This is the Epi of Cardiovascular diseases.ppt

Dr Ibrahim Abdi Hassan

1. EPIDEMIOLOGY OF EPIDEMIOLOGY OF
CARDIOVASCULAR CARDIOVASCULAR
DISEASESDISEASES

2. OutlineOutline

What is cardiovascular diseasesWhat is cardiovascular diseases

Types of cardiovascular diseasesTypes of cardiovascular diseases

Magnitude of cardiovascular diseasesMagnitude of cardiovascular diseases

Prevention and control of Prevention and control of cardiovascular cardiovascular
diseasesdiseases

3. IntroductionIntroduction

Cardiovascular diseases (CVD) comprise a group Cardiovascular diseases (CVD) comprise a group
of diseases of the heart and the vascular system. of diseases of the heart and the vascular system.

The major conditions are The major conditions are

Ischaemic heart disease (IHD), Ischaemic heart disease (IHD),

Hypertension, Hypertension,

Cerebrovascular disease (stroke) and Cerebrovascular disease (stroke) and

Congenital heart disease. Congenital heart disease.

Rheumatic heart disease (RHD) continues to be Rheumatic heart disease (RHD) continues to be
an important health problem in many developing an important health problem in many developing
countries specially in SSA.countries specially in SSA.

4. Types of CVDsTypes of CVDs

Cardiovascular diseases (CVDs) are a group of disorders of the heart and Cardiovascular diseases (CVDs) are a group of disorders of the heart and
blood vessels. They include:blood vessels. They include:

coronary heart disease coronary heart disease – a disease of the blood vessels supplying the heart – a disease of the blood vessels supplying the heart
muscle;muscle;

cerebrovascular disease cerebrovascular disease – a disease of the blood vessels supplying the brain;– a disease of the blood vessels supplying the brain;

peripheral arterial disease peripheral arterial disease – a disease of blood vessels supplying the arms – a disease of blood vessels supplying the arms
and legs;and legs;

rheumatic heart disease rheumatic heart disease – damage to the heart muscle and heart valves – damage to the heart muscle and heart valves
from rheumatic fever, caused by streptococcal bacteria;from rheumatic fever, caused by streptococcal bacteria;

congenital heart disease congenital heart disease – birth defects that affect the normal development – birth defects that affect the normal development
and functioning of the heart caused by malformations of the heart structure and functioning of the heart caused by malformations of the heart structure
from birth; andfrom birth; and

deep vein thrombosis and pulmonary embolism deep vein thrombosis and pulmonary embolism – blood clots in the leg – blood clots in the leg
veins, which can dislodge and move to the heart and lungs.veins, which can dislodge and move to the heart and lungs.

5. 
Cardiovascular diseases (CVDs) are the leading cause of death Cardiovascular diseases (CVDs) are the leading cause of death
globally.globally.

An estimated 17.9 million people died from CVDs in 2019, An estimated 17.9 million people died from CVDs in 2019,
representing 32% of all global deaths. representing 32% of all global deaths.

Of these deaths, 85% were due to heart attack and stroke.Of these deaths, 85% were due to heart attack and stroke.

Over three quarters of CVD deaths take place in low- and Over three quarters of CVD deaths take place in low- and
middle-income countries.middle-income countries.

Out of the 17 million premature deaths (under the age of 70) Out of the 17 million premature deaths (under the age of 70)
due to noncommunicable diseases in 2019, 38% were caused due to noncommunicable diseases in 2019, 38% were caused
by CVDs.by CVDs.
Magnitude of CVDs

6. 
Heart attacks and strokes are usually acute events and are Heart attacks and strokes are usually acute events and are
mainly caused by a blockage that prevents blood from flowing to mainly caused by a blockage that prevents blood from flowing to
the heart or brain. the heart or brain.

The most common reason for this is a build-up of fatty deposits The most common reason for this is a build-up of fatty deposits
on the inner walls of the blood vessels that supply the heart or on the inner walls of the blood vessels that supply the heart or
brain. brain.

