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Community Medicine V Dr. Mehrdad Askarian MD, MPH Professor of Community Medicine

Atherosclerosis

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Community Medicine V Dr. Mehrdad Askarian MD, MPH Professor of Community Medicine

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    1. Community Medicine V Dr. Mehrdad Askarian MD, MPH Professor of Community Medicine

    3. Atherosclerosis Introduction Most common cause of death in most countries One third of MI patients die (half of them during the 1st hr of MI and before hospitalization)

    4. Atherosclerosis Prevalence 12 million death/yr in the world. Half of deaths in all developed and developing countries. Early mortality rate of males is 2 times of women. In women, sign and symptoms appear 10 years later than males.

    5. Atherosclerosis Risk factors Group 1: their modification causes lowering risk of disease acquisition Cigarette smoking

    6. Atherosclerosis Risk factors Group 1: their modification causes lowering risk of disease acquisition Cigarette smoking High LDL Cholesterol

    7. Atherosclerosis Risk factors Group 1: their modification causes lowering risk of disease acquisition Cigarette smoking High LDL Cholesterol High fat and Cholesterol diet

    8. Atherosclerosis Risk factors Group 1: their modification causes lowering risk of disease acquisition Cigarette smoking High LDL Cholesterol High fat and Cholesterol diet Hypertension (HTN)

    9. Atherosclerosis Risk factors Group 1: their modification causes lowering risk of disease acquisition Cigarette smoking High LDL Cholesterol High fat and Cholesterol diet Hypertension (HTN) Left Ventricular Hypertrophy (LVH)

    10. Atherosclerosis Risk factors Group 1: their modification causes lowering risk of disease acquisition Cigarette smoking High LDL Cholesterol High fat and Cholesterol diet Hypertension (HTN) Left Ventricular Hypertrophy (LVH) Hypercoagulable state (high blood fibrinogen level)

    11. Atherosclerosis Risk factors Group 2: their modification is most probable to lower risk of disease acquisition Diabetes Mellitus

    12. Atherosclerosis Risk factors Group 2: their modification is most probable to lower risk of disease acquisition Diabetes Mellitus Immobilization

    13. Atherosclerosis Risk factors Group 2: their modification is most probable to lower risk of disease acquisition Diabetes Mellitus Immobilization Low HDL Cholesterol

    14. Atherosclerosis Risk factors Group 2: their modification is most probable to lower risk of disease acquisition Diabetes Mellitus Immobilization Low HDL Cholesterol High Triglyceride, high LDL

    15. Atherosclerosis Risk factors Group 2: their modification is most probable to lower risk of disease acquisition Diabetes Mellitus Immobilization Low HDL Cholesterol High Triglyceride, high LDL Obesity

    16. Atherosclerosis Risk factors Group 2: their modification is most probable to lower risk of disease acquisition Diabetes Mellitus Immobilization Low HDL Cholesterol High Triglyceride, high LDL Obesity Menopause

    17. Atherosclerosis Risk factors Group 3: their modification may cause lowering risk of disease acquisition Psychosocial factors

    18. Atherosclerosis Risk factors Group 3: their modification may cause lowering risk of disease acquisition Psychosocial factors High levels of blood lipoprotein (a)

    19. Atherosclerosis Risk factors Group 3: their modification may cause lowering risk of disease acquisition Psychosocial factors High levels of blood lipoprotein (a) High levels of homocysteine No alcohol consumption

    20. Atherosclerosis Risk factors Group 4: their modification is not possible, lowering risk of disease acquisition Age > 45y/o in males and >55 y/o in females

    21. Atherosclerosis Risk factors Group 4: their modification doesn’t cause lowering risk of disease acquisition Age > 45y/o in males and >55 y/o in females Male gender

    22. Atherosclerosis Risk factors Group 4: their modification doesn’t cause lowering risk of disease acquisition Age > 45y/o in males and >55 y/o in females Male gender Low socioeconomic class

    23. Atherosclerosis Risk factors Group 4: their modification doesn’t cause lowering risk of disease acquisition Age > 45y/o in males and >55 y/o in females Male gender Low socioeconomic class Family history of early onset coronary artery disease

    24. Cholesterol Blood cholesterol level more than 160mg/dl has a strong correlation with CAD and death rate due to it and other causes of mortality, totally. High saturated TG intake in presence of normal blood level of cholesterol is associated with high prevalence of CAD. Each 1% decrease of cholesterol can cause 2-5% decrease risk of CAD.

    25. Cholesterol In Iran Total cholesterol in 41% of males and 47% of females was 200 mg/dl or higher. Hypertriglyceridemia in 32% of population High LDL (>130 mg/dl) in 51% Low HDL (<35 mg/dl) levels in 6% of population.

    26. Cigarette smoking The most important factor to cause early death in 35-69 y/o people in developed countries. (cause of 30% of deaths in this age group. About 50% increase in mortality rate due to CAD. Each 10 increases 18% mortality in males and 31% in females. 37% of nonsmokers are passive smokers which increases CAD by 30% in this group.

