Hội Tim mạch học Việt Nam

Association of risk factors with acute myocardial infarction in men and women after adjustment for age, sex, and geographic region Yusuf S etal.: Lancet 2004; 364: 937– 52... Risk of acu

Diabetes and CVD burden

in Asia population

National Center for Global Health and Medicine

Tokyo, Japan Hiroshi Kajio, M.D., Ph D/

Diabetes and CVD

Diabetes Population in 2010 and 2030

Europe 58.70 million

↓ 66.2 million

Med & Middle East

26.6 million

↓

51.7 million

SE Asia 58.7 million

↓

101 million Africa

1210 万人

↓

2390 万人

Total 28.46 million in 2010

↓ 43.84 million in 2030

West pacific 76.7 million

↓ 112.8 million

South and Central America

18 million

↓ 29.6 million

North America 37.4 million

↓ 53.2 million

+ 72.1%

+ 20.0%

+ 47.0%

+ 65.1% + 42.4%

+ 54.0%

+ 98.1%

IDF Map in 2009

+ 93.9%

Relative Risk of CVD

In Patients with IGT and DM

The Hisayama Study

Fujishima M, et al: Diabetes, Vol.45 Suppl 3, S14-S16, 1996

HDL-C, tobacco and alcohol

Previous history: stroke (-)

MI (-) Follow-up period: 5 years

Abnormality of glucose tolerance

Ueshima, H et al Circulation 2008;118:2702-2709

Age-standardized death rates per 100 000 for stroke and CHD

across countries in different regions of Asia in 2002

CVD Risk Factors

Association of risk factors with acute myocardial infarction

in men and women after adjustment for age, sex, and geographic region

Yusuf S etal.: Lancet 2004; 364: 937– 52

Risk of acute myocardial infarction associated with exposure to multiple risk factors

Smk=smoking DM=diabetes mellitus HTN=hypertension Obes=abdominal obesity PS=psychosocial RF=risk factors.

Yusuf S etal.: Lancet 2004; 364: 937–

52

Odds of myocardial infarction according to

Yusuf S etal.: Lancet 2004; 364: 937– 52

Reduced risk of acute myocardial infarction associated with various risk factors

Smk=smoking Fr/vg=fruits and vegetables Exer=exercise Alc=alcohol

Note the doubling scale on the y axis Odds ratios are adjusted for all risk factors

Yusuf S etal.: Lancet 2004; 364: 937– 52

Risk of acute myocardial infarction associated with current or former

smoking , overall and by region after adjustment for age and sex

W Eur=western Europe CE Eur=central and eastern Europe MEC=Middle East Crescent Afr=Africa

S=South HK=Hong Kong SE=southeast ANZ=Australia and New Zealand N=North Am=America

Yusuf S etal.: Lancet 2004; 364: 937– 52

Risk of acute myocardial infarction associated with ApoB/ApoA1 ratio

(top vs lowest quintile), overall and by region after adjustment for age, sex, and smoking

PAR is for the top four quintiles versus the lowest quintile

Yusuf S etal.: Lancet 2004; 364: 937– 52

Risk of acute myocardial infarction associated with self-reported

hypertension , overall and by region after adjustment for age, sex, and

smoking

Yusuf S etal.: Lancet 2004; 364: 937– 52

Risk of acute myocardial infarction associated with self-reported

diabetes , overall and by region after adjusting for age, sex,

and smoking

Yusuf S etal.: Lancet 2004; 364: 937– 52

Risk of acute myocardial infarction associated with abdominal obesity

measured as waist/hip ratio (upper tertile vs lowest tertile),

overall and by region after adjusting for age, sex, and smoking

PARs are for top two tertiles vs lowest tertile

Yusuf S etal.: Lancet 2004; 364: 937– 52

Risk of acute myocardial infarction associated with

the composite psychosocial index , overall and by region

Yusuf S etal.: Lancet 2004; 364: 937–52

Cardiovascular risk prediction tool for populations in Asia

Observed and predicted cardiovascular event rate according to deciles of predicted risk using the (A) Framingham risk equation, (B) “other Asian” risk equation and (C) recalibrated Framingham risk equation.

J Epidemiol Community Health 2007 February; 61(2): 115–121

Smoking

Ueshima, H et al Circulation 2008;118:2702-2709

Trends in smoking rate by sex and by selected Asian countries

Hazard ratios (HRs) associated with a 2 kg/m2 higher body mass index

for coronary heart disease events in current smokers and non-smokers,

by sex, region, age and overall

Analyses are adjusted by age and stratified by study and sex The horizontal lines (or widths of diamonds for overall results) show 95% confidence intervals (CIs) The p values shown are for the test of interaction between body mass index and smoking status The dashed and continuous lines represent current smokers and non-smokers, respectively

The Asia Pacific Cohort Studies Collaboration BMC Public Health 2009 9:294e

Smoking

Smoking

Hazard ratios (HRs) associated with a 2 kg/m2 higher body mass index

for ischaemic stroke events in current smokers and non-smokers, by sex, region, age and overall

Analyses are adjusted by age and stratified by study and sex The horizontal lines (or widths of diamonds for overall results) show 95% confidence intervals (CIs) The p values shown are for the test of interaction between body mass index and smoking status The dashed and continuous lines represent current smokers and non-smokers, respectively

