Hall A 1 Thomas Allison Global burden of CV disease 2

Hall A 1 Thomas Allison Global burden of CV disease 2 tài liệu, giáo án, bài giảng , luận văn, luận án, đồ án, bài tập l...

Greetings from Rochester, MN

Global Burden of Cardiovascular Disease

Lessons for Vietnam from Experience of USA and

Other Countries?

Dr Thomas G AllisonCardiovascular Diseases and Internal Medicine

Mayo ClinicRochester, MN

CV Trends in USA

Is the US experience being repeated

internationally?

Modified Model of the Epidemiological Transition as it

Pertains to Cardiovascular Disease

Yusef et al Circulation 2001;104:276-2753

Stage 1: Age of Pestilence and Famine

Life expectancy < 55 years

CVD deaths 5-10% of total deaths

< 5% of years of potential life lost (YPLL)

Prominent CV diseases

and risk factors

Rheumatic heart disease, infections, nutritional

cardiomyopathies

Example Sub-Saharan Africa

• Life expectancy m/f = 53/55 years

• HIV/AIDS is #1 cause of death

– 25% of deaths and 27% of YPLL

• Malaria is #2 cause of death

– 12% of deaths and 15% of YPLL

• Measles is #3 cause of death

– 7% of deaths and 10% of YPLL

• Ischemic heart disease is #6 cause of death

– 4% of deaths and 1% of YPLL

• Cerebrovascular disease is #8 cause of death

– 4% of deaths and 1% of YPLL

Stage 2: Age of Receding Pandemics

Life expectancy 55-65 years

CVD deaths 10-35% of total deaths

Example Bangledesh

• Life expectancy m/f = 63/63 years

• Ischemic heart disease is #1 cause of death

– 12% of deaths and 6% of YPLL

• Lower respiratory infections is #2 cause of death

– 11% of deaths and 13% of YPLL

• Perinatal conditions is #3 cause of death

– 8% of deaths and 13% of YPLL

• Tuberculosis is #4 cause of death

– 7% of deaths and 7% of YPLL

• Diarrhea #5 cause of death

– 6% of deaths and 9% of YPLL

• Cerebrovascular disease is #6 cause of death

– 5% of deaths and 2% of YPLL

Stage 3: Age of Degenerative and Man-Made

Diseases

Life expectancy 65-75 years

CVD deaths 35-65% of total deaths

Regional examples Eastern Europe

• Life expectancy m/f = 69/76 years

• Ischemic heart disease is #1 cause of death

– 25% of deaths and 21% of YPLL

• Cerebrovascular disease is #2 cause of death

– 20% of deaths and 16% of YPLL

• Hypertensive heart disease is #3 cause of death

– 4% of deaths, 4% of YPLL

• Trachea, bronchus, lung cancer is #4

– 4% of deaths, 3% of YPLL

Stage 4: Age of Delayed Degenerative

Diseases

Life expectancy > 75 years

CVD deaths 50% of total deaths

• Life expectancy m/f = 75/80 years

• Ischemic heart disease is #1 cause of death

– 21% of deaths and 15% of YPLL

• Cerebrovascular disease is #2 cause of death

7% of deaths and 4% of YPLL

• Trachea, bronchus, lung cancer is #3

– 7% of deaths, 7% of YPLL

• Alzheimer’s, other dementias is #5

– 4% of deaths, 1% of YPLL

Increased mechanization

of food productionMore processed foodIncreased salt intake

Hypertension

Hypertensive heart disease

Hemorrhagic stroke

Increased caloric intakeMore meat consumption

Incubation Period for Chronic Disease

Transition Factors 3 → 4

More educated public

Increased spending on medical careSecondary prevention practices

Primary prevention practices

Improved survival from MI

Reduced MI, stroke at young ages

Risk Factor Trends in US

Risk Factor Years* Prevalence Current

Reduction in CVD Death Rate in US

Pre-1985 due largely to

McGovern et al Circulation 2001;104:19-24

[Primary Prevention] [Secondary Prevention]

CHD Trends

McGovern et al, Circulation 2001;104:19-24

Epidemiologic Transition

in East Asia

Cam VN China ROK

Estimated deaths per 100,000 population, 2004

Cancer Maternal and perinatal conditions Communicable diseases

CV Risk Factors Vietnam

Mixed Urban and Rural Populations

Smoking tobacco 2003 34.8% 1.8%Cholesterol ≥ 6.2 mmol/L 2001 6.5% 11.7%Diabetes age 55-64

age ≥ 65

20012001

7.6%

11.5%

12.4%18.2%SBP ≥140 or DBP ≥90 mmHg 2002 18.0% 9.8%Physical inactivity 2003 7.7% 8.8%

Preventing CV Disease Epidemic

• Resist US, British, Chinese cigarette

marketing

– Discourage smoking, especially among youth

• Continue to eat a diet high in locally-grown, unprocessed foods

– Minimize high sodium pre-prepared and

packaged foods

– Minimize intake of saturated fat and cholesterol

• Encourage leisure-time physical activity as work-based physical activity decreases

Can Vietnam Rely on Technology to

In US we treat coronary disease

with devices

$93,000 USD

Some less expensive devices to

treat coronary disease

• CV diseases are already the leading cause of

death in Vietnam – and rates will likely increase

• Primary prevention is the key to controlling the epidemic of CV disease

– Awareness of risk factors

– Good community programs

– Physician training and incentives to treat risk factors

• Optimal medical therapy for secondary

prevention

• Perhaps Vietnam can avoid the crippling

expense of improperly managed CV disease

• Questions?

• Comments?