Cardiovascular Diseases (CVD)
BY
Dr Eman Sameh
Assistant professor of preventive
medicine
Cardiovascular Diseases (CVD)
- A disease that affects the heart or blood vessels
- CVD and stroke are rapidly growing problems, and are the major causes of illness and deaths in the Eastern Mediterranean Region, accounting for 31% of deaths.
- In developed countries approximately 50% of deaths are related to cardiovascular diseases mainly ischemic heart disease.
- In Egypt, Cardiovascular disease is the leading cause of death.
CVDs mortality accounts for 46% of total deaths, all ages and both sexes; according to WHO (2014).hypertension prevalence was 40%.
Cardiovascular disease includes
Coronary heart disease (heart attacks) Cerebrovascular disease (stroke),
Raised blood pressure (hypertension) Peripheral artery disease
Rheumatic heart disease Congenital heart disease and heart failure.
Although heart attacks and strokes are major killers in all parts of the world, 80% of premature deaths from these causes could be avoided by controlling the main risk factors: tobacco, unhealthy diet and physical
inactivity.
Why am I at risk?
The decisions you make now will affect your health later in life.
Symptoms may not show up for years
Risk Factors for CVDs
Controllable Tobacco Use
High Blood Pressure High Cholesterol
Sedentary Lifestyle Excessive Weight Stress
Drug and Alcohol Use
Uncontrollable Heredity
Gender
Age
WEB OF CAUSATION
Changes in life style stress
Abundance of food lack of physical activity smoking emotional disturbance
aging
Obesity hypertension
Hyperlipidemia thrombotic tendency
changes artery
walls Coronary arthrosclerosis coronary occlusion
Myocardial infarction
Hypertension
High blood pressure
Can damage heart, blood vessels, and other body organs
Can occur at any age, but more common for people over the age of 35
23% of Americans age 20-74 have hypertension
“silent killer” – no symptoms at early stages Get BP checked regularly
Management
Medication, weight management, adequate physical activity, proper nutrition
Atherosclerosis
The process in which plaques accumulate on artery walls
Build up of plaque causes arteries to thicken and lose their elasticity Clots can form from plaque
If blood flow is stopped to the heart = heart attack
If blood flow is blocked to the brain
= stroke
Heart Attack
Blood flow is blocked to the coronary arteries
Many are sudden and cause intense chest pain
Common symptoms
Pressure, fullness, squeezing, or aching in the chest area
Discomfort spreading to the arms, neck, jaw, upper abdomen, and back Chest discomfort with shortness of breath, lightheadedness, sweating, nausea, and vomiting
Other symptoms
Immediate response and treatment is needed to treat a heart attack
Congestive Heart Failure
Heart gradually weakens
Can result from high blood pressure, atherosclerosis, heart valve defect, or other factors
Strategies for prevention – healthy lifestyle and sometime medication
Stroke
Arterial blockage interrupts the flow of blood to the brain
Severity of stroke depends on which part of the brain lost blood
Hypertension in Pregnancy Why worry?
Common: ~ 10% of pregnancies
Morbidity: fetus: 12% of preterm deliveries
mother: stroke, CHF, renal injury
Mortality: 12-13% of maternal mortality
Pregnancy-Related Mortality United States (1998-2005)
Preeclampsia (12.3%) Other medical
conditions (13.2%)
Embolism (18%) PE (10%) AFE (8%)
Cardiomyopathy (11.5%) CVA (6%)
Anesthesia (1%) Unknown (2.1%)
Hemorrhage (12.5%)
Obstet Gynecol 2010
Cardiovascular disease (12.4%) Infection (11 %)
There are 4 approaches to prevention
Clinical prevention: interventions involving a health care provider and a recipient of care. Clinical prevention services are provided to individuals who may accept or decline the service or the recommended health actions. A physician counselling individual patients to quit smoking is an example of a clinical prevention activity.
Health protection: interventions that reduce health risks by changing the physical or social environment in which people live. Prohibiting smoking in public places is an
example of a health protection intervention
.
Health promotion: interventions that aim at encouraging individual behaviours believed to produce positive health effects and discouraging behaviour that produces negative health effects.
Health promotion interventions frequently take the form of public information campaigns. A media-based antismoking campaign is an example of health promotion; taxation on tobacco products to reduce use is another tool.
Public health policy: social or economic interventions that affect health but do not have health as the main
policy objective .
Primary care physicians at all levels need to integrate both preventive and promotive aspects into their practices.
The comprehensive approach entails providing curative, preventive and rehabilitative care and active involvement of the patients, their families and the community.
Primary health care physicians must also play their part in providing education in healthy living.
Health care workers are thus role models and
leaders in all matters that influence health.
Noncommunicable diseases are frequently under- diagnosed and under-treated.
In Scotland and elsewhere, it has been found that half of hypertensives were undetected; of those detected, half went untreated; and only half of those treated were controlled.
While this “rule of halves” may be improving in recent years for hypertension in some
industrialized countries, it has been found to apply to other chronic diseases and suggests that the
true economic burden could even be higher than
the figures mentioned above.
It has been predicted that mortality from coronary heart disease (CHD) in the United Kingdom could be halved by small changes in cardiovascular risk factors: a 1% decrease in cholesterol in the population could lead to a 2–4% CHD mortality reduction;
a 1% reduction in smoking prevalence could lead to 2000 fewer CHD deaths per year; and
a 1% reduction in population diastolic blood pressure could prevent around 1500 CHD deaths each year.
Prevention
Primary prevention:
1- diet control:
- Avoiding the excess intake of carbohydrate and animal fat.
- Vegetable oils are preferred than animal fat.
- Adequate intake of antioxidant rich foods.
- Regular checking of body weight to avoid overweight and obesity.
2- Quit smoking.
3- Physical activity: walking (40 minute per session) for at least three time per week 4- Mental health promotion: Avoiding stress, worry and mental over activity.
5- Control of oral contraception by screening of females before its use and continuous follow up.
6- Prevention and control of diabetes, hypertension and obesity.
Secondary prevention
Early case finding through periodic medical check up, periodic health appraisal.
Treatment of cases and emphasize the importance of avoiding and minimizing the modifiable risk factors to avoid future attacks.
Cardiovascular diseases:
Treatment
Effective measures are available for people at high risk. For example, combination drug therapy (such as aspirin, beta blocker, diuretic and statin) can lead to a 75% reduction in myocardial infarction (heart attack) among those at high risk of having one.
But many such interventions are not being
implemented, and about half of coronary patients in the world still require more intensive blood
pressure management.
