Cardio vascular diseases Introduction and epidemiology.ppt

CVD intro

1. Epidemiology of Coronary
Heart Disease, Diabetes &
Obesity

2. CHRONIC DISEASES
An impairment of bodily structure or function that necessitates a
modification of the patient's normal life
and has persisted over an extended period of time

3. CHARACTERS
Are permanent
Leave residual disability
Are caused by non-reversible
pathological alteration
Require special training of the
patient for rehabilitation
May be expected to require a long
period of supervision, observation
and care.

4. Risk factors
Biological(HPV-cancer )
Environmental
(allergens-asthma)
Socio cultural
(Kashmir women-kangri)
Behavioral(Smoking, Alcohol )
Health care related
(physical inactivity)
Genetic (hemophilia, diabetes)

5. Non communicable diseases risk factors
•Cigarette use & other forms of smoking
•Alcohol abuse
•Failure or inability to obtain preventive health
services ( HT , DM, Cancer detection)
•Life style changes( dietary patterns, physical activity)
•Environment risk factors( occupational hazards, air
& water pollution)
•Stress factors

6. Cardiovascular diseases
A group of diseases of heart & the vascular system
a)Ischemic heart diseases (IHD)
b)Hypertension
c)Cerebrovascular diseases (stroke)
d)Congenital heart diseases
e)Rheumatic heart diseases ( RHD )

7. Problem statement
WORLD:
16.7 million deaths / yr
1/3
rd
of these deaths are in middle age adult
Cardiovascular diseases-25% of DALYs lost due to
Non communicable diseases
Urban > Rural
Ironically CVD decreases in developed & increasing
in developing countries

9. INDIA :
Estimate increases in death due to CVD is 2.03
million(2010) from 1.59 million(2000)
Prevalence : 2-3 times more in urban population
then rural population

10. GAPS IN NATURAL HISTORYOF NCD’s
1.Absence of specific etiological
agent
2.Multifactorial causation
3.Long latent period
4.Indefinite onset

11. NCD’s share common risk factors ( overlapping )
-Smoking-Lung cancers, CVD’s
Incubation period -about 10 years
Aim-To identify and prevent risk factors
Major problem-Long gap between Onset and Manifestation
(we can overcome by retrospective studies)

12. Example:-
Surveillance of chronic respiratory diseases
1.questionnaire (history based study)
2.physical measurements (standard
methods like spirometry)
3.biochemical measurements (lung
function tests, oxymetry )

13. IMPACT
1.Individual level
Disability /Mortality
2. National level-
Economic loss to country

14. AIM :-
preventing the emergence and development of risk
factors in countries or population groups in which
they have not yet appeared
GOAL:-lifestyle modification
Behavioral habits
PRIMODIAL PREVENTION

15. PRIMARY PREVENTION
AIM-Action taken prior to onset of
disease
GOALS -Health promotion
Specific protection
STRATAGIES-Population strategy
(mass strategy)
High risk strategy
(in India)

16. POPULATION STRATEGY
Directed at the whole population irrespective of
individual risk levels.
1.Dietary changes
.Reduction of saturated fats to <10% of total energy
intake
.Salt intake < 5 g/ day
.Increase in complex
carbohydrates. ( Fiber )

17. Coronary vascular disease (CVD) remains the
leading cause of mortalityin industrialized
countries and is rapidly becoming a primary
cause of death worldwide.
Thus, identification of the dietary changesthat
most effectively prevent CVD is critical.

18. Magnitude of the problem
CVDresulted in 17.5 millionor 30%of total global
deaths in yr 2005according to WHO. 80% of these
deaths occurred in low & middle income
countries
Preventable by action
on major risk factors:
unhealthy diet,
physical inactivity,
& smoking.

19. Balanced Diet
“A balanced diet is defined as one which contains a
variety of foodsin such quantities & proportions that
the need for energy, amino acids, vitamins, minerals,
fats, carbohydrates & other nutrients is adequately met
for maintaining health, vitality &general well-being&
also makes a small provision for extra nutrientsto
withstand short duration of leanness”

20. Healthy Diet/Balanced Diet
Protein 15 % of total energy
Carbohydrates 50 to 60 % of total energy
Total fats 25 to 35 % of total energy
Saturated fat <7 % total energy
Poly unsaturated fat up to 10 % total energy
Mono unsaturated fat up to 20 % total energy
Fiber diet 20 to 30 g/day
Vitamins and minerals
Water
Salt One teaspoon of salt
Cholesterol < 300 mgm/day

21. Prudent Diet (Dietary Goals):
All countries develop a national nutrition & food policy setting out
“dietary goals” for achievement.