Strokes can be caused by bleeding from a blood vessel in the Strokes can be caused by bleeding from a blood vessel in the
brain or from blood clots.brain or from blood clots.
Magnitude of CVDs

7. Magnitude of CVDs in SSA

NCDs are the second common cause of death in sub-Saharan Africa NCDs are the second common cause of death in sub-Saharan Africa
(SSA) accounting for about 35% of all deaths, after a composite of (SSA) accounting for about 35% of all deaths, after a composite of
communicable, maternal, neonatal, and nutritional diseases.communicable, maternal, neonatal, and nutritional diseases.

In 2013, an estimated 1 million deaths were attributable to CVD in In 2013, an estimated 1 million deaths were attributable to CVD in
sub-Saharan Africa alone, which constituted 5.5% of all global CVD-sub-Saharan Africa alone, which constituted 5.5% of all global CVD-
related deaths and 11.3% of all deaths in Africarelated deaths and 11.3% of all deaths in Africa

SSA has 23% of the world’s prevalent rheumatic heart disease SSA has 23% of the world’s prevalent rheumatic heart disease
cases.cases.

The leading causes of heart failure in SSA are hypertensive heart The leading causes of heart failure in SSA are hypertensive heart
disease,disease,

8. 
The most important behavioural risk factors of heart disease and stroke are The most important behavioural risk factors of heart disease and stroke are

Unhealthy diet, Unhealthy diet,

Physical inactivity, Physical inactivity,

Tobacco use and Tobacco use and

Harmful use of alcohol. Harmful use of alcohol.

The effects of behavioural risk factors may show up in individuals as The effects of behavioural risk factors may show up in individuals as raised raised
blood pressureblood pressure, , raised blood glucoseraised blood glucose, , raised blood lipidsraised blood lipids, and , and overweight overweight
and and obesityobesity. .

These “intermediate risks factors” can be measured in These “intermediate risks factors” can be measured in primary care facilities primary care facilities
and indicate an increased risk of heart attack, stroke, heart failure and other and indicate an increased risk of heart attack, stroke, heart failure and other
complications.complications.
Risk factors for cardiovascular disease

9. Risk factors for cardiovascular disease

There are also a number of underlying determinants of CVDs.
These include

Social, Economic and Cultural change due to globalization,
urbanization and population ageing.

Other determinants of CVDs include poverty, stress and
hereditary factors.

In addition, drug treatment of hypertension, diabetes and high
blood lipids are necessary to reduce cardiovascular risk and
prevent heart attacks and strokes among people with these
conditions.

10. Why are cardiovascular diseases a development issue in
low- and middle-income countries?

The poorest people in low- and middle-income countries are
most affected.

At least three-quarters of the world's deaths from CVDs occur in
low- and middle-income countries.

Lack of the benefit of primary health care programmes for early
detection and treatment of people with risk factors for CVDs.

Less access to effective and equitable health care services which
respond to their needs.

11. Why are cardiovascular diseases a development issue in
low- and middle-income countries?

As a result, people die at a younger age from CVDs and other
noncommunicable diseases, often in their most productive
years.

At the household level, evidence is emerging that CVDs and
other noncommunicable diseases contribute to poverty due to
catastrophic health spending and high out-of-pocket
expenditure.

At the macro-economic level, CVDs place a heavy burden on
the economies of low- and middle-income countries.

12. Preventions of cardiovascular diseasePreventions of cardiovascular disease

Most cardiovascular diseases can be prevented by addressing Most cardiovascular diseases can be prevented by addressing
behavioural risk factors such as behavioural risk factors such as tobaccotobacco useuse, , unhealthy diet unhealthy diet and and
obesityobesity, , physical inactivity physical inactivity and and harmful use of alcoholharmful use of alcohol..

It is important to detect cardiovascular disease as early as possible It is important to detect cardiovascular disease as early as possible
so that management with counselling and medicines can begin.so that management with counselling and medicines can begin.

Therefore, Cessation of tobacco use, reduction of salt in the diet, Therefore, Cessation of tobacco use, reduction of salt in the diet,
eating more fruit and vegetables, regular physical activity and eating more fruit and vegetables, regular physical activity and
avoiding harmful use of alcohol have been shown to reduce the avoiding harmful use of alcohol have been shown to reduce the
risk of cardiovascular diseases.risk of cardiovascular diseases.

