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EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE: An Asian Perspective

Epidemiology of. CVD in ASIA. EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE: An Asian Perspective. RODY G. SY, M.D., FPCP, FPCC, FACC Professor, Section of Cardiology Dept of Medicine, UP College of Medicine. Epidemiology of. CVD in ASIA. CVD Mortality (as % of total mortality) 1995-96.

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EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE: An Asian Perspective

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  1. Epidemiology of CVDin ASIA EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE:An Asian Perspective RODY G. SY, M.D., FPCP, FPCC, FACC Professor, Section of Cardiology Dept of Medicine, UP College of Medicine

  2. Epidemiology of CVDin ASIA CVD Mortality (as % of total mortality)1995-96 Percent of mortality from all causes Female Male Khor GL. Asia Pacific J Clin Nutr 2001;10(2):76-80.

  3. Epidemiology of CVDin ASIA CHD and Stroke Mortality in Asia-Pacific1995-96 CHD STROKE Per 100,000 population Per 100,000 population Female Male Khor GL. Asia Pacific J Clin Nutr 2001;10(2):76-80.

  4. Epidemiology of CVDin ASIA Stroke and CHD Death Rateper 100,000 person-year STROKE CHD Ueshima H et al. Circ 2008; 118: 2702-2709.

  5. Epidemiology of CVDin ASIA Global Trends in Systolic BP, 1980-2008Global Burden of Metabolic Risk Factors of Chronic Diseases CG Danaei G et al. Lancet 2011; 377: 568-577.

  6. Epidemiology of CVDin ASIA Global Trends in Systolic BP, 1980-2008Global Burden of Metabolic Risk Factors of Chronic Diseases CG SBP ≤ 3.5 mmHg / decade in women in W Europe and Australasia ≤ 2.0 – 2.8 mmHg in men in N American, Australasia and W Europe ≥ 0.8 – 1.6 mmHg / decade in men and ≥ 1.0 – 2.7 mmHg / decade in women in Oceania, E Africa, S Asia and SE Asia Danaei G et al. Lancet 2011; 377: 568-577.

  7. Epidemiology of CVDin ASIA Global Trends in BMI, 1980-2007Global Burden of Metabolic Risk Factors of Chronic Diseases CG Finucane MM et al. Lancet 2011; 377: 557-567.

  8. Epidemiology of CVDin ASIA Global Trends in BMI, 1980-2008Global Burden of Metabolic Risk Factors of Chronic Diseases CG • Mean BMI worldwide increased by 0.4 kg/m² in men and 0.5 kg/m² in women. • In 2008, 1.46B adults had BMI ≥ 25 kg/m², of these 205M men and 297M women were obese. • Highest in some Oceania countries (Nauru – 33.9 kg/m² in men and 35.0 kg/m² in women). • Lowest in men in Congo at 19.9 kg/m² and in women in Bangladesh at 20.5 kg/m². • BMI < 21.5 kg/m² in few countries in E Asia, S Asia, SE Asia and Sub-saharan Africa. Finucane MM et al. Lancet 2011; 377: 557-567.

  9. Epidemiology of CVDin ASIA Ethnic Differences in Visceral Fat and Diabetes Mellitus Araneta, MR & Barrett-Connor, E. Obesity Research 2005

  10. Epidemiology of CVDin ASIA Global Trends in DM Prevalence, 1980-2008Global Burden of Metabolic Risk Factors of Chronic Diseases CG Danaei G et al. Lancet 2011; 378: 31-40.

  11. Epidemiology of CVDin ASIA Global Trends in FPG & DM Prev, 1980-2008Global Burden of Metabolic Risk Factors of Chronic Diseases CG *Age-standardized Danaei G et al. Lancet 2011; 378: 31-40.

  12. Epidemiology of CVDin ASIA Global Trends in Serum Cholesterol, 1980-2008Global Burden of Metabolic Risk Factors of Chronic Diseases CG Farzadfar F et al. Lancet 2011; 377: 578-586.

  13. Global Trends in Serum Cholesterol, 1980-2008Global Burden of Metabolic Risk Factors of Chronic Diseases CG Epidemiology of CVDin ASIA Mean total cholesterol (TC) was highest in high-income region (Australasia, N America and W Europe). TC fell in high-income region, central and eastern Europe. TC rose in east and southeast Asia Farzadfar F et al. Lancet 2011; 377: 578-586.

  14. Epidemiology of CVDin ASIA Asia Mean = 4.86; SD = 1.02 ANZ Mean = 5.58; SD = 1.13 20 15 10 Percentage 5 0 2 4 6 8 10 Cholesterol (mmol/l) Distribution of baseline cholesterol among participants in Asian and Australia and New Zealand (ANZ) levels. APCSC Int. J. Epidemiol 2003;32: 563-572 .