22. Prudent Diet (Dietary Goals):
(Recommended by various Expert Committees of WHO)
Dietary fat limited to approximately 15-30 % of
total daily intake.
Saturated fat should not contribute >10% of
total energy intake. Unsaturated vegetable oils
should be submitted for the remaining fat
requirements.
Excessive consumption of refined carbohydrate
should be avoided; some amount of
carbohydrate rich in natural fiber should be
taken.

23. Cont…
Sources rich in energy such as alcohol & fats
should be avoided.
Salt intake should be reduced to an average of
not >5 gm/day.
Protein should account for approximately 10-
15% of daily intake.
Junk foods such as colas, ketchups & other
foods that supply empty calories should be
avoided

24. Recommended Dietary Intake
CHO
CHO (55-60%)FAT
FAT (30%)
PRO
PRO(10-15%)

25. Clinical Nutrition
Clinical nutrition is the use of food and eating
habits to promote health, treat and prevent
disease.
Diet plays an acknowledged therapeutic role for
the management of diabetes, hypertension,
CAD, obesity, bone health, and cancer
The objective of healthy eating advice is to
promote the consumption of a balanced diet by
everyone in the community.

26. CaloriesPrescription:
Calorie prescription is an important element in
nutritional management.
Calorie needs vary with age, sex and activity level.
Recommended calorie level is based on individual’s
desired weight.
IDEAL BODY WEIGHT (IBW) KG = HT IN CM -100
CALORIE INTAKE BASED ON ACTIVITY IS AS FOLLOWS:
SEDENTARY 30-35 CAL/KG (IBW)
MODERATE 35-40CAL/KG (IBW)
STRENUOUR 40-45 CAL/KG (IBW)

27. Eight Guidelines for a Healthy Diet
The Balance of Good Health is based on the Eight Tips for
Eating Well:
1. Base your meals on starchy foods
2. Eat lots of fruit and veg
3. Eat more fish
4. Cut down on saturated fat and sugar
5. Try to eat less salt –no more than 5g/day
6. Get active and try to be a healthy weight
7. Drink plenty of water
8. Don’t skip breakfast

28. Major dietary factors of CVD
Fat
Cholesterol
Omega-3 fatty acids
Trans-fatty acids
Carbohydrates,
Glycemic index, fiber, folate,
Specific foods
Salt
Alcohol

29. Glycemic index
Glycemic index is a ranking system for carbohydrates
based on their effect on blood glucose levels after
ingestion compared with glucose or white bread,
standardizing the carbohydrate content to 50 g.
ClassificationGI range Examples
Low GI 55 or <
most fruit and vegetables (except potatoes),
whole grains, basmati rice, pasta
Medium GI 56 -69 sucrose, candy bar, some brown rice
High GI 70 or >
cornflakes, baked potato, some white rices
(e.g. jasmine), white bread

30. ω−3 fatty acids
Omega-3 fatty acids prevent cardiac arrhythmia,
lower serum triglyceride levels, decrease
thrombotic tendency, and improve endothelial
dysfunction
Omega-3 fatty acids are
polyunsaturated fatty acids
Dietary Sources –Fish, Cod liver
oil, Flax, Walnuts, Butternuts,
Soybean oil, Olive oil, Corn oil….

31. Trans-fatty acids
Trans fat is the common name ofunsaturated fat
Most trans fats consumed today are industrially created by
partially hydrogenating plant oils
Trans fatty acids are not essential and provide no known
benefit to human health
Trans fat raises your
("bad") LDL cholesterol
& lowers your ("good")
HDL cholesterol

32. 2. SMOKING
. Strict implementation of
legislative restrictions
. Promoting educational
activities and
. Smoking cessation
programmes

33. BLOOD PRESSURE:
Decrease in average B.P of the whole
population by 2-3 mm would produce a
large reduction in the incidence of CVD’s

34. PHYSICAL ACTIVITY:
Promoting physical
activity as a normal part of daily life.

35. HIGH RISK STRATEGY.
Identifying risk
Simple clinical methods.
Studying personal H/O.
Family H/O.
Specific advice
Daily physical exercise.
Helping patient to
break addiction.
( nicotine chewing gum-Smokers )
Limitation:-many cases occur in those who are not apparently at
risk.

36. SECONDARY PREVENTION
AIM-To prevent progress of disease.
GOALS-Early diagnosis and
treatment
Example:-
Early diagnosis –Pap smear for
cervical Ca
Treatment –Regular treatment with
B-blockers-Reduced risk of CVD in
those who suffered one impactby 25%

37. TERTIARY PREVEVTION
AIM –intervening in later stages and
post surgical care
GOALS-Disability limitation and
rehabilitation.
(rehabilitation centers for blind
and mentally retarded people)

38. INTEGRATED APPROACH FOR PREVETION &
CONTROL OF NCD’s
More advantageous
than individual
approach of diseases.
Easier because of
common risk factors.
( smoking and alcohol )