Global Burden of Coronary Heart Disease

Global Burden of Coronary

Heart Diseases

Rochmad RomdoniPresident of Inaheart

Department of Cardiology and Vascular MedicineAirlangga School of Medicine - Dr. Soetomo Hospital

Surabaya

Cardiovascular Diseases

CVDs due to

Atherosclerosis:

• Coronary Artery Disease (Heart Attack, AMI)

• Cerebrovascular Disease (Stroke)

• Aorta & Artery Diseases :

• Hypertension & PAD

Other CVDs:

• Congenital Heart Disease

• Rheumatic Heart Diseases

• Cardiomyopathies

• Cardiac Arrhythmias

WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization.

Risk Factors(Factors that Promote The Process of Atherosclerosis)

Behavioural risk

factors:

• Tobacco use

• Physical inactivity

• Unhealthy diet (rich in salt, fat, and calories)

• Harmful use of alcohol

Metabolic risk

factors:

• Raised blood pressure (hypertension)

• Raised blood sugar (diabetes)

• Raised blood lipids (cholesterol)

• Overweight and obesity

Other risk factors:

• Poverty and low educational status

• Advancing age

• Gender

• Inherited (genetic) disposition

• Psychological factors (stress, depression)

• Other risk factors (e.g. excess homocysteine)

Global Map Risk Factors of Cardiovascular

Diseases

Surveillance Map and Monitor

The Epidemic of CVDs

WHO 2011: Cause of Death

Distribution of major causes of death including CVDs

WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011

Cardiovascular

diseases

Injuries

9%Communicable, maternal, perinatal and

nutriotional conditions

Other NCOs

WHO 2011: Cause of Death

Distribution of CVD deaths due to heart

attacks, strokes and other types of

cardiovascular diseases (MALES)

Distribution of CVD deaths due to heart

attacks, strokes and other types of

cardiovascular diseases (FEMALES)

Other cardiovascular diseases

Inflamatory heart

diseases

Cerebrovascular

diseases

Rheumatic heart diseases

Hypertensive heart

diseases

Ischemic heart disease

Other cardiovascular diseases

Inflamatory heart

diseases

Cerebrovascular

diseases

Ischemic heart disease

Hypertensive heart

diseases

Rheumatic heart diseases

World Map Showing The Global Distribution of CVD Mortality

Rates in Males (Age Standardized, per 100.000)

World Map Showing The Global Distribution of CVD Mortality

Rates in Females (Age Standardized, per 100.000)

Global Burden Hidden of

WHO (2009):

“CHD is now the leading cause of death worldwide; it is on the rise

and has become a true pandemic that respects no borders

Coronary Artery Disease

Leading cause of mortality

Happened globallyHappened globally

Leading cause of loss of productivity

Increase new cases

CAD is Leading Cause of

Premature Death

CAD is Leading Cause of

Premature Death

Calls for a different approach

on handling CAD

Calls for a different approach

on handling CAD

in Indonesia

Riset Kesehatan dasar (RisKesDas) 2007:

• Prevalence of Heart Diseases 7.2 %

• Prevalence of Coronary Risk Factors :

• Smoking 35.4 % (65.3 % men & 5.6 % women)

• Hipertension 31.7 %

• Diabetes Mellitus 1.1 % (Urban 5.7 %)

DepKes RI: RisKesDas. 2007

in Indonesia

Riset Kesehatan dasar (RisKesDas) 2007:

• Mortality of Various Diseases:

• Ischemic Heart diseases (5.1 %)

• Stroke (15.4 %)

• Hipertension (6.8 %)

• Other Heart Diseases (4.6 %)

• Diabetes Mellitus (5.7 %)

• Accidence (6.5 %)

• Cancer (5.7 %)

• Chronic Lower Respiratory Tract Diseases (5.1 %)