  15. Epidemiology of CVDin ASIA APCSC: Relation between Cholesterol and CHD events, 352033 subjects A 3.0 B 3.0 CHD death CHD death or non-fatal MI 2.0 2.0 Hazard ratio 1.4 Hazard ratio 1.4 1.0 1.0 0.7 0.7 4.5 5.0 5.5 6.0 6.5 4.5 5.5 6.0 5.0 6.5 Mean usual total cholesterol (mmol/l) Mean usual total cholesterol (mmol/l) C D 3.0 CHD death or non-fatal MI 3.0 CHD death Asia ANZ 2.0 2.0 Asia 1.4 Hazard ratio Hazard ratio 1.4 ANZ 1.0 1.0 P for homogeneity = 0.82 P for homogeneity = 0.29 0.7 0.7 6.5 5.5 6.0 4.5 5.0 6.5 5.5 6.0 4.5 5.0 Mean usual total cholesterol (mmol/l) Mean usual total cholesterol (mmol/l) APCSC Int. J. Epidemiol 2003;32:563-572.

  16. Epidemiology of CVDin ASIA INTERHEART: 15,152 MI Cases and 14,820 Controls DISTRIBUTION BY REGION China, HongKong = 6086 Southeast Asia = 2168 South Asia = 3936 Australia, NZ = 1270 Total Asians = 13460 Total subjects = 27098 Yusuf S, et al. Lancet 2004; 364: 937-52.

  17. INTERHEART:Risk Factors for Myocardial Infarction Epidemiology of CVDin ASIA Yusuf S et al. Lancet 2004; 364: 937-52.

  18. Epidemiology of CVDin ASIA INTERHEART:Mean Lipid Levels in Subjects from Asian and other Regions Karthikeyan G et al. JACC 2009; 53: 244-253.

  19. INTERHEART:Preponderance of Lower HDL-C among South Asians Epidemiology of CVDin ASIA Karthikeyan G et al. JACC 2009; 53: 244-253.

  20. Epidemiology of CVDin ASIA INTERHEART: Odds ratio of first AMI in different LDL-C categories adjusted to HDL-C levels among Asian subjects Karthikeyan G et al. JACC 2009; 53: 244-253.

  21. Epidemiology of CVDin ASIA Subjects with Individual or Combined Lipid Abnormalities UNITED STATES 13% No lipid disorder 52% Ghandehari H et al. Am Heart J 2008; 156: 112-9.

  22. Epidemiology of CVDin ASIA Subjects with Individual or Combined Lipid Abnormalities No lipid disorder 52% Ghandehari H et al. Am Heart J 2008; 156: 112-9.

  23. Prevalence (%) of Metabolic SyndromeNCEP Criteria (unmodified), age  35 Epidemiology of CVDin ASIA Patel A et al. Atherosclerosis 2006; 184: 225-232.

  24. Epidemiology of CVDin ASIA Proportion (S.E.) with Each Metabolic Abnormality Patel A et al. Atherosclerosis 2006; 184: 225-232.

  25. Epidemiology of CVDin ASIA Japan Collaborative Cohort Study1988-2006 • 18,747 men and 24,263 women aged 40-79 without history of stroke or CHD at baseline in 1988-90 were followed up until 2006 (mean 16.5 yrs) • Lifestyle behaviour scored for follwing (1 point each): • Consumption of fruits ≥ 1 intake / day • Consumption of fish ≥ 1 intake / day • Consumption of milk almost everyday • Exercise ≥ 5 h / week &/or walking ≥ 1 h per day • BMI of 21-25 Kg/m² • Alcohol intake < 46.0 g / day • Non-smoking • Sleep duration of 5.5-7.5 h /day • 1,907 Deaths – 849 strokes and 402 CHDs Eguchi E et al. Eur Heart J2012;33: 467-477.

  26. Epidemiology of CVDin ASIA Japan Collaborative Cohort Study1988-2006 Healthy Lifestyle Score: 0-1 2 3 4 5 6-7 Eguchi E et al. Eur Heart J2012;33: 467-477.

  27. Epidemiology of CVDin ASIA Japan Collaborative Cohort Study1988-2006 • Multivariable hazard ratio (95% CI, population attributable fraction) – highest score (7-8) versus lowest (0-2) MENWOMEN CVD 0.35(0.25-0.49, 52.3%) 0.24(0.16-0.36, 44.6%) Stroke 0.36(0.22-0.58, 45.0%) 0.28(0.15-0.53, 43.4%) CHD 0.19(0.08-0.50, 76.2%) 0.20(0.09-0.47, 34.5%) Eguchi E et al. Eur HeartJ2012;33: 467-477.

  28. Lipid Goals in Guidelines Epidemiology of CVDin ASIA

  29. Epidemiology of CVDin ASIA REALITY ASIA: Low LDL-C goal attainment particularly in high-risk patients n = 2,622 patients recently initiated with statins CHD/Diabetes Non-CHD & <2 risk factors (LDL-C <130mg/dL) Non-CHD & <2 risk factors (LDL-C <160mg/dL) Percentage of Population Kim HS et al. Current Medical Research and Opinion 2008; 24(7): 1951-1962.

  30. Epidemiology of CVDin ASIA Summary • Asia is a very diverse region with mortality from CVD rising despite downward trend in developed countries; • Global burden trends showed CV risk factors still rising in most Asian countries; • Prevalence of diabetes and obesity is a major problem in the region; • Asians may have lower serum cholesterol levels than Caucasians but carry the same risk for CHD; • Low HDL-c is prevalent in many Asian countries; • Lifestyle modification strategies have been shown to reduce CV events in Asians.

  31. Epidemiology of CVDin ASIA THANK YOU

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