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POPULATION CARDIOVASCULAR HEALTH – Update on Prevention Professor Christopher Reid, Co-Director CCRE Therapeutics School of Public Health & Preventive Medicine, Monash University Dire

POPULATION CARDIOVASCULAR HEALTH – Update on Prevention

Professor Christopher Reid,

Co-Director CCRE Therapeutics

School of Public Health & Preventive Medicine, Monash University

Director, Curtin Centre of Clinical Research & Education

School of Public Health, Curtin University

15 th Vietnam National Congress of Cardiology

Hanoi, October 2016

the US National Institutes of Health

NIL related to this presentation

Population Cardiovascular Health

WHO, 2016

4 Population Cardiovascular Health

Projections of global mortality and burden of disease from 2002 to 2030, WHO Report 2010

Burden of disease by broad cause group 1990 – 2020 in Developing

maternal and perinatal

conditions and nutritional

deficiencies

Injuries

*DALY = Disability adjusted life-year

1990

2020

Noncommunicable conditions

interaction between pattern of health and disease and

“their demographic, economic & social determinants and

consequences”

Pestilence &

Famine

Receding Pandemics

Degenerative &

Man-made

Chronic diseases

Globalisation & Urbanisation

Coca-colarisation

INDIA

9 Life Expectancy at Birth - 2016

Population Ageing as a driver of CVD

% 65 and over

“Based on population projections by the Australian Bureau of Statistics, there will be 9.6 million people aged 65 and over and 1.9 million people aged 85 and over

by 2064”

AIHW, 2016

11 Population Ageing as a driver of CVD

Population Cardiovascular Disease

13 Risk Factors leading to all-cause deaths

WHO, 2016

Prevention can work

16 Prevention can work

Strategies for Prevention

18 Strategies for Prevention

Populations Surveillance of Risk Factors

Quality risk factor surveillance data is possible in even the least resourced countries

20 Best buys for Population prevention and control of CVD

Majority are public policy based interventions

Weight Loss in Overweight / Obese Individuals

22 Physical Inactivity

Prevention Works - Physical Activity

Quintiles of activity (MET-hour/week**)

0.0 0.2 0.4 0.6 0.8 1.0

*Includes aerobics, aerobic dancing, jogging, tennis, and swimming laps

Women’s Health Initiative Observational Study

Diabetes Prevention Program (DPP)

Knowler WC et al NEJM 2002;346:393-403

0 10 20 30

40

Placebo (n=1082) Metformin (n=1073, p<0.001 vs Plac) Lifestyle (n=1079, p<0.001 vs Met , p<0.001 vs Plac )

Percent developing diabetes

All participants All participants

Years from randomization

3,234 patients with elevated fasting and post-load glucose levels randomized to placebo,

metformin (850 mg bid), or lifestyle modification* for 3 years

Lifestyle modification reduces the risk of developing DM

High Risk CVD Management - Blood Pressure Lowering

Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data Lancet, 2014

Effects of blood pressure reduction on

absolute and proportional risks of

events

Avoidable events by baseline risk

26

High Risk CVD Management - Lipid Lowering

The effects of lowering LDL cholesterol with statin therapy in people at low risk

of vascular disease: meta-analysis of individual data from 27 randomised trials

CTTC, Lancet 2012

High Risk CVD Management - Lack of Risk Factor Control world-wide

28 New Strategies Required

CVD Therapeutic Risk Factor Management

A focus on implementation of effective pharmacotherapies

- Individual and combination (poly-pill) therapies

Yusuf et al, 2016

HOPE - 3

30% RR in CVD events with combination

BP lowering & Lipid lowering therapy

Thank You