Coronary Heart Disease lectures/Community Medicine/2018/Coronary... · noncommuniblicable diseases (hlfhalf of which will be due to cardiovascular disease)haveincreasedby20%, While

CARDIOVASCULARDISEASES

Dr Naveen KrishanGoelf dProf. & Head,

Deptt. of Community MedicineGMC ChandigarhGMC, Chandigarh

IntroductionIntroduction

Cardiovascular disease (CVD):Leading cause of global morbidityand mortalityand mortalityResponsible for one‐in‐threeResponsible for one in threedeaths.

Between 2006 and 2017, deaths due toi bl di (h lf fnoncommunicable diseases (half of

which will be due to cardiovasculardisease) have increased by 20%,Whil d th f i f ti di While deaths from infectious diseases,nutritional deficiencies, and maternal andf ,perinatal conditions combined havedeclined by 3 5%declined by 3‐5% .

• The majority individuals who developj y pheartheart attacksattacks andand strokesstrokes every yearhave one or more cardiovascular riskhave one or more cardiovascular riskfactors i.e. hypertension, diabetes,smoking, high blood lipids or physicalinactivityinactivity.

• Most of these CVD events arepreventablepreventable if meaningful action istaken against these risk factorstaken against these risk factors.

However, the focus is on single riskf t th th h ifactors, rather than on comprehensivecardiovascular risk. For CVD prevention and controlactivities to achieve the greatestgimpact, a paradigm shift is requiredfrom the “treatment of risk factors infrom the treatment of risk factors inisolation” to “comprehensive

di l i kcardiovascular riskmanagement”(CCRM).g

EpidemicityEpidemicity

U.S. : 1920sB it i   Britain: 1930s Now…. Developing countries.p g Decline in CHD mortality in U.S. & other countriescountries Changes in life‐styles, diet, exercise, cigarette use

Inverse relation in SES & CHD in  Inverse relation in SES & CHD in developed countries

Distribution of CVD deaths

World map showing the global distribution of CADt lit t ( t d di d 100 000)mortality rates (age standardized, per 100 000)

in Males

World map showing the global distribution of CADli ( d di d )mortality rates (age standardized, per 100 000)

in Females

Distribution of global CVD burdenDistribution of global CVD burden (DALYs)

Risk FactorsRisk Factors

Hypertension Smoking Smoking Serum Cholesterol ? Other: GeneticGenetic Physical activity Type A personality Type A personality AlcoholO l C i Oral Contraceptives

P ti f CHDPrevention of CHD

Population strategyHi h  i k  t t High risk strategy Secondary prevention Secondary prevention

Population StrategyPopulation Strategy

Specific intervention: Dietary changes Smoking Smoking Blood pressureBlood pressure Physical activity

P i di l P ti Primordial Prevention

High Risk StrategyHigh Risk Strategy

Identifying riskfy gSpecific advicep f

Secondary PreventionSecondary Prevention

Early diagnosis and Treatment

CVD RISKCVD RISK ASSESSMENTASSESSMENT ANDAND MANAGEMENTMANAGEMENT

Clinical assessment ofClinical assessment of cardiovascular riskClinical assessment should be conducted with 04aims:aims:

1. to search for all cardiovascular risk factors andclinical conditions that may influence prognosis andy p gtreatment;

2. to determine the presence of target organ damage(heart, kidneys and retina);

3. to identify those at high risk and in need of urgenti iintervention;

4. to identify those who need special investigations orreferal (e g those ith secondar h pertension)referal (e.g. those with secondary hypertension)

WHO CVDCVD Risk ManagementRisk ManagementWHO CVDCVD‐‐Risk Management Risk Management PackagePackagePackagePackage The package has been designed primarily for the

management of cardiovascular risk in individualsgdetected to have hypertension throughopportunistic screening.

However, it could be adapted for use withdiabetes or smoking as entry points.

The package has been designed for 03scenarios that reflect the commonlyf yencountered resource availability stratain such settings.g

Characteristics of the three scenarios

Counseling on diet & physicalCounseling on diet & physical activity

DIETDIET SALT (sodium chloride) Restrict to less than 5 grams (1 teaspoon level) per day Reduce salt‐

when cooking and limit processed and fast foods

FRUITSANDVEGETABLES 05 servings (400‐500 grams) of fruits and vegetable perdayday.

One serving ‐‐‐1 orange or apple or mango or banana orbl f k d bl3 tablespoons of cooked vegetables. or

2 Katories of vegetables + Salad + 1 fruit or 3 katories off g f fvegetables( if fruit not available).

FATTY FOODOO Limit fatty meat, dairy fat and cooking oil (less than two

tablespoons per day) 500‐900gm per person per month.p p y 5 9 g p p p Replace palm or coconut oil with Groundnut/olive/soya/corn/rapeseed/safflower oil.

i / i f il Oil should be used in rotation/ mixture of oil. Replace other meatwith chicken (without skin)

FISH FISH Eat fish at least three times per week, preferably oily fish such as tuna,

mackerel, salmon. Fried fish to be avoided. Preferably‐‐roasted.

Any dry fruit but not more than 06 pieces per dayl i h bWalnut is the best.

NoNo alcoholalcohol NoNo alcoholalcohol

Ph i l ti itPhysical  activity  Progressively increaseg y

moderate physicalp yactivity such as brisk walking,cycling to at least 45 minutesper day

Co nseling on cessation ofCounseling on cessation of tobacco (5 As)tobacco  (5 As)

Askd iAdvise

AAssessAssistAssistArrangeArrange

Patient Record Card

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