13. Preventions of cardiovascular diseasePreventions of cardiovascular disease

In 2013, WHO Member States agreed on global
mechanisms to reduce the avoidable NCD burden
including a "Global action plan for the prevention and
control of NCDs 2013-2020".

This Plan aims to reduce the number of premature deaths
from NCDs by 25% by 2025 through nine voluntary global
targets.

14. Global action plan for the prevention and control of NCDs 2013-20201Global action plan for the prevention and control of NCDs 2013-20201

15. Rheumatic heart diseaseRheumatic heart disease

16. Rheumatic heart disease Rheumatic heart disease

Rheumatic heart disease is caused by damage to the heart Rheumatic heart disease is caused by damage to the heart
valves and heart muscle from the inflammation and scarring valves and heart muscle from the inflammation and scarring
caused by rheumatic fever. caused by rheumatic fever.

Caused by an abnormal response of the body to infection with Caused by an abnormal response of the body to infection with
streptococcal bacteria, which usually begins as a sore throat or streptococcal bacteria, which usually begins as a sore throat or
tonsillitis in children.tonsillitis in children.

Rheumatic fever mostly affects children in developing Rheumatic fever mostly affects children in developing
countries, especially where poverty is widespread. countries, especially where poverty is widespread.

Globally, about 2% of deaths from cardiovascular diseases are Globally, about 2% of deaths from cardiovascular diseases are
related to rheumatic heart disease.related to rheumatic heart disease.

17. 
Symptoms of rheumatic heart disease include: Symptoms of rheumatic heart disease include:
shortness of breathshortness of breath, , fatiguefatigue, , irregular heartbeatsirregular heartbeats, ,
chest pain chest pain and and faintingfainting..

Symptoms of rheumatic fever include: fever, pain Symptoms of rheumatic fever include: fever, pain
and swelling of the joints, nausea, stomach cramps and swelling of the joints, nausea, stomach cramps
and vomiting.and vomiting.
Symptoms of rheumatic heart diseaseSymptoms of rheumatic heart disease

18. HypertensionHypertension

19. HypertensionHypertension

Hypertension or elevated blood pressure is a serious
medical condition that significantly increases the risks of
heart, brain, kidney and other diseases.

Blood pressure is the force exerted by circulating blood
against the walls of the body’s arteries, the major blood
vessels in the body.

diagnosed when it is measured on two different days, and
the systolic blood pressure readings on both days is ≥140
mmHg and/or the diastolic blood pressure readings on
both days is ≥90 mmHg.

20. Magnitude of HypertensionMagnitude of Hypertension

An estimated 1.28 billion adults aged 30-79 years worldwide have
hypertension, most (two-thirds) living in low- and middle-income countries

An estimated 46% of adults with hypertension are unaware that they have
the condition.

Less than half of adults (42%) with hypertension are diagnosed and treated.

Approximately 1 in 5 adults (21%) with hypertension have it under control.

Hypertension is a major cause of premature death worldwide.

One of the global targets for noncommunicable diseases is to reduce the
prevalence of hypertension by 33% between 2010 and 2030.

21. Risk factors for hypertension?Risk factors for hypertension?

Modifiable risk factors include

Unhealthy diets (excessive salt consumption, a diet high in
saturated fat and trans fats, low intake of fruits and vegetables),

Physical inactivity,

Consumption of tobacco and alcohol, and

Being overweight or obese.

Non-modifiable risk factors include

a family history of hypertension,

age over 65 years and

co-existing diseases such as diabetes or kidney disease.

22. Hypertension in low- and middle-Hypertension in low- and middle-
income countries?income countries?

The prevalence of hypertension varies across regions and
country income groups.

The WHO African Region has the highest prevalence of
hypertension (27%) while the WHO Region of the Americas
has the lowest prevalence of hypertension (18%).

