心血管疾病流行病学研究ppt课件

Click to edit Master title style Click to edit Master subtitle style Slide 1 Epidemiology of Cardiovascular Disease Slide 2 Major Types of Cardiovascular Disease (CVD) Adapted from Mackay J, Mensah G, eds. The Atlas of Heart Disease and Stroke. The WHO and the US CDC, 2004. Coronary heart disease (CHD) Rheumatic heart disease Congenital heart disease Stroke Aortic aneurysm and dissection Deep venous thrombosis and pulmonary embolism Peripheral artery disease Slide 3 Deaths Due to CHD and Stroke in Europe Adapted from Allender S, et al. European Cardiovascular Statistics, 2008. /files/statistics%202008%20web-161229A.pdf. Accessed 9 November 2008. 960,632 494,188 963,404 744,550 0 200,000 400,000 600,000 800,000 1,000,000 1,200,000 CHD Stroke Total Number of Deaths in Latest Available Year Men Women Slide 4 Deaths Due to CVD vs Other Diseases in Europe Men Adapted from Allender S, et al. European Cardiovascular Statistics, 2008. /files/statistics%202008%20web-161229A.pdf. Accessed 9 November 2008. Injuries and poisoning All other causes Stroke CHD Respiratory disease Stomach cancer Colorectal cancer Other cancer Other CVD Lung cancer 17% 12% 7% 11% 6% 2% 2% 11% 11% 21% Injuries and poisoning All other causes Stroke CHD Respiratory disease Stomach cancer Colorectal cancer Other cancer Other CVD Lung cance r 18% 5% 6% 9% 2% 2% 1% 15% 17% 22% Breast cancer 3% Women Slide 5 Cardiovascular Mortality Increases Sharply With Serum Cholesterol Concentration in Patients With Diabetes Adapted from Stamler J, et al. Diabetes Care. 1993;16:434444. Deaths per 10,000 Person-Years 100 50 0 Cholesterol Level 150 180 mg/dL200219 mg/dL240259 mg/dL280 mg/dL (n=62,448)(n=1105)(n=75,122)(n=1038)(n=40,090)(n=529)(n=17,604)(n=353) No diabetes Diabetes Slide 6 Slide 7 Slide 8 The Gap Between CHD Prevention Guidelines and Practice Statin therapy effectively reduces the risk of mortality and major coronary events in individuals with hypercholesterolemia or hyperlipidemic patients with or without CHD. Nevertheless, there is a wide gap between target LDL-C levels established by treatment guidelines and those achieved in clinical practice. Adapted from Waters DD. Am J Manag Care. 2001;7:S138S143; Graham I, et al. Eur J Cardiovasc Prev Rehabil. 2007;14(suppl 2):E1E40; National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 2001;285(19):24862497; Pearson TA, et al. Arch Intern Med. 2000;160:459467. Slide 9 Only 15.5% of German Physicians Reported Knowledge of ESC Guidelines for CHD Prevention N=1023 Physicians surveyed. ESC Guidelines=European Society of Cardiology Guidelines; German Guidelines=German Society of Cardiology/German Society of Cardiac Prevention and Rehabilitation Guidelines; AHA/ACC Guidelines=American Heart Association Guidelines/American College of Cardiology. Adapted from Heidrich J, et al. Eur J Cardiovasc Prev Rehabil. 2005;12(6):521529. 70 63.6 15.5 36 0 10 20 30 40 50 60 70 80 90 100 At Least 1 Guideline German Guidelines ESC Guidelines AHA/ACC Guidelines Physicians Reporting Knowledge, % Slide 10 Only 15% of European Primary Care Physicians Surveyed Adhered to Current European CVD Prevention Guidelines Adapted from Hobbs FD, Erhardt L. Fam Pract. 2002;19(6):596604. Believe in the Need for Formal Guidelines Agree With the Content of Current Guidelines Currently Use European Guidelines 0 10 20 30 40 50 60 70 80 90 100 Physicians Who Believed Statement, % 87 89 15 Slide 11 EUROASPIRE II: Almost 40% of At-Risk Patients With Hyperlipidemia Did Not Receive Dietary Advice N=4306 Patients with a history of hyperlipidemia. EUROASPIRE=European Action on Secondary Prevention through Intervention to Reduce Events; CABG=coronary artery bypass graft; PTCA=percutaneous transluminal coronary angioplasty; AMI=acute myocardial infarction. Adapted from EUROASPIRE II Study Group. Eur Heart J. 2001;22:554572. 0 10 20 30 40 50 60 70 80 90 100 Patients Receiving Dietary Advice, % 62 66.6 61.9 56.5 62.2 Post-CABGPost-PTCAPost-AMIIschemicTotal Slide 12 EUROASPIRE II: Almost 40% of At-Risk Patients With Hyperlipidemia Did Not Receive Lipid-Lowering Therapy Adapted from EUROASPIRE II Study Group. Eur Heart J. 2001;22:554572. Lipid-Lowering Medication (n=3180) No Lipid-Lowering Medication (n=2044) 39% 61% 0 10 20 30 40 50 60 70 80 90 100 Patients, % Slide 13 EUROASPIRE II: Only 51% of Patients on Lipid-Lowering Therapy Achieved Total Cholesterol Goala aTotal cholesterol 190 mg/dL (5 mmol/L). Adapted from EUROASPIRE II Study Group. Eur Heart J. 2001;22:554572. Center Patients, % 39 31 70 44 41 42 48 55 49 66 49 41 52 65 54 51 Belgium Czech Republic Finland France Germany Greece Hungary Ireland Italy Netherlands Poland Slovenia Spain Sweden UK All 020406080100 Slide 14 57%b not achieving goal aFrance, Germany, Italy, and Spain; bPercentage of high-risk patients not achieving LDL-C goal. REALITY=Return on Expenditure Achieved for Lipid Therapy. Adapted from Van Ganse E, et al. Curr Med Res Opin. 2005;21(9):13891399. REALITY Study: Most Patients Did Not Achieve LDL-C Goal of 100 mg/dL in 4 European Countriesa Slide 15 Summary CVD (primarily CHD and stroke) is the most common cause of mortality in Europe. Although dyslipidemia is a modifiable risk factor, studies in Europe showed A Knowledge Gap A minority of German physicians surveyed reported knowledge of ESC guidelines An Action Gap A minority of European physicians surveyed were treating patients according to ESC guidelines A Treatment Gap Only half of at-risk patients were achieving total cholesterol goals Less than half of hyperlipidemic patients were achieving LDL-C goals Adapted from Allender S, et al. European Cardiovascular Statistics, 2008. /files/statistics%202008%20web-161229A.pdf. Accessed 9 November 2008; Mackay J, Mensah G, eds. The Atlas of Heart Disease and Stroke. The WHO and the US CDC, 2004; Grundy SM, et al. Circulation. 2000;101:E3E11; Heidri