DepKes RI: RisKesDas. 2007

Reducing Cardiovascular Risk

to Prevent Heart Attacks and

Strokes

Cardiovascular Continuum

Intervention Intervention

Focusing on high risk people

To prevent one from having a

CHD or CVD event

People with established disease

To reduce morbidity and mortality

Primary

Prevention

Primary

Prevention

Secondary

Prevention

Secondary

Prevention

To prevent one from having a first

time or repeated CVD event

Population-BasedStrategy

High RiskStrategy

Ideal Cardiovascular Health

Targetting on modifiable

risk factors

Introduction of

pharmacotherapy

How To Apply CVD Prevention

No Smoking

Healthy diet

Sufficient physical

activity

Low blood pressure

Low cholesterol

Risk Assessment

Individu

Level of Risk

Low RiskLow Risk

Moderate RiskModerate Risk

High RiskHigh Risk

Very High RiskVery High Risk

How To Apply CVD Prevention

Starts with Behaviour ChangeStarts with Behaviour Change

Key to succesful lifestyle changes

Should involved patients, family dan physician altogether

Communication plays vital role

Cardiovascular Risk Prediction Chart

WHO and International Society of Hypertension (ISH)

Cardiovascular Risk Prediction Chart (shows the 10 year

risk of a fatal or nonfatal cardiovascular event by gender,

age, smoking status, systolic blood pressure, blood

cholesterol and presence or absence of diabetes).

Different charts are available for all WHO subregions.

10 Year Risk Predictor Charts of Fatal CVD

10 Year CVD Risk Predictor Chart in Indonesia

Recommendation for CVD Prevention

General Practitioner Cardiologist

Serve as consultant

Further diagnostic tools :

ECG, echocardiography,

vascular ultrasound

Pivotal Role

Screening

Ability to do risk

assesment

Primary care

Role of General Practitioner and Cardiologist

Motivating, counseling the

patient

Implementation of

evidence-based

Communication to patient

regarding severity of

disease, therapeutic

options and target

SUMMARY

Cardiovascular Disease (CVD), especially Coronary Artery Disease is the

leading cause of morbidity and mortality worldwide.

CVD Prevention is the cornerstone of reducing global burden of

cardiovascular disease.

The implementation of CVD prevention by Population-based strategy

and High Risk strategy should give a more benefit in achieving

prevention target.

General practitioner and Cardiologist has a different yet vital role in CVD

prevention with synergistic effect one to the other.

“The doctor of the future will give “The doctor of the future will give “The doctor of the future will give “The doctor of the future will give no medicine, but will interest his no medicine, but will interest his no medicine, but will interest his no medicine, but will interest his

patients in the care of human patients in the care of human patients in the care of human patients in the care of human frame, in diet and in the cause and frame, in diet and in the cause and frame, in diet and in the cause and frame, in diet and in the cause and

prevention of disease”prevention of disease”prevention of disease”prevention of disease”(Thomas Edison)(Thomas Edison)(Thomas Edison)(Thomas Edison)

CVD Prevention and Control:

Why It should not be Ignored any Longer?

International efforts in poverty reduction will be derailed if the global challenge of CVD

is not addressed.

If no action is taken, increasing numbers of people will slip into highrisk categories or

develop CVD due to continuing exposure to risk factors.

Millions of deaths due to CVD can be prevented by scaling up implementation of high-

impact interventions that already exist.

High-impact interventions include policies that promote governmentwide action:

stronger anti-tobacco controls; promotion of healthier diets and physical activity;

reducing the harmful use of alcohol; improving people's access to essential health care.

CVD Prevention and Control:

Why It should not be Ignored any Longer?

CVD s are eminently preventable.

Investment in prevention is the most sustainable solution for theCVD epidemic.

Over the last two decades, CVD mortality has declined in developedcountries due to a combination of prevention and control measures.

Prevention of CVD by reducing the total cardiovascular risk is costeffective.

SUMMARY

• During the last century, Cardiovascular Disease (CVD) has burgeoned from a

relatively minor disease worldwide to a leading cause of morbidity and mortality.

• A substantial portion of the increasing global impact of CVD is attributable to

economic, social, and cultural changes that have led to increases in risk factors

for CVD.

• CVD Prevention is the cornerstone of reducing global mortality and morbidity

worldwide.

• Risk factor screening should be considered in adult men >40 years old and in

women >50 years of age or post menopausal.

• The physician in general practice is the key person to initiate, coordinate, and

provide long term follow-up for CVD prevention.

• The practising cardiologist should be the advisor in cases where there is

uncertainty over the use of preventive medication or when usual preventive

options are difficult to apply.

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