CHD Prevention and Risk Asssessment : Old concepts new context?

1. CHD Prevention and Risk Asssessment:Old concepts new context? Dr Paul D MacIntyre Director of Cardiology, RHH

2. Why Prevent CHD ? • Premature Mortality <65yrs of age • Avoid chronic disease • Quality of life • Economic costs • Delay or prevent • We all die ! • CVD v Cancer

3. Prevention of CHD:3 Silos • Low risk primary prevention • High risk primary prevention • Secondary prevention

4. Risk Factors for CVD • Modifiable • Smoking • Physical Activity • Obesity • Medical Conditions • Hypertension • Diabetes • Hyperlipidemia • Chronic Kidney Disease • Non Modifiable • Age • Sex • Family History • Socio economic status • Ethnicity • Relative poverty • Lack of hope

6. Low Risk Primary Prevention • General population at low risk of CHD • Public Health measures to improve lifestyle • Smoking • Diet • Exercise • Prioritise children • Childhood Obesity • Needs both population and individual approach

7. Population Risk Physical activity Cholesterol Mean

8. Population risk • Public Health policy • Partnership working • Health Services • Central government • Local authorities • Primary care • Voluntary sector • Create environmental change • Smoking ban in public places • Plain packaging of cigarettes • Healthy eating • Environmental change to facilitate physical activity • Social Determinants of Health

9. Public Health measuresHealthy Eating • Food labelling • Restrictions • Ban Junk food from public sector • Engage with the food industry • Junk Tax • Fat Tax • Fruit shops in public sector buildings

10. Individual Approach

11. Smoking • Stop starting and start stopping • Young • Programmes for low income • Hospital Smoking cessation services including NRT • Primary care services

12. Physical Activity • Inactivity doubles risk of CVD • Physical activity for Health • Adults accumulate 30 mins of moderate intensity exercise most days of week • Children 60 mins • Physical activity for fitness • 3 x 20 mins of vigorous intensity exercise per week • ? Intensity Level required for CVD protection

13. Barriers to Exercise Master Tom MacIntyre

14. Diet • Noddy’s guide • Cut the crap • Accessibility • Cost • Convenience • Reduce portion size • Eat fruit and vegetables

15. Hospital Fruit Shop ?

16. High risk primary prevention • Anticipatory care • Case finding • High risk registers • Structured • Opportunistic • Outreach • Social deprivation • Risk assessment • Risk factor modification

17. High risk primary prevention • ?Already have the disease • JBS2 guidelines • ≥ 20% 10yr risk of CVD on Framingham score • Health inequalities • ASSIGN risk calculator for Scotland • Prof Tunstal-Pedoe • Social Deprivation and Family History • SIGN 97 • Health behaviour change • Statin and aspirin prescription

18. Flower of Scotland

20. Magnificent All Blacks

25. Predict • Prof Rod Jackson • Predict • Absolute risk • Unique identifier • 90 % penetration in primary care • >400,000 • IT issues resolved • Outcome data

26. Hope for Australia ?

27. Australian absolute cardiovascular disease risk calculator • http://www.cvdcheck.org.au/

32. Secondary prevention • Step change • Menu based Cardiac Rehabilitation • Multidisciplinary team • Components • Education • Medical risk factor modification • Optimise pharmacological treatment • Health Behaviour Change interventions • Smoking • Diet • Exercise • Stress, anxiety and depression • Does it work? • Chronic disease management

33. Secondary prevention • Chronic Stable CHD • Primary care setting • Medical risk factor modification • Optimise treatment • Chronic disease management programmes • Health behaviour change • Smoking cessation services • Diet • Exercise referral • Health coach model