EPIDEMIOLOGY and overview of cardiac DISEASE

INTRODUCTION  The 20th century saw unparalleled increase in life expectancy & major shift in the cause of illness throughout the world

GLOBAL BURDEN OF CVD.  A century ago, CVD death <10%  Today, approximately 30% of deaths worldwide including nearly 40% in high income countries and about 28% in low and middle income countries -Braunwald’s Heart Disease 2008

EPIDEMIOLOGICALTRANSITIONS StageTypical proportion of deaths caused by CVD % Predominant types of CVD Pestilence and Famine <10Rheumatic heart disease, cardiomyopathies Receding Pandemics 10-35Rheumatic valvular disease, HT,CHD, Stroke

Contd… Degenerative & Manmade diseases 35 – 65CHD, Stroke Delayed degenerative Diseases 40 – 50CHD, Stroke, CHF.

PREVALENCE OF CHD-US Age in yearsMale % Female %

PREVALENCE  The prevalence of CHD is about 7.4% in men and 4.5% in women.  The prevalence is higher in lower socio-economic groups.  Of note, mortality from CHD is falling but morbidity appears to be rising.

EPIDEMIOLOGY OF IHD MORTALITY RATES-UK  CHD is the most common cause of death (and premature death) in the UK  1 in 5 men and 1 in 6 women die from CHD

Contd…  There are 101,000 deaths from CHD in the UK each year.  Death rates from CHD have fallen by 46% for people under 65 years in the last 10 years in UK, Australia (48%) and Norway (54%).  Death from CHD is more likely during winter.

MORBIDITY RATES IN UK  The average incidence of Myocardial Infarction is 600 per 100,000 in men aged and 200 per 100,000 in women. The incidence increases with age  There are about 52,000 new cases of Angina per year in all men living in the UK and about 43,000 new cases in women

PREVALENCE OF CVD-UK DiseaseAge% Heart attackMen Women 04 % 02% Angina Men 55-64yrs Women 08% 05 % Men yrs Women 17% 08%

NEWS ALERT Aug 13, 2009 The heart of the matter  Premature heart attack is common in Indians compared to the Western population  Beyond the age of 50, the risk of heart attack per year approximately 2-3 per 1000

Contd… Aug 13, 2009.The Hindu  one in 200 deaths of adults over age 40 occurs due to Sudden Cardiac Arrest

Contd… November 4, 2006 The Hindu  MYSORE: Incidence of heart disease has doubled in India during the last 20 years on account of changes in lifestyle and economic development.

Contd…  Dr Rajesh Pande (Cardiovascular disease in India and the impact of lifestyle and food habits)  80 % of global CVD related deaths now occur in low and middle-income nations, which covers most countries in Asia

INCIDENCE OF MI IN URBAN INDIA GenderIncidencePrevalenceMortality Male06/1000 Urban -35 – 90/1000 Rural -17 – 45/ % in Urban Female02/1000 Urban -28 – 93/1000 Rural -13 – 43/ % in Rural.

PREVALENCE IN CHENNAI YearUrban % Rural %

OUR FUTURE  The World Health Organization estimated that 60 % of the world's cardiac patients will be Indian by 2010  50 % of CVD-related deaths in India occur below the age of 70, compared with just 22 % in the West

Contd…  CVD will increase rapidly in India and this country will be host to more than half the cases of heart disease in the world within the next 15 years

RESEARCH EXCERPTS  South Asians have elevated levels of LDL cholesterol and triglycerides, while also suffering from a deficiency in HDL cholesterol  South Asians seem more naturally vulnerable to heart disease than other ethnic groups

Contd…  The disease occurs at a much younger age in Indians as compared to those in North America and Western Europe  In general, the incidence of all rhythm problems is 8-10 per 1000 people

VITAL STATISTICS-WHO  2 million people die of CVD in India every year  32 % are in the age group  Four Indians die of a heart ailment every minute

prevalence of major risk factors for CVD.  Diabetes 11.9%  hypertension 25.4%  dyslipidaemia 40.2%  hypertriglyceridaemia 28.3%  overweight 60.2% and  metabolic syndrome 34.1%.

Contd…  Use of tobacco in any form was present in 22.9% of men and 0.5% of women  79% of the subjects followed a sedentary lifestyle. --Natl Med J India Jan-Feb

CURRENT WORLDWIDE VARIATIONS  Currently 85 % of the world’s population lives in low and middle income countries.  About 30 % of the world’s population lives in East Asia and the pacific islands and another 22 % live in south Asia.

CORONARY ARTERY DISEASE IN WOMEN  Stroke and MI- Number one killer of women with 500,000 deaths per year  First myocardial infarction in women is more severe and more lethal than they are in men.

Contd…  Women’s mortality rate at 6 months post myocardial infarction double that of men  Coronary artery bypass surgery operative mortality 4.5% women, 2.6% men

Contd…  Menopause often cause increase in total cholesterol and LDL  Framingham Study: Risk of CAD doubles with onset of menopause

 Heart disease or cardiopathy is an umbrella term for a variety of different diseases affecting the heart umbrella termheart  Cardiovascular disease is any of a number of specific diseases that affect the heart itself and/or the blood vessel system, especially the veins and arteries leading to and from the heart.

Types of cardiovascular disease  Atherosclerosis Atherosclerosis  Ischaemic heart disease Ischaemic heart disease  Heart failure  Hypertensive heart disease  Include:Left ventricular hypertrophyLeft ventricular hypertrophy  Coronary heart disease Coronary heart disease  (Congestive) heart failure (Congestive) heart failure  Hypertensive cardiomyopathy Hypertensive cardiomyopathy  Cardiac arrhythmias Cardiac arrhythmias

  Inflammatory heart disease  Valvular heart disease

Risk factors  hypertension, diabetes, high cholesterol (hypercholesterolemia, hyperlipidemia), obesity, sedentary lifestyle, male gender, increasing age, drinking excessive amounts of alcohol, long-term stress, smoking and heredityhypertensiondiabeteshigh cholesterolhypercholesterolemiahyperlipidemia obesity  high C-protein levels & high homocysteine levels

Signs and symptoms  · chest pain or abdominal distress  · cough  · cyanosis  · enlarged veins in the neck  · fainting  · loss of appetite  · palpitations  · shortness of breath  · swelling in the legs  · weakness and fatigue

Diagnosis History Physical examination  blood and urine tests  · cardiac catheterization, a special X-ray done with a contrast agent to look at the heart and its blood supply  · chest X-ray  · echocardiogram, which uses sound waves to view the beating heart  · electrocardiogram, or EKG, which shows the electrical activity of the heart  · stress EKG tests, in which the person either walks on a treadmill or receives a medicine while the effects on the heart are examined with an EKG or imaging test

CONCLUSION  It is possible that the efficient transfer of low-cost preventive and therapeutic strategies may alter the natural course of the epidemiological transition in every part of the world and thus reduce the excess global burden of preventable CVD