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Prevention of Cardiovascular Diseases in population

Prevention of Cardiovascular Diseases in population. Lecturer MD , Ph.D. Furdela Victoria Assistant Professor, Pediatric s Department #2, Ternopil State Medical University, Ukraine. Outline. World status of CVDs Prevention efficacy Recommendations re risk factors

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Prevention of Cardiovascular Diseases in population

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  1. Prevention of Cardiovascular Diseases inpopulation Lecturer MD, Ph.D. Furdela Victoria Assistant Professor, Pediatrics Department #2, Ternopil State Medical University, Ukraine

  2. Outline World status of CVDs Prevention efficacy Recommendations re risk factors Role of CV specialist in prevention

  3. World Status of CVD Represents 30% of all deaths worldwide (15 million deaths/year) Leading cause of death and disability CVD burden  in developing countries Risk factors  worldwide 1999 WHF "Impending Global Pandemic of CVDs

  4. Preceding Facts Defined Risk Factors in adults associated with accelerated atherosclerosis and CVD rates Atherosclerosis begins in childhood Extent of atherosclerosis in children correlated with same risk factors as in adults

  5. Development of atherosclerosis and its complications during human life

  6. Early Appearance of Atherosclerosis: Bogalusa Heart Study 80 60 40 20 0 Prevalence of Fibrous Plaque Lesions 80 Aorta Coronary Arteries 60 % 40 20 0 2-15 16-20 21-25 26-39 2-15 16-20 21-25 26-39 Age (Years) p = 0.001 for trend toward increasing prevalence with age in aorta and coronary arteries.

  7. The Evidence physical activity associated with  life expectancy Direct association between obesity & insulin resistance in children Direct association between obesity & lipid levels in children Tracking: BMI>weight>skinfold thicknesses>lipids>BP Clusters of multiple risk factors persist strongly from child-to-adulthood

  8. Risk Factors for Atherosclerosis Smoking Obesity High blood pressure Physical Inactivity High blood fat levels Diabetes Positive family history Other (ethnicity, anger)

  9. Recommendations Cardiovascular Health in Childhood (AHA Scientific Statement) Circ 2002;106:143-160 Circ 2002;107:1562-1566 Canadian Cardiovascular Society Consensus Conference on Prevention of CVD: The Role of the CV Specialist CJC 1999;15(supple.G)

  10. Tobacco Complete cessation for those who smoke No exposure to environmental tobacco smoke No new initiation of cigarette smoking or tobacco use

  11. Obesity Appropriate body weight (BMI for age) Overall healthy eating pattern (limit salt, fat, calories & sugar > 2 years age) Balance “Energy in = energy out” for weight Begin treatment before adolescence

  12. Trends in prevalence of overweight in USA (CDC – NHANES) % 1963-70 1971-74 1976-80 1988-94 1999 6-11 yrs 12-19 yrs

  13. Physical Activity Physical activity every day (60 minutes per day for children) Reduce/limit sedentary time (e.g.. TV maximum 2 hours per day) May add resistance training to aerobic activity in adolescents

  14. Lipids & Lipoproteins Total cholesterol <4.4 mmol/L recommended (USA>170mg/dL borderline; >200 mg/dL is ) LDL-C <2.85 mmol/L recommended (USA<110mg/dL) Triglycerides <1.5 mmol/L recommended (USA <150 mg/dL) HDL-C >35 mg/dL recommended

  15. Effect of SBP and DBP onAge-Adjusted CAD Mortality: MRFIT CAD Death Rate per 10,000 Person-years 80.6 48.3 43.8 38.1 37.4 34.7 31.0 25.3 25.8 25.2 24.9 24.6 23.8 160+ 16.9 13.9 12.6 12.8 11.8 20.6 140-159 10.3 11.8 8.8 8.5 9.2 120-139 <120 100+ 90-99 80-89 75-79 70-74 <70 Systolic BP (mmHg) Diastolic BP (mmHg)

  16. Blood Pressure Systolic & diastolic BP>90th% for age, sex and height is abnormal (www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm.) >130/~80 is almost always pathological in youth. Use proven effective therapies recommended for adults (CPGs)

  17. Diabetes Adequate nutrition (neither over nor undernutrition) of pregnant women: Barker hypothesis Limit sugar intake Maintain normal weight for age & height For type 1 diabetics, ongoing strict control (Hgb A1c)

  18. Other Risk Factors • Ethnicity (esp. South Asian / aboriginal/black/Hispanic) • Low socioeconomic level • Social isolation • Depression • Pregnancy (HTN and gestnl diabetes) • “Emerging” risk factors

  19. Childhood Abuse Adverse childhood experiences (ACEs) 1.7x  risk with emotional abuse 1.7x  risk with crime in household 1.3x  risk with emotional neglect 1.3x  risk with substance abuse Depressed affect OR 2.1 Anger: OR 2.5 7 or > ACEs  risk almost 4x Dong M et al CIRC 110; 2004

  20. Specialized medicine Hyper First line medicine High Risk Low Primary prevention Secondary prevention Clinical Application of the Concept of Risk - Vascular, unstable Pluri-vascular Diabetic + risk factors Diabetic Vascular Asymptomatic + risk factors Asymptomatic Symptomatic

  21. Economic Burden of Coronary Artery Disease (CAD) Direct and Indirect Cost of CADCountry (not adjusted for inflation) US (2000) $118.2 billion USD Canada (1993) $19.6 billion CDN (15.2% of total economic burden of illness) UK (1996) £10 billion Germany (1996) 112 billion DM Taiwan (1991) 9.0-11.9 billion new Taiwan $ Sweden (1994) 276 billion SEK

  22. BMI <75%ile 75-85%ile 85-95%ile at risk for ow >95%ile overweight Reaffirm healthy Habits; f/u annually Assess family history, food habits, activity Council to change food intake; increase physical activity Council to change food intake; increase physical activity Assess RF; If >1 RF, treat as >95%ile Assess RF; Treat RFs; Involve family Nesbitt SD et al Ethnicity & Disease 14;2004

  23. Role of Cardiovascular Specialist Education of other health care personnel Advocate for heart healthy public policies Treat individual patients, including children with significant risk factors.

  24. Conclusions The burden of global CVD is increasing The burden of risk factors is rising alarmingly in children and youth Cardiovascular specialists have an obligation to lead in prevention Educate, Advocate, Treat

  25. Gracias!

  26. Questions for readers of Prevention of Cardiovascular Diseases: Begin in Childhood! lecture by Ruth Collins-Nakai(developed by Supercourse Team) At what age do we begin to see fatty streaks associated with atherosclerosis? What is the difference in risk from the lowest to highest risk factors Why should we intervene with children to prevent MIs 60 years later?

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