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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 Allison Cardiovascular Diseases and Internal Medicine Mayo Clinic Rochester, 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 Rheumatic heart disease, and risk factors infections, nutritional cardiomyopathies Example Sub-Saharan Africa Congo • 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 Prominent CV diseases and risk factors Rheumatic heart disease, infections, nutritional cardiomyopathies, hypertensive heart disease, hemorrhagic strokes Example Bangledesh Bengladesh • 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 Prominent CV diseases and risk factors All forms of stroke, ischemic heart disease at young ages, increasing obesity and diabetes Regional examples Eastern Europe Transition Factors → More educated public Increased spending on medical care Secondary 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 Smoking 1965 42% 20% Hypertension 1960-2 37% 20% Cholesterol > 240 1960-2 32% 18% Diabetes 1960-2 3% 6% * Reported in MMWR 1999;48(30):649-656 Reduction in CVD Death Rate in US [Primary Prevention] [Secondary Prevention] Pre-1985 due largely to lifestyle changes • Smoking cessation • Decreased dietary fat intake, lower cholesterol in population Post-1985 due largely to medical management • Coronary care units • Electrical defibrillators • Thrombolysis • Emergent angioplasty • Medical Rx – Aspirin, beta-blockers, ACE-inhibitors, statins McGovern et al Circulation 2001;104:19-24 CHD Trends McGovern et al, Circulation 2001;104:19-24 Epidemiologic Transition in East Asia Estimated deaths per 100,000 population, 2004 Communicable, maternal, perinatal, nutritional conditions Infectious, parasitic diseases Non-communicable diseases Cardiovascular diseases Ischemic heart disease Cerebrovascular disease Lung cancer Life expectancy male/female Cam 604 VN 143 China 73 ROK 30 303 81 33 420 422 526 174 201 246 61 83 55 47 74 138 15 29 59/65 69/75 72/75 15 488 170 41 98 36 75/82 Changing Distribution of the Causes of Death in Peoples Republic of China Proportion of deaths (%) 100 Unknown Injury Other non-communicable diseases Chronic obstructive pulmonary disease Cerebro-cardiovascular disease Cancer Maternal and perinatal conditions Communicable diseases 80 60 40 20 1973 2005 Year Yang Lancet, 2008 CV Risk Factors Vietnam Mixed Urban and Rural Populations Risk Factor Year Men Smoking tobacco 2003 34.8% 1.8% Cholesterol ≥ 6.2 mmol/L 2001 6.5% 11.7% Diabetes age 55-64 age ≥ 65 SBP ≥140 or DBP ≥90 mmHg 2001 7.6% 2001 11.5% 2002 18.0% 12.4% 18.2% 9.8% Physical inactivity 2003 8.8% 7.7% Women 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 Prevent CV Disease? • Gross national income per capita – Vietnam: $2,310 US: $44,070 • Total expenditure on health per capita – Vietnam: $264 US: $6,347 • Total expenditure on health as % of GNI – Vietnam: 3.0% US: 14.4% • Total expenditure on health as % of GDP – Vietnam: 6.6% US: 15.2% In US we treat coronary disease with devices $93,000 USD $26,000 USD $5,000 USD Some less expensive devices to treat coronary disease $19.95 USD $8.09 USD $5.95 USD Conclusions • 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? ... 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. .. #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,... 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,