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Global burden of Cardiovascular Diseases

Global burden of Cardiovascular Diseases. Andrew M Tonkin, MD. PROJECTED GLOBAL BURDEN OF CVD. B. Neal et al. Eur. Heart J 2002. Global CVD. GLOBAL BURDEN OF DISEASE: COMMON CVD RISK FACTORS. Risk factor Exposure Variable Theoretical Contribution Minimum to GBD

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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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