1. 1 Trends in risk factors for cardiovascular disease in Canada: Temporal, socio-demographic and geographic factors, 1994–2004 CIHR Team Grant in Cardiovascular Outcomes Research Douglas S. Lee MD PhD, Maria Chiu MSc, Douglas G. Manuel MD MSc, Karen Tu MD MSc, Xuesong Wang MSc, Peter C. Austin PhD, Michelle Y. Mattern PhD, Tezeta F. Mitiku BSc, Lawrence W. Svenson BGS, Wayne Putnam MD, William M. Flanagan BM, Jack V. Tu MD PhD, for the Canadian Cardiovascular Outcomes Research Team

2. CCORT CCORT is a group of over 30 outcomes researchers from 5 provinces (NS, QC, ON, AB, BC) who are working together on projects to measure and improve the quality of cardiac care in Canada Funded by a CIHR Team Grant in Cardiovascular Outcomes Research Institute for Clinical Evaluative Sciences (ICES) in Toronto is the national coordinating centre for CCORT www.ccort.ca CIHR Team Grant in Cardiovascular Outcomes Research

3. Purpose of Study To examine national trends between 1994 and 2005, in the prevalence of heart disease and cardiovascular disease risk factors To see whether the rate of change of risk factors differs in Canadians of different age, sex and socioeconomic groups CIHR Team Grant in Cardiovascular Outcomes Research

4. Methods We analyzed mortality data from Statistic Canada’s National Population Health Surveys and the Canadian Community Health Surveys for the period 1994-2005 We determined age- and sex-standardized rates of heart disease and cardiovascular risk factors in those aged 12 years and over CIHR Team Grant in Cardiovascular Outcomes Research

5. Overview The following is a set of slides that highlight key findings from the original manuscript. Please feel free to use these slides to disseminate this information CIHR Team Grant in Cardiovascular Outcomes Research

6. Statistics Canada’s 4-group categorization of income adequacy

7. Age- and sex-adjusted trends in heart disease from 1994 to 2005 stratified by income adequacy category

8. Reasons for increasing trends More patients with heart disease – Patients with heart disease are living longer because of better treatments – However, there will be a need for more cardiac care with the increasing number of individuals living with heart disease

9. Age- and sex-adjusted trends in hypertension from 1994 to 2005 stratified by income adequacy category

10. Age- and sex-adjusted trends in diabetes from 1994 to 2005 stratified by income adequacy category

11. Age- and sex-adjusted trends in smoking from 1994 to 2005 stratified by income adequacy category

12. Age- and sex-adjusted trends in obesity from 1994 to 2005 stratified by income adequacy category

13. Hypertension Trends by Body Mass Index Smoking Trends by Body Mass Index Diabetes Trends by Body Mass Index Age- and sex-adjusted trends in hypertension, smoking, and diabetes stratified by body mass index from 1994 to 2005 Body mass index: <25 normal, 25-29.9 overweight,  30 obese

14. Map of risk factors for cardiovascular disease in Canada. Health regions are shown according to the number of risk factors with a prevalence exceeding the national average by at least 10%. Greater risk factor prevalence in eastern provinces; Fewer risk factors In western provinces

15. Trends in hypertension from 1994 to 2005 stratified by age and sex

16. Trends in diabetes from 1994 to 2005 stratified by age and sex

17. Trends in obesity from 1994 to 2005 stratified by age and sex

18. Reasons for increasing risk factors Obesity – Physical inactivity and sedentary lifestyles – Environments not built to encourage exercise or “walkability” – Excessive caloric intake – Obesogenic diet: High fat; Little fresh fruits and vegetables Diabetes – Increasing rates of obesity – Physical inactivity and sedentary lifestyles

19. Reasons for increasing risk factors Hypertension – High rates of salt consumption – Obesity also increases hypertension risk – Better screening and detection of hypertension – Improved survival of patients with hypertension due to more and better medications

20. Trends in age- and sex-standardized rates of hypertension from 1994 to 2005 by province – Hypertension is increasing in all provinces

21. Trends in age- and sex-standardized rates of diabetes from 1994 to 2005 by province – Diabetes is increasing in all provinces

22. Trends in age- and sex-standardized rates of diabetes from 1994 to 2005 by province – Obesity is increasing in many Canadian provinces

23. Conclusions Key cardiovascular risk factors including hypertension, obesity, and diabetes are increasing fastest among younger Canadians (in their 50s or younger) Hypertension and obesity are increasing in all socioeconomic groups Diabetes is increasing in nearly all income groups, with the greatest increases in the poorest Canadians and the gap between the lowest and highest socioeconomic groups is widening Heart disease is increasing in Canada with the prevalence increasing fastest in lower socioeconomic groups

24. Funding This study was supported by a Team Grant in Cardiovascular Outcomes Research to the Canadian Cardiovascular Outcomes Research Team from the Canadian Institutes of Health Research CIHR Team Grant in Cardiovascular Outcomes Research

25. Thank You For more information please visit www.ccort.ca CIHR Team Grant in Cardiovascular Outcomes Research