1、Heart Disease is the major health challenge of the 21st century. Unless something is done, by 2020, 36 out of every 100 people will die of heart disease and stroke. The rate of increase will be greatest in low and middle income countries, those countries that can least afford it.“Heart disease and s
2、troke are not inevitable. They are largely preventable. Preventive measures will reduce the incidence of death and disability.” Prof. Mario Maranho, Past-President, World Heart FederationSource : World Health Report 2002WORLD HEART FEDERATION “Superior Doctors Prevent the Disease. Mediocre Doctors T
3、reat the Disease Before Evident. Inferior Doctors Treat the Full Blown Disease.”-Huang Dee: Nai - Ching (2600 B.C. 1st Chinese Medical Text)Population6,000,000,000Total deaths per year 54,000,000 (0.9%)Cardiovascular death17,000,000 (31%)44% coronary heart disease31% stroke78% in low income countrie
4、sAIDS3,000,000Tuberculosis1,000,000Malaria1,000,000 (mostly in Africa) Global causes of death One out of every 3 deaths 17 million deaths worldwide 1999 estimated to reach 25 million in 2020 Six times the current number of deaths from HIV/Aids 80% of deaths are in low/middle income countries Sources
5、: WHO World Health Report 2000, CVD infobaseWORLDWIDE CVD FACTSAtherothrombosis = major cause of death in the western worldATHEROSCLEROSIS: A SYSTEMIC DISEASEATHEROSCLEROSIS Chronology of Atherosclerotic Artery Disease Atherosclerosis Plaque SCA Prevention Vulnerable SecondaryIschemicArtery Disease
6、CoronaryCerebral PeripheralAntman EM modf. Libby P. Circulation 2001;104:365Cardiovascular Risk FactorsProtecting your Heart Maternal and children undernutrition HIgh Risk Sex High Blood Pressure Tobacco Smoking Alcohol Abuse Unsafe Water and lack of basic sanitary and hygiene High Cholesterol Pollu
7、tion of the air at home Iron defficiency Obesity Causes of 40% of the 56 millions of deathIn the world. WHO 10 MORE IMPORTANT RISKS 2002SmokingHypertension (BP 140/90 mmHg)Low HDL-C ( 40 mg/dL)Early Family History atherosclerosis (1st grade relatives 55 years for men and 65 for womenAge ( 45 years m
8、ales/ 55 years females)AF* + CAD/ relatives 1st grade (55 anos males/ 126 mg/dL)Caracterization of the Independent Risk Factors for atherosclerosisINDEPENDENTHypertensionTobacco SmokingTotal Cholesterol & High LDL-C HDL-CDiabetes MelitusAgingMenopause CVD Risk Factors for AtherosclerosisCONDITIONALT
9、riglyceridesLDL type BHomocysteinLp (a)*FibrinogenInflammatory MarkersFAVOURINGObesityAbdominal Obesidade Physical InactivityEarly Family HistoryEthnicSocial & Psychologic Factors ObesityMetabolic SyndromePhysical InactivityHigh cholesterol and saturated fat dietNew Risk FactorsInflamatory factors (
10、RCP + de high sensibility) Homocystein high levels Lp (a)+ Prothrombotic Factors Glucose intolerance Sub-clinical Aterosclerose (coronary Ca+, intimal thickness)Potentiation of Risk by the Following FactorsPREVALENCE OF RISK FACTORSOVERWEIGHT/ OBESITY-MCI 25Kg/m 41,0% SMOKING 32,9% DIABETES 7,6%HYPE
11、RTENSION -BRASIL IBGE 15,0% HIGH CHOLESTEROL 240mg 16,0% World-wide sales/consumption increasing 2/3 young men in China smoke 40% men in India use Tobacco products 50% women under age 30 in East Germany smoke (doubled in 5 years)Source: Sir Richard Peto / Bundeszentrale fr gesundheitliche AufklrungL
12、IFESTYLE TRENDS & CVD TOBACCOSources: WHO World Health Report 2000, CVD infobase600 million with Hypertension at risk of heart attack, stroke, heart failure 180 million high income countries from low/middle income countriesLIFESTYLE TRENDS & CVD HYPERTENSIONARTERIAL BLOOD PRESSURE CLASSIFICATION IN
13、ADULTSSP* mmHg 120 120-139 140-159 160DP E80 or 80-89 or 90-99 or 100 GOAL General Population 140/90 High Risk Patients for CAD & Diabetes 110 and 126 140 Low Glucose Tolerance 126 and 140 and 200 Diabetes Mellitus 126 or 200 or 200 (classic symptoms)Objectives in the treatment of Diabetes Mellitus
14、Fasting Blood Glucose (mg/dL) Post-Prandrial Glucose (2h)(mg/Dl) HbA1c(%) BMI Optimal 110* 140 6,0* 25Accept1261601,0 aboveM Also trend in low/middle income countriesKuwait 44% women 32% menBrazil 12% women 7% menPakistan (urban) 20% women 10% men Source: British Medical Journal, Report of WHO Nutri
