus
Obesity
Sedentary Habits
Stress

15. Hypertension
Hypertension - or elevated blood pressure - is a serious medical
condition that significantly increases the risks of heart, brain, kidney
and other diseases.
An estimated 1.13 billion people worldwide have hypertension, most
(two-thirds) living in low- and middle-income countries.
In 2015, 1 in 4 men and 1 in 5 women had hypertension.

16. Fewer than 1 in 5 people with hypertension have the problem under
control.
Hypertension is a major cause of premature death worldwide.
One of the global targets for noncommunicable diseases is to reduce
the prevalence of hypertension by 25% by 2025 (baseline 2010).

17. HTN in India
The prevalence of hypertension among men aged 15-49 yrs was
somewhat higher than among women, 15% men were hypertensive
(10% with stage 1, 2% with stage 2 and 1% with stage 3 hypertension)
; 43% men had normal blood pressure and same percentage were
prehypertensive.
The prevalence of HTN is higher among Sikhs (24% for men and
16% for women), Jains 19% for men and 16% for women and Buddhist/
Neo-Buddhist men 19% than the rest of the religion groups

18. The prevalence of HTN among women at 15-49 yrs ranges from
8% in Bihar to 18% in Sikkim and Assam. For men, the prevalence
ranges from 6% in Delhi to 31% in Sikkim.
For both men and women. the North-eastern states (except
Meghalaya for men) have a higher prevalence than the national
average.

19. Risk Factors of HTN
Non Modifiable Modifiable
Age
Sex
Genetic factors
Ethnicity
Obesity
Salt Intake
Saturated fat & dietary fibre intake
Alcohol intake
Heart rate
Physical activity
Stress
Socio economic status
Others

20. Strokes ( Cerebrovascular Disease )
In 2016 it was estimated that cerebrovascular disease accounted
for 5. 78 million deaths worldwide, equivalent to 10.2% of all deaths.
Majority of these deaths occurred in people living in developing
countries and 33. 72% of the subjects were aged less than 70 yrs.
In demographically developed countries, the average age at which
stroke occurs is around 73 years reflecting the older age
structure of these countries

21. Strokes in India
The prevalence of stroke appears to be comparatively less in
India than in developed countries.
In India 0.706 million people died of stroke in 2016 of which
0.372 million were men and 0.334 million were women.
The crude death rate of stroke was about 54.2/100,000 population .

22. Risk Factors for Strokes
 Age :- >70 yrs
 Sex :- Male > Female
 Hypertension
 Obesity
 Left ventricular hypertrophy
 Diabetes
 Dyslipidaemia
 Personal History

23. Rheumatic Heart Disease
During 2008, There are over 15 million cases of RHD with 282,000
new cases. About 220,000 deaths from this disease occurred which is
about 0.4% of total deaths.
In India, RHD is prevalent in the range of 5- 7/1000 in 5-15 years age
group and there are about 1 million RHD cases in India.
RHO constitutes 20- 30% of hospital admissions due to CVD in India.

24.  The African, South-East Asia and the Western Pacific regions are the worst
affected, accounting for 84% of all prevalent cases and 80% of all estimated
deaths due to rheumatic heart disease in 2015. India in the South-East Asia
Region, has the highest global prevalence, with about 27% of all cases
globally.
The risk of developing rheumatic heart disease is up to 2 times higher for
females than males, and females accounted for 2/3rd with rheumatic
heart disease admitted to selected hospitals in 12 countries in the
African Region, India and Yemen,

25. Agent Factors
Agent : Group A beta haemolytic Streptococcus with rheumatogenic
strain.
Its causes onset of rheumatic fever preceded by a streptococcal
sore throat.
Carriers : Convalescent
Transient
Chronic carriers

26. Host & Environmental Factors
 Age :- 5-15 yrs but also occur in adults.
 Sex :- Equal prevalence but poor prognostic in female.
 Socio-economic status : More prevalence in poor.
 High risk groups : School age children mainly slum dwellers & those
living in closed community.
 Immunity

28. References
1) PSM by K Park 25th edition.
2) Harrison Internal Medicine 20th edition
3) www.who.int/health-topics/cardiovascular-diseases

29. Thank You