The Asia Pacific Cohort Studies Collaboration BMC Public Health 2009 9:294e

Hazard ratios (HRs) associated with a 2 kg/m2 higher body mass index

for haemorrhagic stroke events in current smokers and non-smokers,

by sex, region, age and overall

Analyses are adjusted by age and stratified by study and sex

The horizontal lines (or widths of diamonds for overall results) show 95% confidence intervals (CIs)

The p values shown are for the test of interaction between body mass index and smoking status

The dashed and continuous lines represent current smokers and non-smokers, respectively

The Asia Pacific Cohort Studies Collaboration BMC Public Health 2009 9:294 a

Hypertension

Estimated Number of Individuals Aged >20 Years With Blood Pressure >140/90 mm Hg

in 2000 and Predicted Number of Affected Individuals in 2025

Region Prevalence Predicted Prevalence Increase,

2000, Millions 2025, Millions Millions

Established market economies 239.5 309.7 70.2

Latin America and the Caribbean 114.3 200.6 86.3

Former socialist economies 93.1 103.7 10.6

Middle East crescent 73.8 152.6 78.8

Nakamura, K et al Stroke 2008;39:1694-1702

Associations between usual systolic blood pressure (SBP) and overall events by smoking

status for: (A) coronary heart disease , (B) ischemic stroke , (C) hemorrhagic stroke , and (D)

other strokes

The higher risk of (A) fatal and nonfatal coronary heart disease and (B) stroke ,

in the Asia Pacific Cohort Studies Collaboration

Hypertension 2007;50;991-997

Coronary heart disease

Stroke

Nakamura, K et al Stroke 2008;39:1694-1702

Hazard ratios (HRs) associated with a 10-mm Hg increase in usual systolic blood pressure

for coronary heart disease (CHD), ischemic stroke, and hemorrhagic (Hem) stroke, in

present smokers and non-smokers, by sex, region, age, and overall

CHD

Ischemic stroke

Hem stroke

Wu, Y et al Circulation 2008;118:2679-2686

Map showing the estimated age- and sex-standardized prevalence of hypertension

in each region of China

High Prevalence

Low Prevalence

The effects of a perindopril-based blood pressure–lowering regimen on the risk of subsequent stroke among Asian and Caucasian participants in the

Perindopril Protection Against Recurrent Stroke Study

Reproduced from Rodgers et al.J Hypertens 2004;22: 653-659

Metabolic abnormality

Joint effects of SBP and total cholesterol levels

on stroke and CHD in the Asia Pacific Region

Hazard ratio vs SBP level

for 4 strata of total cholesterol

P = 0.001

Hazard ratio

vs both SBP and total

cholesterol

P = 0.002

Circulation 2005;112;3384-3390

Mean levels of risk factors by 10 yr age interval group in men and women

from Asia and ANZ.

Int J Epidemiol 2006;35:1025-1033

Triglyceride

HDL Cholesterol Total Cholesterol

Systemic Blood Pressure

Cigarette Smoking

Body Mass Index Diabetes

Ueshima, H et al Circulation 2008;118:2702-2709

Serum total cholesterol levels (Serum T-CHOL) for men among Asian populations in 1980 to 2000 and in the United States in 1960 to 1991

USA

Japan

China

Obesity

and Change of nutrition

Prevalence of obesity/overweight and diabetes

Trends in the prevalence of overweight and obesity (BMI≥25 kg m−2) in Australian, Chinese and

Japanese adult populations

BMI and Body fat percent of Dutch and Indonesian

1975 Total

1984 Total

1992 Total

1998 Total

1998 males

1998 Females

1998 Total

1998 Males

1998年 Females

Insulin sensitivities in Indian and Caucasian

▲：Indian 、□Caucasian

Prevalence of diabetes in China

In 1985-1994 and 1995-2003

Changes of Percent Poor and GDP in India and China

GDP=gross domestic product

Food consumption in China and India

Energy source in China(A) and India(B)

Young Generation

００

Risk factors for lifestyle-related diseases

China and India in 1995年 and 2025

Overweight

Low Body Weight

Age, study and year of birth adjusted HRs (95% CIs) for each outcome

by height quarters in all participants.

Lee C M Y et al Int J Epidemiol 2009;38:1060-1071

●males, ○females

The influence of early life factors on the burden of type 2 diabetes and other

non-communicable diseases

Current concept of the Developmental Origins of

Health and Disease (DOHaD)

Metabolic Syndrome

Population-based Study in Asian countries

Metabolic Syndrome

Accumulation

of risk factors

Onset

of disease Waist Circumference

Cross-sectional

Study

Follow-up Study

Definition of the state of risk-factor clustering

（NCEP-ATPⅢ except for waist circumference）

（１）

（２）

（３）

（４）

a history of hyperlipidemia, hypertension,or diabetes were deemed

as having the respective risk factors,regardless of the biochemical values.

Female Male

Sensitivity plus Specificity for having multiple risk factors

Waist circumference (WC)

Waist circumference (WC)

Beijin g

Hanoi Mean = 79.0

33.6%

30.0%

Hanoi Mean = 76.3

35.4%

37.9%

Urban Rural

Thai Binh 30-54

Accumulation of the people with multiple risk factors

in Men

Hanoi 55-69

Hanoi 30-54

Aging

36.8% 33.7%

31.3%

27.3%

Thai Binh 30-54

Hanoi 55-69

Hanoi 30-54

Diabetes and CVD in Asia

Accumulation

of risk factors

Onset

of disease

Genetic factors

Thank you for your attention!