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Prevention strategies Preventive Council Peshawar Heart Study

Prevention strategies Preventive Council Peshawar Heart Study. Prof Mohammad Hafizullah Cardiology Department Postgraduate Medical Institute Lady Reading Hospital Peshawar. Mortality from CAD in Indians and Pakistanis Overseas. CAD in South Asians in UK.

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Prevention strategies Preventive Council Peshawar Heart Study

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  1. Prevention strategies Preventive Council Peshawar Heart Study Prof Mohammad Hafizullah Cardiology Department Postgraduate Medical Institute Lady Reading Hospital Peshawar

  2. Mortality from CAD in Indians and Pakistanis Overseas

  3. CAD in South Asians in UK • Early onset / malignant course • First MI 5 years earlier in average • Occurrence of first MI before the age of 40, 10 times higher (UK- Hughes 1989) • 40% higher death rates across all age groups with CAD • Two fold excess of deaths in men before the years 45 • Prevalence of CAD (before 40 yrs) in the young: West (less than 2%) South Asians (12%) • McKeigue PM. Marmot MG. BMJ 1988;297:903.

  4. Q: But can we fight the relentless onslaught of heart diseases? Answer : NO We have to PREVENT Heart problems

  5. Ray of hope!

  6.                                                                                          <>

  7. EuroAction -SMOKING • Over half (58%) of the patients who were smokers prior to their coronary event had stopped by the end of the hospital programme. • One in five partners also stopped smoking cigarettes.

  8. EuroAction- improvements in the dietary habits - pts and families • Saturated fat consumption levels of patients decreased by almost 16% (12% in partners) • Patients increased their consumption of fruit and vegetables by an average of 155 grams each day (113 grams each day for partners) • Patients increased fish consumption 58% ; (71% of partners) eating oily fish three times or more each week.

  9. EuroAction- Physical activity • 25% pts regularly active (20% of partners) • Absolute increase of 11% compared to baseline (5% in partners). • 86% of pts (83% of partners) highly active; an improvement of around one-fifth against baseline. • Step counter showing an increase of 1362 steps (739 for partners) equates to around an extra three quarters of a mile each day.

  10. Yes we can do it!

  11. Preventive Cardiology Council - The way forward • Pakistan Cardiac society established council of Preventive Cardiology • -‘preventive cardiology’. most arduous but very important job of looking after the orphan • Plan for every thing from the scratch and hopefully develop it as a vibrant body so that we can set the program for whole of the country.

  12. Prevention and Research Preventive Cardiology Council - The way forward

  13. Prevention through research • Risk factors detection in major cities • Risk factors in Karachi AKUH • Risk factors in rural areas of Peshawar • Risk factors in urban areas of Peshawar • INTER HEART • Heart File – wealth of data • Peshawar Heart Study

  14. PESHAWAR HEART STUDY(PHS) CARDIOVASCULAR DISEASE RISK ASSESSMENT IN DIFFERENT POPULATIONS OF PESHAWAR

  15. AIMS OF PHS • To identify the risk factors for coronary artery disease (CAD) in various occupational groups of Peshawar. • Risk stratification (European Task Force risk scores).

  16. AIMS To determine any correlation between conventional risk factors, educational level social status and CAD risk score. To determine risk score in “High-risk” occupations

  17. Occupational groups • Secretariat 217 • Lawyers 159 • Journalists 150 • Meat related professions 156 • Class IV workers 157 • Teachers 429 • Nurses • Total 1268

  18. Peshawar Heart Study -Civil Secretariatage • Total no 217 • All males • Age mean 42 + 9.032 • Range 18- 59

  19. Peshawar Heart Study Civil Secretariat - BMI • Total no 217 • BMI • mean 25.88 (5.1) • > 23 overweight • > 25 obese • > 30 OBESE

  20. Peshawar Heart Study - Weight Civil Secretariat • Total no 217 Weight (Kg) • Mean 72.57 (SD 11.1) • Range 48- 105 • > 70 = 52 • > 80 = 22 • >90 = 9 • >100 = 1

