高血压英文ppt精品课件epidemiology and overview of cardiac

EPIDEMIOLOGY and overview of cardiac DISEASE INTRODUCTION o The 20th century saw unparalleled increase in life expectancy & major shift in the cause of illness throughout the world GLOBAL BURDEN OF CVD. oA century ago, CVD death 10% oToday, approximately 30% of deaths worldwide including nearly 40% in high income countries and about 28% in low and middle income countries -Braunwalds Heart Disease 2008 EPIDEMIOLOGICALTRANSITIONS Stage Typical proportion of deaths caused by CVD % Predominant types of CVD Pestilence and Famine 10 Rheumatic heart disease, cardiomyopathies Receding Pandemics 10-35 Rheumatic valvular disease, HT,CHD, Stroke Contd Degenerative & Manmade diseases 35 65 CHD, Stroke Delayed degenerative Diseases 40 50 CHD, Stroke, CHF. PREVALENCE OF CHD-US Age in years Male % Female % 40-49 07 05 50-59 13 08 60-69 16 11 70-79 22 14 PREVALENCE oThe prevalence of CHD is about 7.4% in men and 4.5% in women. oThe prevalence is higher in lower socio-economic groups. oOf 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 oThere are 101,000 deaths from CHD in the UK each year. oDeath rates from CHD have fallen by 46% for people under 65 years in the last 10 years in UK, Australia (48%) and Norway (54%). oDeath from CHD is more likely during winter. MORBIDITY RATES IN UK oThe average incidence of Myocardial Infarction is 600 per 100,000 in men aged 30-69 and 200 per 100,000 in women. The incidence increases with age oThere 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 Disease Age % Heart attack Men Women 04 % 02% Angina Men 55-64yrs Women 08% 05 % Men 65-74 yrs Women 17% 08% NEWS ALERT Aug 13, 2009 The heart of the matter oPremature heart attack is common in Indians compared to the Western population o Beyond the age of 50, the risk of heart attack per year approximately 2-3 per 1000 Contd Aug 13, 2009.The Hindu oone in 200 deaths of adults over age 40 occurs due to Sudden Cardiac Arrest Contd November 4 , 2006 The Hindu oMYSORE: Incidence of heart disease has doubled in India during the last 20 years on account of changes in lifestyle and economic development. Contd oDr Rajesh Pande (Cardiovascular disease in India and the impact of lifestyle and food habits) o80 % 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 Gender Incidence Prevalence Mortality Male 06/1000 Urban -3590/1000 Rural -1745/1000 40 % in Urban Female 02/1000 Urban -2893/1000 Rural -1343/1000 30 % in Rural. PREVALENCE IN CHENNAI Year Urban % Rural % 1960 2 1970 6.5 2 1980 7.0 2.5 1990 9.7 4 2000 10.5 4.5 OUR FUTURE oThe World Health Organization estimated that 60 % of the worlds cardiac patients will be Indian by 2010 o 50 % of CVD-related deaths in India occur below the age of 70, compared with just 22 % in the West Contd oCVD 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 oSouth Asians have elevated levels of LDL cholesterol and triglycerides, while also suffering from a deficiency in HDL cholesterol oSouth Asians seem more naturally vulnerable to heart disease than other ethnic groups Contd oThe disease occurs at a much younger age in Indians as compared to those in North America and Western Europe oIn general, the incidence of all rhythm problems is 8-10 per 1000 people VITAL STATISTICS-WHO o2 million people die of CVD in India every year o32 % are in the age group 35-44. oFour Indians die of a heart ailment every minute prevalence of major risk factors for CVD. oDiabetes 11.9% ohypertension 25.4% o dyslipidaemia 40.2% ohypertriglyceridaemia 28.3% ooverweight 60.2% and ometabolic syndrome 34.1%. Contd oUse of tobacco in any form was present in 22.9% of men and 0.5% of women o79% of the subjects followed a sedentary lifestyle. -Natl Med J India. 2008 Jan-Feb CURRENT WORLDWIDE VARIATIONS oCurrently 85 % of the worlds population lives in low and middle income countries. o About 30 % of the worlds population lives in East Asia and the pacific islands and another 22 % live in south Asia. CORONARY ARTERY DISEASE IN WOMEN qStroke and MI- Number one killer of women with 500,000 deaths per year oFirst myocardial infarction in women is more severe and more lethal than they are in men. Contd oWomens mortality rate at 6 months post myocardial infarction double that of men oCoronary artery bypass surgery operative mortality 4.5% women, 2.6% men Contd oMenopause often cause increase in total cholesterol and LDL oFramingham Study: Risk of CAD doubles with onset of menopause oHeart disease or cardiopathy is an umbrella term for a variety of different diseases affecting the heart oCardiovascular 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 oAtherosclerosis oIschaemic heart disease oHeart failure oHypertensive heart disease oInclude:Left ventricular hypertrophy oCoronary heart disease o(Congestive) heart failure oHypertensive cardiomyopathy oCardiac arrhythmias o oInflammatory heart disease oValvular heart disease Risk factors o hypertension, diabetes, high cholesterol (hypercholesterolemia, hyperlipidemia), obesity, sedentary lifestyle, male gender, increasing age, drinking excessive amounts of alcohol, long-term stress, smoking and heredity ohigh C-protein levels & high homocysteine levels Signs and symptoms o chest pain or abdominal distress o cough o cyanosis o enlarged veins in the neck o fainting o loss of appetite o palpitations o shortness of breath o swelling in the legs o weakness and fatigue Diagnosis History Physical examination o blood and urine tests o cardiac cathe