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Mini Lecture 1 Module: Effects of Tobacco on the Cardiovascular System

EPIDEMIOLOGY OF CVD AND SMOKING. Mini Lecture 1 Module: Effects of Tobacco on the Cardiovascular System. Objectives of the Mini Lecture. GOAL OF MINI LECTURE: Provide students with knowledge about the burden of smoking and tobacco use among patients with cardiovascular diseases (CVD).

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Mini Lecture 1 Module: Effects of Tobacco on the Cardiovascular System

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  1. EPIDEMIOLOGY OF CVD AND SMOKING Mini Lecture 1 Module:Effects of Tobacco on the Cardiovascular System

  2. Objectives of the Mini Lecture GOAL OF MINI LECTURE: Provide students with knowledge about the burden of smoking and tobacco use among patients with cardiovascular diseases (CVD). LEARNING OBJECTIVES Students will be able to: • Understand the global burden of CVD and smoking • Discuss the burden of smoking in CVD patients • Describe the association between active and passive smoking and CVD

  3. Contents Core Slides: Optional Slides: Cardiovascular Diseases (CVDs) as a Leading Cause of Global Death Smoking-attributable Deaths:The Global Context Smoking-attributable Deaths in the Asia Pacific Region Mortality from CVD in India Smoking as a CVD Risk Factor Smoking Attributable CVDDeaths in India Cost-effectiveness of Smoking Cessation for CVD Prevention Cardiovascular Risks of Secondhand Smoke Constituents of Cigarette Smoke that Contribute to CVD Smoking and Acute Myocardial Infarction (AMI) Factors Associatedwith Risk of AMI

  4. CORE SLIDES Epidemiology of CVD and Smoking Mini Lecture 1 Module: Effects of Tobacco on the Cardiovascular System

  5. Cardiovascular Diseases (CVDs) as a Leading Cause of Global Death • Globally, non-communicable diseases (NCD) accounted for 58% and 62% of deaths in men and women, respectively, in 2004. • Cardiovascular disease (CVD) deaths in 2004: 26.8 million in men and 31.5 million in women. • Two leading causes of death: ischemic heart disease (12.2% of all deaths) and cerebrovascular disease (9.7%). • Both diseases were the leading causes of death globally, in middle- and high-income countries. • In low income countries, ischemic heart disease was 2nd cause of death (9%) and cerebrovascular disease was 5th (6%). World Health Organization 2008

  6. Smoking-attributable Deaths:The Global Context • In 2030, smoking will account for 10% of global deaths. • Between 2002 and 2030, tobacco-related deaths are projected to: • Decrease by 9% in high-income countries. • Double in low-and middle-income countries (from 3.4 million to 6.8 million). • Leading causes of tobacco-attributable deaths are: cancer (33%), cardiovascular diseases (29%), and chronic respiratory diseases (29%).

  7. Smoking-attributable Deathsin the Asia-Pacific Region • Smoking contributes to 30% of cardiovascular deaths in Pacific and South-East Asia regions.1 • Smoking causes: • 10–33% of heart diseases among men (10% in Australia and 33% in Kiribati). • 3–12% of hemorrhagic stroke among men (3% in Australia and Palau, and 12% in Kiribati). • 8–27% of ischemic stroke among men (8% in Australia and 27% in Kiribati). 1. Martiniuk et al., 2006

  8. Mortality from CVD in India • CVD accounted for 29% of all deaths in India in 2005.1 • Nearly 10 million deaths are predicted to occur in the year 2015; CVD will account for one third of these deaths.2 • CVD death toll is projected to rise from 3 million in 2000 to 4.8 million in 2020, and will account for 42% of total deaths. • Between 2000 and 2020, about 35% deaths will occur among 35-64 year olds, mostly attributable to tobacco use.3 • Reddy 2007; 2. Indrayan et al. 2008; 3. Reddy and Gupta 2004

  9. Smoking as a CVD Risk Factor • Smoking is an established risk factor for many cardiovascular diseases such as: peripheral vascular disease (PVD), aortic aneurysm, coronary heart disease (CHD), and cerebrovascular disease (stroke).1 • 12% of deaths in China were attributable to smoking (22% to respiratory disease, 16% to neoplastic disease, and 9% to vascular disease).2 • 30% of cardiovascular deaths in the Pacific and Southeast Asia regions are attributable to smoking. 1. World Health Organization 2002; 2. Niu et al. 1998

  10. Smoking AttributableCVD Deaths in India India • Smoking causes a large and growing number of premature deaths.1 • Overall, smoking in India accounts for 20% of deaths from stroke and 24% of deaths from cardiac and other vascular diseases.2 1. Jha et al. 2008; 2. Gajalakshmi et al. 2003 http://www.bloodpressurenormalized.com/images/blood_circulation.jpg

  11. Cost-effectiveness of Smoking Cessation for CVD Prevention • Compared to other CVD prevention strategies (such as lowering blood pressure, blood glucose, LDL cholesterol, BMI), smoking cessation is the most cost-effective intervention for CVD prevention. Kahn et al. 2008

  12. Cardiovascular Risks of Secondhand Smoke • Secondhand smoke (SHS) exposure in the home and workplace increases the risk of coronary heart disease among nonsmokers by 25%-30% among both men and women.1 • A significant dose-response relationship exists between intensity and duration of exposure to SHS and CVD risks: • Risk increases sharply with low doses of SHS (< 5 cigs/day). • Risk increases more slowly and linearly with higher level of exposure (5-20 cigs/day).2 1. He et al. 1999; 2. Pechacek et al. 2004

  13. OPTIONAL SLIDES Epidemiology of CVD and Smoking Mini Lecture 1 Module: Effects of Tobacco on the Cardiovascular System

  14. Constituents of Cigarette Smokethat Contribute to CVD Main contributors: • Nicotine • Carbon monoxide • Oxidant (chemical) gases: oxides of nitrogen and free-radicals Other contributors promote atherogenesis: • Polycyclic aromatic hydrocarbons • Other constituents Benowitz 2003

  15. Smoking and Acute Myocardial Infarction (AMI) • A current smoker has a 3x higher risk of experiencing non-fatal MI compared with a never smoker. • Dose response relationship between number of cigarettes smoked per day and risk of AMI is independent of age. • The risk of AMI increases even with low levels of smoking. • Risk increases by 5.6% for every additional cigarette smoked. Teo et al. 2006

  16. Factors Associatedwith Risk of AMI • Young smokers are at higher risk of AMI compared to older smokers • Higher prevalence of smoking • Higher numbers of cigarettes smoked per day • Risk of acute myocardial infarction (AMI) from: • Smoking beedies: 2.89 • Chewing tobacco: 2.23 • Smoking and chewing: 4.09 • Low doses of exposure (1–7 hour/week)=1.24 • High doses of exposure (>21 hour/week)=1.62 Teo et al. 2006

  17. The most important health message a doctor can give to patients is to quit smoking.

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