【医学英文精品课件】epidemic of cardiovascular disease

Epidemic of Cardiovascular disease Global and US trends Any Lessons for Honduras?,Dr. Thomas G. Allison Cardiovascular Diseases and Internal Medicine Mayo Clinic Rochester, MN,Disclosures,Conflicts of interest: none Off-label use of drugs or devices: none,Global Burden of Cardiovascular Disease,Total deaths 57 million,Cardiovascular,16.7 million,HIV TB Malaria,5 million,Lopez. Lancet 2006; Reddy. NEJM 2004,2002 statistics,International Comparison,(Men ages 35-74),Cardiovascular Disease in the Americas,Highest,Lowest,Life Expectancy in the Americas,Haiti: 55 years Guyana: 63 years Bolivia: 65 years Honduras: 67 years Brazil: 70 years Peru: 71 years Jamaica: 72 years Paraguay: 72 years Columbia: 73 years,Mexico: 74 years Argentina: 75 years Uruguay: 75 years Panama: 76 years Costa Rica: 77 years Chile: 77 years Cuba: 78 years USA: 78 years Canada: 80 years,Modified Model of the Epidemiological Transition as it Pertains to Cardiovascular Disease,Yusef et al. Circulation 2001;104:276-2753,Stage 1: Age of Pestilence and Famine,Stage 1: Haiti,Life expectancy = 55 years,Causes of Death Haiti 2002,Stage 2: Age of Receding Pandemics,Stage 2: Bolivia,Life expectancy = 65 years,Causes of Death Bolivia 2002,Stage 3: Age of Degenerative and Man-Made Diseases,Stage 3: Jamaica,Life expectancy = 72 years,Causes of Death Jamaica 2002,Yang. Lancet, 2008,Changing Distribution of the Causes of Death in Peoples Republic of China,Stage 4: Age of Delayed Degenerative Diseases,Causes of Death USA 2002,Age-adjusted US CVD Disease Trends,Nemetz et al. Arch Intern Med 2008;163:264-270,Despite decrease in Heart Disease Mortality Heart disease remains highly prevalent #1 Cause of death in US #1 Contributor to US health care costs,Years 1996-2004,Hospital discharges for cardiovascular diseases. (United States: 1970-2006). Note: Hospital discharges include people discharged alive, dead and status unknown. Source: NCHS and NHLBI.,Estimated direct and indirect costs (in billions of dollars) of major cardiovascular diseases and stroke (United States: 2009). Source: NHLBI.,Total Cost = 344.9 billion dollars,Transition Factors 1 2,Sanitation water quality Immunization Antibiotics,Population growth Older population,Increased mechanization of food production More processed food,Increased salt intake,Hypertension Hypertensive heart disease Hemorrhagic stroke,Transition Factors 2 3,Changing economy Affluence Mass media,Cigarette smoking Reduced physical activity Increased caloric intake More meat consumption,Obesity Diabetes Hyperlipidemia Ischemic Stroke MI,Incubation Period for Chronic Disease,Transition Factors 3 4,More educated public Increased spending on medical care Secondary prevention practices Primary prevention practices,Improved survival from MI Reduced MI, stroke at young ages,CHD Trends,McGovern et al, Circulation 2001;104:19-24,Reduction in CVD Death Rate in US,Pre-1985 due largely to lifestyle changes Smoking cessation 59% 25% Decreased dietary fat intake Increased leisure-time physical activity,Post-1985 due largely to medical management Coronary care units Electrical defibrillators Thrombolysis Emergent angioplasty Medical Rx Aspirin, beta-blockers, ACE-inhibitors, statins,McGovern et al. Circulation 2001;104:19-24,Primary Prevention,Secondary Prevention,CAD Prevalence in Patients Who Died of Unnatural Causes in Olmsted County, MN and Had Autopsy,Nemetz et al. Arch Intern Med 2008;168:264-270,Causes of Death Honduras versus US Where is Honduras in the Epidemiologic Transition?,Source: Death and Daly estimates by cause, 2002 /entity/healthinfo/statistics/bodfbddeathdalyestimates.xls,Causes of Death Honduras 2002,Honduras versus US Statistics,Life expectancy at birth Honduras: M = 67/F = 73 US: M = 75/F = 80 Healthy life expectancy at birth Honduras: M = 56/F = 61 US: M = 67/F = 71 Probability of dying between 15-60 years Honduras: M = 22.9%/F = 13.3% US: M = 13.7%/F = 8.0%,Honduras versus US Statistics,Total expenditure on health per capita Honduras: $241 US: $6,714 Gross national income per capita Honduras: $3,240 US: $44,070 Total expenditure on health as % of GDP Honduras: 7.4% US: 15.3%,World Health Statistics 2008 Financial data from 2006,Risk Factors in Honduras,No data on hyperlipidemia for Honduras Hypertension highly prevalent throughout Latin American and Caribbean No specific figures for Honduras Greater for persons of African descent 1 survey on diabetes in Tegucigalpa Prevalence 7.8%; 42% unrecognized 1 survey 2005-6 on females aged 15-49 for tobacco use and obesity Urban rural for both Tobacco use 3.7 versus 0.6% Obesity 23 versus 14%,Risk Factors, Honduras,Risk Factors, Honduras,Conclusions,Honduras is moving into the age of man-made and degenerative diseases All risk factors will be increasing Honduras may not afford US high-tech