    27. Cigarette smoking In Iran: 27% of males in age groups of 15-69 y/o 3% of females in age groups of 15-69 y/o, smoke. 66% of respondents started smoking around 15-24 y/o. Cost of smoking in Iran estimated to be 9.2 milliard Rials annually.

    28. Hypertension Strong positive linear correlation between level of systolic and diastolic blood pressure and CAD exists, in presence of normal levels of blood pressure. With controlling of blood pressure levels, we can prevent CAD, CVA and CHF.

    29. Diabetes mellitus Important risk factor for atherosclerosis (both IDDM and NIDDM). Atherosclerosis is the leading cause of mortality in 80% of diabetic patients. IDDM increases risk of mortality due to CAD by 300%. Death rates increases due to cardiovascular diseases in NIDDM males by 2 and females by 4 times.

    30. Obesity BMI=27 is indicative of obesity Risk factors of obesity is related to degree of obesity and fat distribution. Abdominal obesity less than 0.9 in males and less than 0.8 in women is suggested. Obesity increases risk of CAD by 2 times in males and by 2.5 times in females. Obesity has been detected in 36% of males and 52% of females inTehran.

    31. Low Physical Activity Increases risk of CAD by 2 times. 80% of males and 85% of females in Tehran did not reported any physical activity except than their job.

    32. Prevention of CVD Smoking cessation Low fat diet and healthy diet from 2 y/o on. In which total fat intake per day should not be exceeds to 20% of calorie intake. Decrease saturated fat to 8-10% of daily fat intake. And decrease cholesterol intake to less than 300 mg/day. Decrease salt intake (NaCl)

    33. Prevention of CVD Increase fresh fruit and vegetables to 5 times a day. Increase physical activity to 30 minutes/day as an average intensity, 3 times a week. 21<BMI<25 Measuring Blood pressure levels every other years (at least) Measuring cholesterol levels and HDL every 5 years for those with the age of 20 or more.

    34. Hypertension Levels of blood pressure in which patient has increased risk of mortality and morbidity. (Systolic BP = 140 mmHg and diastolic BP of =90 mmHg). Is one of the major causes of CAD and CVD Most common cause of renal failure Law of halves

    35. Hypertension High risk groups Blacks > Whites (prevalence and complications) females < males (before 55 y/o) (lower complications) BP level is inversely related to level of education and economic status.

    36. Hypertension In Iran: Diastolic HTN in more than 14% of 12-69 y/o population. Diastolic HTN in more than 34% of 35-69 y/o population.

    37. Hypertension Prevention and control Primary prevention & Secondary prevention Healthy diet, low salt, low saturated fat and cholesterol Increase intake of fresh vegetables and fruits Appropriate calorie intake and prevention of obesity. Increase activity to 3 days in a week and 30 minutes for each time. Avoiding Cigarette smoking BP<140/90 and <130/85 in diabetics

    38. Lipids Modification In persons without risk factor or one risk factor, except for DM, LDL: 130-159. In persons with 2 risk factors except for DM and probability of CAD during next 10 yrs lower than 20% , LDL<130 mg/dL In persons with DM and probability of CAD during next 10 yrs greater than 20% , LDL<100 mg/dL.

    39. Hypertension Limitations for controlling of Hypertension Not to follow physician’s orders Communication problems Psycho-behavioral problems Side effects of drugs

    40. Hypertension Limitations for controlling of Hypertension Not to follow physician’s orders Communication problems Psycho-behavioral problems Side effects of drugs Limited knowledge of physicians regarding importance of BP control.

    41. Hypertension Inadequate response to drug prescription

    42. Hypertension Inadequate response to drug prescription Inappropriate prescription of drug

    43. Hypertension Inadequate response to drug prescription Inappropriate prescription of drug Secondary hypertension

    44. Hypertension Inadequate response to drug prescription Inappropriate prescription of drug Secondary hypertension Drug interaction

    45. Hypertension Inadequate response to drug prescription Inappropriate prescription of drug Secondary hypertension Drug interaction Associated disorders

    46. Hypertension Inadequate response to drug prescription Inappropriate prescription of drug Secondary hypertension Drug interaction Associated disorders Renal failure

    47. Hypertension Inadequate response to drug prescription Inappropriate prescription of drug Secondary hypertension Drug interaction Associated disorders Renal failure obesity

    48. Hypertension Inadequate response to drug prescription Inappropriate prescription of drug Secondary hypertension Drug interaction Associated disorders Renal failure obesity Economical limitations

    49. Hypertension Recommendations for controlling hypertension in Iran: To increase knowledge of physicians and all other HCWs with the disease and its complications. To increase knowledge of physicians regarding new treatments and objectives of treatment. To aware population regarding the disease and its complications Calculating the rate of hypertension in different groups of population To create centers for screening and offering treatments and guidance of patients.

    51. Any Comments or Questions?

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