1、-Leading cause of mortality in developed countries and a rising tendency in developing countries(disease of civilization)-A major impact on life expectancy-Significantly contributes to morbidity and death rates in the middle aged population:potential life years lost,common cause of premature death,l
2、abor force(economic costs),family life-Morbidity:nearly 30%of all disability cases-Contributes to deterioration of the quality of life1.,Descriptive epidemiology:=Describing distribution of cardiovascular disease by means of certain characteristics such as:PERSON(i.e.,age,gender,ethnicity)TIME and P
3、LACE2.,Analytic epidemiology=Analyzing relationships between CVD and risk factors(which elevate the probability of a disease at population level),risk model and multicausal developments3.,Experimental epidemiology/Interventions=Strategies of cardiovascular prevention(primordial,primary,secondary,ter
4、tiary;individual and community levels)In the world:CVD deaths account for one third of all deaths(25-50%depending on the level of economic development)among which 50%:coronary deathsCVD made up 16.7 million of global deaths in 2002,among which 7 million due to coronary heart disease,6 million due to
5、 strokeDistribution of types of CVD in global deaths:Global cardiovascular deaths in 2002:16.7 millionamong which:coronary heart disease 7.2 million stroke 6.0 million 0.9 million hypertensive heart disease 0.4 million inflammatory heart disease 0.3 million rheumatic heart disease 1.9 million other
6、CVDQuestion:What is the relative amount of CVD in death rates in different age groups?-Early lesions of blood vessel,atherosclerotic plaques:around 20 years-adult lifestyle patterns usually start in childhood and youth(smoking,dietary habits,sporting behavior,etc.)-Increase in CVD morbidity and mort
7、ality:in age-group of 30-44 years-Premature death(65 yrsPROPORTION OF MORTALITY IN DIFFERENT AGE-GROUPS (MEN)externalotherscancerCVD7,3%17,7%35,0%40,0%31,3%36,5%24,0%8,2%64,7%12,2%18,3%4,8%0%10%20%30%40%50%60%70%80%90%100%1-24 yrs25-64 yrs65 yrsPROPORTION OF MORTALITY IN DIFFERENT AGE-GROUPS(WOMEN)e
8、xternalotherscancerCVDQuestion:What is the relative amount of CVD in death rates in women and men?-Widespread idea:CVD is often thought to be a disease of middle-aged men.-Cardiovascular mortality(fatal cases)are more common among men.However,CVD affect nearly as many women as men,albeit at an older
9、 age-Women:special case(WHO,2004)a.,Higher risk in women than men(smoking,high triglyceride levels)b.,Higher prevalence of certain risk factors in women(diabetes mellitus,depression)c.,Gender-specific risk factors(risks for women only)(oral contraceptives,hormone replacement therapy,polycystic ovary
10、 syndrome)Question:What is the relative amount of CVD in death rates in different ethnic groups?-In the US:increased cardiovascular disease deaths in African-American and South-Asian populations in comparison with Whites-Increased stroke risk in African-American,some Hispanic American,Chinese,and Ja
11、panese populations-Migration:Ni-Hon-San Study:Japanese living in Japan had the lowest rates of CHD and cholesterol levels,those living in Hawaii had intermediate rates for both,those living in San Francisco had the highest rates for bothQuestion:What is the relative amount of CVD in different geogra
12、phical places?What are the time trends?International and regional characteristics of distributionSDR:Standardized Death RateDirect mode of standardization,using the age distribution of a hypothetical European standard populationPremature death rates for comparison purposes (140 Hgmm and/or a diastol
13、ic blood pressure 90 Hgmm-Free of clinical symptoms for many years(screening)-In most countries,up to 30 percent of adults suffering,increasing with age in civilized countries-Positive family history-Dietary habits(a high intake of salt,processed food,low levels of water hardness,high thyramine cont
14、ent of food,alcohol use)-Modern lifestyle(increased sympathetic activity,psychosocial stress,leading position in job)Development:Rheumatic fever usually follows an untreated beta-haemolytic streptococcal throat infection in childrenAs a consequence,the heart valves are permanently damaged which may
15、progress to heart failureToday mostly affects children in developing countries,linked to poverty,inadequacy of health care accessOccurrence:12 million people currently affected by rheumatic fever and RHD,two-thirds are children(5-15 years),for example:approx.1 000 000 in Sub-Saharan Africa,700 000 i
16、n South-Central Asia,176 000 in China,150 000 in North Africa,40 000 in Eastern Europe(!)-Se cholesterol:structure and functioning of blood vessels,atherosclerotic plaques-Altering functions of cholesterol fractions(LDL:risk,HDL:protection)-Estrogen:tends to raise HDL-cholesterol and lower LDL-chole
17、sterol,protection for women in reproductive age-Partially genetic determination of metabolism,partially dependent of nutrition(egg,meats,dairy products)European guidelinesUS guidelinesTotal cholesterol5.0 mmol/l240 mg/dl(6.2 mmol/l)LDL-cholesterol3.0 mmol/l=1.0 mmol/l(men)=1.2 mmol/l(women)=40 mg/dl
18、(1 mmol/l)Triglycerides(fasting)1.7 mmol/l200 mg/dl(2.3 mmol/l)-The link between smoking and CVD(mainly CHD)was identified in 1940-Greatest risk:initiation 25:overweight,30:obesity-A modern”epidemic”:More than 60%of adults in the US are overweight or obese,in China:70 million overweight people-Eleva
19、tes the risk of both CVD and diabetes mellitus-Diabetes mellitus:damages both peripheral and coronary blood vessels-Unhealthy diet:low fruit and vegetable,fiber content,and high saturated fat intake,refined sugar-Psychological factors(Type A behavior,hostility)-Depression and CVD:bidirectional linka
20、.,depression may increase the risk of CVD and worsen recovery process b.,CVD may induce depression-Low socioeconomic status(SES):a.,in developed countries:less educated and lower SES groups(accumulation of risk factors)b.,in developing countries:more educated and higher SES groups(western lifestyle)
21、Primordial:Social,legal and other(often nonmedical)activities which may lead to a lowering of risk factors(e.g.,socioeconomic development,smoke-free restaurants)Primary:Controlling risk factors contributing to CVD(health education programs,anti-smoking campaign,sports programs,nutrition counselling,
22、regular check of blood pressure and certain blood parameters,e.g.,cholesterol,blood lipids,glucose)Secondary:Screening and treatment of symptomatic patients,set up personal risk profile Tertiary:Cardiovascular rehabilitation,prevention of recurrence of CVD(new heart attack:5-7 times higher risk amon
23、g CVD patients)The individual approach(detecting those at greatest risk):lifestyle guidelines(e.g.,smoking cessation)The population-wide approach:(the whole population,western lifestyle)Example for community-wide CV prevention programs:-Framingham Heart Study(1948-)Framingham Risk Scoring-North-Kare
24、lia Project(1972-)Finland-Stanford Projects(1972-75,1980-86)USA-Minnesota Cardiovascular Health Program(1980-88)USA-Multiple Risk factor Intervention Trial(1972-79)USA What may be the reasons for the declining CVD incidence rates?At the same time that there has been an epidemic of obesity,the rates of CVD has markedly declined.Why hasnt CVD go up in the population as obesity has skyrocketed?Define the steps to prevent CHD
