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Global burden of Cardiovascular Diseases

This article examines the projected global burden of cardiovascular diseases (CVD) and explores the common risk factors driving the CVD epidemic. It discusses the impact of urbanization, global trade, tobacco industry, and physical inactivity on CVD. The article also highlights the current and projected population percentages affected by CVD and emphasizes the importance of integrating NCD prevention and control programs into primary health care. It provides priorities for developing and developed countries in terms of control strategies and prevention initiatives for CHD.

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Global burden of Cardiovascular Diseases

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  1. Global burden ofCardiovascular Diseases • Andrew M Tonkin, MD

  2. PROJECTED GLOBAL BURDEN OF CVD B. Neal et al. Eur. Heart J 2002 Global CVD

  3. GLOBAL BURDEN OF DISEASE:COMMON CVD RISK FACTORS Risk factor Exposure Variable Theoretical Contribution Minimum to GBD High BP Usual SBP 115mmHg (SD6) 4.4% Tobacco Smoking impact ratio; No use 4.1% oral tobacco use High cholesterol Usual TC 3.8mmol/L (SD0.6) 2.8% High BMI BMI 21kg/m2 (SD1) 2.3% Low fruit and Intake daily 600g (SD50) 1.8%veg. Intake Inactivity Categories >2.5h/week, mod. 1.3% M. Ezzati et al. Lancet 2003;362:271-80 Global CVD

  4. EPIDEMIOLOGIC TRANSTION Global CVD From S Yusuf et al. Circulation 2001;104:2746-53

  5. DRIVERS OF THE CVD EPIDEMIC • Urbanisation • Global trade and marketing developments • Tobacco industry • Physical inactivity Tobacco use, inappropriate diet and physical inactivity (expressed through unfavourable lipid profiles, overweight and raised BP) explain at least 75% of new CHD cases Global CVD

  6. CHD TRENDS IN BEIJING 1984 TO 1999 Critchley J et al. Circulation 2004;110:1236-1244 Global CVD

  7. CURRENT AND PROJECTED POPULATION PERCENTAGES FOR 2000, 2020 AND 2040 S. Leeder 2003

  8. CVD IN AUSTRALIA: 11% TOTAL HEALTH SPENDING

  9. USE OF MEDICATION IN STROKE AND CHD % WHO PREMISE project, 2002 Global CVD

  10. Available Affordable Locally manufactured ANTIHYPERTENSIVE DRUGS 57% 67% 30% 48% 45% 91% 89% 74% 64% 83% 7% 46% 100% 96% 92% 88% 71% 70% Africa Americas Eastern Europe South-East Western Mediterranean Asia Pacific Percentage of countries in each region where drugs are available, affordable to low income groups, or manufactured locally WHO 2001 Global CVD

  11. POLYPILL: EFFECTS AFTER TWO YEARS, AGE 55-64 RRR (95% CI) (%) Factor Agent Reduction IHD Stroke LDL-C Statin 1.8 mmol/L 61 (51,71) 17 (9-25) BP Three agents, 11 mmHg 46 (39-68) 63 (55-70) half dose DBP Platelet funct. ASA (75mg) Not quant. 32 (23-40) 16 (7-25) Homocysteine Folic acid, 3 μmol/L 16 (11-20) 24 (15-33) (0.5mg) Combined All 88 (84-91) 80 (71-87) BMJ, 28 June 2003 Polypill

  12. HHP Japanese American Men FIVE-YEAR HARD CHD EVENTS Deciles based on Framingham function Absolute risk D'Agostino, Sr, R. B. et al. JAMA 2001;286:180-187

  13. FRAMEWORK CONVENTION ON TOBACCO CONTROL • Key provisions encourage countries to: • Enact comprehensive bans on tobacco advertising, promotion and sponsorship; • Obligate placement of rotating health warnings on tobacco packaging that cover at least 30% (but ideally ≥ 50%) of principal display areas; • Ban use of deceptive terms such as “light” and “mild”; • Protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places; • Combat smuggling, including placing of final destination markings on packs; • Increase tobacco taxes Tobacco

  14. PUBLIC HEALTH POLICY • Comprehensive health programs led by primary care • Appropriate balance between primary and secondary prevention • Particularly population approaches (Only 5% in wealthy countries at ideal cholesterol, BP, weight) • Also high-risk approaches to primary prevention (although latter may increase inequalities) • Acute management and secondary prevention • Surveillance and monitoring Global CVD

  15. NCD PREVENTION AND CONTROL 94% 88% 88% 76% 65% 39% Percentage of countries with integration of components of NCD prevention and control programmes in primary health care WHO 2001 Global CVD

  16. PRIORITIES FOR DEVELOPING COUNTRIES • Control strategies, initially based on extrapolation from knowledge from other population, e.g. tobacco control: whole population initiatives • Cross-sectional surveys (ecological comparisons), case-control studies and prospective longitudinal studies for incidence data • Workforce training and capacity building • Low cost, high yield interventions CHD prevention

  17. PRIORITIES FOR DEVELOPED COUNTRIES • Prevention including implementation of proven strategies • Chronic disease strategies • Health inequalities • Primary care strategies • Strategies to combat overweight CHD prevention

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