INTERNATIONAL CONGRESS OF CAD REVIEW OF MAJOR NON MAJOR RISK FACTORS OF CORONARY ARTERY DISEASE IN “JAVAD AL AEMEH “ HEART HOSPOTAL OF MASHHAD. 5-7 OCT. 2011 Dr. M Mohammadi cardiologist

Agency for Health Care Policy and Research (AHCPR) 1995: Cardiovascular disease is the leading cause of morbidity and mortality in united states,accouting for 50% of all deaths.

Global Perspective Ischemic heart disease Ischemic heart disease leading causes of mortality 1990 leading causes of mortality 2020 Ischemic heart disease Cerebrovascular disease Lower respiratory disease ………………. Road – traffic accidents Throat and lung cancers Ischemic heart disease Unipolar major depression Road – traffic accidents Cerebrovascular disease COPD Lower respiratory disease ………………. War injuries HIV

2. Method 2.1. Study area and population From 21 November 2006 to 20 November 2007, patients with a new stroke in defined study areas (450129 residents) were identified.

No strokes were found in children aged less than 15 years. The incidence rates increased significantly with each decade of life and were similar in men and women

Ischaemic strokes are occurring approximately one decade earlier than in other countries

Discussion: Major finding 1- The incidence of stroke was approximately double that of the majority of ‘ideal’ studies conducted in the last decade 2-It was greater than in most western countries with the exception of the Ukraine 3-It was even higher than those of Novosibirsk, Russia; a region known for its high incidence of stroke 4-The crude incidence rate of stroke was relatively low which is related to our younger population. 5- Ischaemic strokes are occurring approximately one decade earlier than in other countries 6- The high incidence of total stroke is largely attributable to a high incidence of IS. 7-It also appears that the incidence of ICH is greater than in all other countries except Georgia Mihalka L, et al.A population study of stroke in West Ukraine: incidence, stroke services, and 30-day case fatality. Stroke. 2001. Tsiskaridze A, et al. Stroke incidence and 30-day case-fatality in a suburb of Tbilisi: results of the first prospective population-based study in Georgia. Stroke. 2004 Feigin VL, et al.Stroke epidemiology in Novosibirsk, Russia: a population-based study. Mayo Clin Proc. 1995.

Discussion: The reason for the high incidence of stroke in Mashhad, and the fact that stroke occurs at younger ages, is not clear: 1- It might be related to race-ethnic differences 2-Different types of vascular risk factors and their control, 3- The effect of socioeconomic status on stroke

Discussion:Risk factors When assessing risk factors: 1- The proportion of people with diabetes appears to be greater than in other stroke studies 2-There also seems to be a large proportion of stroke patients, particularly women, with a history of hypertension 3-Risk factors were not well controlled in our population Rothwell PM, et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet. 2004

Summary: In summary, the MSIS provided valid and comparative data on the incidence of stroke in Iran as an area in the Middle-East. The incidence of stroke, IS, and ICH were greater than incidence figures reported in most other regions of the world, and strokes occurred at younger ages.

RISK FACTORS FOR ATHEROTHROMBOTIC DISEASE SMOKING HYPERTENSION HYPERLIPDEMIA FAMILY HISTORY DIABETES MELITUS OBESITY

اثرسیگار بر(CAD) 676 بیمار کنگره سلامتی و سیگار بندر عباس-دی86

تعداد سیگاری ها در هر گروه سنی

جمعیت اماری مورد مطالعه 89-84 900بیمار

فراوانی سنی

نسبت مرد / زن در جمعیت مورد مطالعه

SMOKING/ 278cases /30.88%

HYPERTENSION 380cases 42.22%

HYPERLIPIDMIA 417cases 46.33%

DIABETES 226cases 25.11%

FAMILY HISTORY 250cases 27.77%

مقایسه کلی ریسک فاکتورها

تعداد مردان بدون ریسک فاکتور ماژور/کل مردان/کل جمعیت 40 تعداد مردان بدون ریسک فاکتور ماژور/کل مردان/کل جمعیت 40.99% بدون ریسک فاکتور ماژور

تعداد زنان بدون ریسک فاکتور ماژور/کل زنان /کل جمعیت 44 تعداد زنان بدون ریسک فاکتور ماژور/کل زنان /کل جمعیت 44.19% بدون ریسک فاکتور ماژور

ATHEROTHROMBOTIC RISK FACTORS: High sensitivity C –reactive pr. Homocysteine Lipoprotein(a) Fibrinogen D-dimer Abnormalities of intrinsic fibrinolysis