The number of adults with hypertension increased from 594
million in 1975 to 1.13 billion in 2015, with the increase seen
largely in low- and middle-income countries.

This increase is due mainly to a rise in hypertension risk
factors in those populations.

23. Prevention and ControlPrevention and Control
•Reducing hypertension prevents heart attack, stroke, and kidney damage, as well as other
health problems.
•Prevention

Eating more fruit and vegetables.

Being physically active on a regular basis.

Avoiding use of tobacco.

Reducing alcohol consumption.

Limiting the intake of foods high in saturated fats.

Reducing salt intake (to less than 5g daily).

Eliminating/reducing trans fats in diet.
•Management

Regularly checking blood pressure.

Treating high blood pressure.

Reducing and managing stress.

Managing other medical conditions.

24. StrokeStroke

25. StrokeStroke

Stroke is the second leading cause of death and a major cause
of disability worldwide.

Its incidence is increasing because the population ages.

In addition, more young people are affected by stroke in low-
and middle-income countries.

Ischemic stroke is more frequent but hemorrhagic stroke is
responsible for more deaths and disability-adjusted life-years
(DALY) lost.

26. Global Burden of StrokeGlobal Burden of Stroke

In the last decades, a substantial decrease of stroke incidence,
mortality, and DALYs has been achieved in high-income countries,
most likely due to improvement in primary and secondary prevention
as well as acute stroke treatment and neurorehabilitation.

However, Stroke remains an important cause of disability and death
worldwide.

In low- and middle-income countries, the burden of stroke has
increased substantially over the past few decades due to expanding
population numbers and aging as well as the increased prevalence of
modifiable stroke risk factors.

27. Risk factors for stroke

The major risk factors for stroke include:

Hypertension, Diabetes, Heart conditions such as; coronary
heart disease, cardiomyopathy, heart failure, and atrial
fibrillation.

Smoking

Age

gender

Race and ethnicity

Personal or family history of stroke or TIA.

Brain aneurysms or arteriovenous malformations (AVMs)

28. Risk factors for strokeRisk factors for stroke

Other risk factors for stroke, many of which of you can
control, include:

Alcohol and illegal drug use, eg. cocaine, amphetamines

Certain medical conditions, eg. sickle cell disease, vasculitis
(inflammation of the blood vessels), and bleeding disorders

Lack of physical activity

Overweight and Obesity

Stress and depression

Unhealthy cholesterol levels, Unhealthy diet

Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

29. Coronary heart disease Coronary heart disease

30. Coronary heart disease Coronary heart disease

Coronary heart disease (CHD) is now the leading cause of
death and disability globally.

Despite recent declines in age-adjusted death rates from
CHD, the number of CHD deaths have been increasing due to
a combination of growth in population numbers and their
longevity.

In addition, manifestation and outcome of CHD varies
substantially between and within countries.

Unlike many other common medical conditions that disable
and kill and remain unpreventable, CHD is to a large extent
preventable.

31. Coronary heart disease Coronary heart disease

Coronary heart disease (Ischaemic heart disease)is defined as "impairment of heart
function due to inadequate blood flow to the heart compared to its needs, caused by
obstructive changes in the coronary circulation to the heart“

The cause of 25-30 per cent of deaths in most industrialized countries

CHD may manifest itself in many presentations :
1.angina pectoris of effort
2.myocardial infarction
3.irregularities of the heart
4.cardiac failure
5.sudden death.

Myocardial infarction is specific to CHD; angina pectoris and sudden death are not.

Rheumatic heart disease and cardiomyopathy are potential sources of diagnostic
confusion.

The natural history of CHD is very variable. Death may occur in the first episode or after
a long history of disease.

32. Coronary heart disease Coronary heart disease

There are strong, unconfounded relationships between
several risk factors and CHD mortality and non-fatal
myocardial infarction.

The most important risk factors for CHD are smoking, high
blood pressure, dyslipidaemia, diabetes, physical inactivity,
unhealthy diet, and obesity.

Controlling these risk factors, even in middle-aged individuals,
through lifestyle changes, medical treatment, or public health
interventions, may reduce CHD incidence by almost one-half.