  21. Peshawar Heart Study - waist Civil Secretariat • Total no 217 • Waist • > 86 cm (34 inch) South Asians • > 102 cm (40.8 inch) Western standard

  22. Peshawar Heart Study –Blood Pressure Civil Secretariat • Total no 217 • Systolic Blood pressure • > 120 mmHg =53.9% • >140 mmHg =14.3% • >160 mmHg = 3%

  23. Peshawar Heart Study –Blood Pressure Civil Secretariat • Total no 217 • Diastolic Blood pressure • > 80 mmHg =47.5% • >85 mmHg =41.6% • >90 mmHg = 17.1%

  24. Peshawar Heart Study –Cholesterol Civil Secretariat • Total no 217 • Cholesterol • > 150 mg/dl= 63 % • > 180 mg/dl= 36.9% • > 200 mg/dl= 22.6%

  25. Peshawar Heart Study – Glucose Civil Secretariat • Total no 217 • Random Glucose • Mean 112.6 (SD 40.36) • Range 63-375 • > 150 mg/dl= 11% • 50% new cases

  26. PESHAWAR HEART STUDY CURRENT MEDICALSTATUS *MRP: Meat Related Professions **Sectt: secretariat

  27. PESHAWAR HEART STUDY FAMILY HISTORY OF CAD 37

  28. PESHAWAR HEART STUDY CURRENT SMOKERS

  29. PESHAWAR HEART STUDY BODY MASS INDEX

  30. PESHAWAR HEART STUDY SYSTOLIC BP

  31. PESHAWAR HEART STUDY DIASTOLIC BP

  32. PESHAWAR HEART STUDY CHOLESTEROL

  33. PESHAWAR HEART STUDY RANDOM BLOOD SUGAR

  34. PESHAWAR HEART STUDY EXERCISEDAILY FOR ≥ 20 MINS

  35. Lessons to be learnt! • Redefine our enemies • Study correlations • Set new goals • Develop new strategies • Adherence to guidelines

  36. Guidelines GPs/House staff/ doctors working in the periphery Primordial Primary Secondary prevention Topics Diabetes Dyslipidaemia Hypertension Obesity Smoking Lack of exercise Metabolic syndrome Preventive Cardiology Council - The way forward

  37. Guidelines To disseminate the guidelines more effectively Symposia Workshops Media Print material General population Posters Translation in local languages Pictorial Bill boards Preventive Cardiology Council - The way forward

  38. Prevent a Heart attack Heart Mobile 0-30-120-34-150-5 • 0 Tolerance for Smoking • 30 minutes of exercise every day • 120 systolic blood pressure less than that • 34 inch waist & no more • 150 cholesterol less than that • 5 times fruits & vegetables Preventive Council Pakistan Cardiac society

  39. Healthy Heart

  40. 1. Awareness 2. Knowledge data base3. Capacity building

  41. Preventive Cardiology Council - The way forward • Undergraduate Medical training • Projects for Community Medicine • Curriculum/ Final year examination • Part of FCPS training program and examination • Preventive cardiology departments at Institutes/ departments

  42. Recommendations Foster healthy lifestyles and behaviors in schools. ● Improve education inprevention and nutrition in schools. ● Increase opportunities for physical activity in community, school, and work settings

  43. Recommendations - food policy ● Change food policy to foster • the reduction of sodium in the food supply leading to a 5% per year decline • the labeling of the nutritional content • awareness about caloric value and cholesterol content of diet

  44. Recommendations ● Increase the visibility of preventive cardiology at national meetings attended by cardiologists and/or primary care providers. ● Encourage coordination between professional organizations

  45. Message-Ways to healthy life • Search your house for enemies • Refuse to inhale nicotine • Watch what you eat • Take a walk!

  46. PCS –Preventive Council Prevention of CVD • the challenge is huge, • the path is arduous, • resources are meager • persistence is in demand, • BUT fruits are sweet

  47. Thank You

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