15、tion 2000LIFESTYLE TRENDS & CVD OBESITYLIFESTYLE TRENDS & CVD DIABETES 150 Million Diabetics (90% type II) Incidence projected to double in 25 years Projected increase highest in India and China Increased incidence for younger age groupsSource : Diabetes and Cardiovascular Disease, IDF 45678140235 P
16、ooling Project Framingham Study Israel prospective CAD Risk RatioPlasma Cholesterol (mmol/L) 3.95.26.57.82.61.02.03.04.00.71.02.04.0CHDRiskRatioSerum Cholesterol (mmol/L) LDL - cholesterol 190 Very High Total Cholesterol 240 HighHDL-cholesterol60 Highmmo/l mg/dl 6.2 240Cholesterol 3.6 140 1.0 39010
17、20 30 40 50 6070 80Total LDLHDLMen WomenAge2.0 1771.8 1591.6 1421.4 1241.2 1061.0 8925-2930-3435-3940-4445-4950-5455-59mmo/l mg/dl Meanplasma Triglyceride(mmol/l)AgeMenWomenAge group (years)40 - 4950 - 5960 - 6970 - 79122436480 Rate per 1000MenDiabeticNon Diabetic01224364860Age group (years)40 - 495
18、0 - 5960 - 6970 - 79 Rate per 1000WomenDiabeticNon Diabetic HIGH Absolute Risk 20% in 10 years MEANAbsolute Risk 10 a 20% in 10 years LOW Absolute Risk 20% 10 years ( generally with two or more CV risk factors other than cholesterol) Refer to Framinghan Risk TablesIndividuals without Atherosclerosis
19、 Diseases EvidenceHIGH RISK PREVENTIONAbsolute Risk for events 10%, but 20% in 10 yearsIndividuals with 2RF* (except DM) beyond cholesterol (LDL-c 160 mg/dL) Refer the Framinghan score for risk Use the absolute score of risk factors (Framinghan) for events in 10 yearsMEAN RISKAbsolute Risk of events
20、 160 mg/dL) or just high LDL-c Its not necessary to refer to the scores of risk of Framingham.LOW RISKProposed Goals for Lipids Levels according risk factors for CAD LDL-c HDL-c TG HIGH RISKPacients with CAD,PVI* or symptomatic carotid atherosclerosis 40 150 Pacients with Diabetes 45 150Risk for CAD
21、 in 10 years 20% 40 10% e 20% 40 150 LOW RISK Risk for CAD in 10 years 10% 40 150 LIFE STYLE CHANGES DIETEXERCISEWEIGHTSMOKINGSaturated Fats 7% total cal.Poliunsaturated Fats up to 10% total cal.Monounsaturated Fats up to 20% total cal.Total Fat 25 - 30% of the total cal.Complex Carbohydrates 50 - 6
22、0% of the total cal.Fibers 20 - 30g/dailyProteins Approximately 15% of the total cal.Cholesterol 200 mg/dayPhytosterols 3-4g/dayFibers 20 - 30g/day (6g soluble)Total Calories Balance between energetic gain & losses daily to keep the ideal weight. % With CHD Event05101520253090110130150170190210Mean
23、LDL-C Level at Follow-up (mg/dL)4S-PI4S-RxLIPID-RxCARE-RxLIPID-PICARE-PIAFCAPS/TexCAPS-RxAFCAPS/TexCAPS-PIWOSCOPS-RxWOSCOPS-PI1 Prevention2 PreventionLIFESTYLE TRENDS & CVD WOMEN Women unaware of their CVD risk CVD affects women around the globe CVD deaths 8 times higher than breast/ovarian cancers
24、India, China and Latin America account for 48% of deaths.ADDITIONAL RISK FACTORS Mental stress, anxiety and depression,as well as, social factors. Depression is present up to 45% of cases of acute myocardial infarction(AMI). If unknown or untreated, depression favors a second MI (2-4 times more), in
25、creasing the possibility of death up to 5 times more. DEPRESSION AS A RISK FACTOR FOR CARDIOVASCULAR DISEASESHIPPISLEY-COX, J., FIELDING, K., PRINGLE, M. Depression as a risk factor for ischaemic heart disease in men : population based-control study. BRITISH MEDICAL JOURNAL, 1998; 316 : 1714-1719 De
26、pression and CardioVascular DiseasesCOFFEE HEART STUDY Depression is an independent risk factor for cardiovascular diseases (DCV)Analysis of “U.S. National Health and Nutrition Examination Survey (NHANES)” showed that patients with depression has 2,5 to 4 times greater of risk of coronary artery dis
27、eases like myocardial infarction and 5 times greater risk of sudden death.Depression is a bad marker for cardiovascular prognosis and survival. May coffee prevent depression and Myocardial Infarction? Report from WHO/WHF in 2004.演讲完毕，谢谢观看！Thank you for reading! In order to facilitate learning and use, the content of this document can be modified, adjusted and printed at will after downloading. Welcome to download!汇报人：XXX 汇报日期：20XX年10月10日
