Coronary Artery Disease
Transkript
Coronary Artery Disease
Prevention in Coronary Artery Disease 2011 Treating the Turkish Patient: Is he different? Prof. Mehdi Zoghi-Ege University, İzmir καλωσόρισμα WELCOME Cardiovascular disease (CVD) is a major cause of death throughout the world. 5 HIV AIDS 14 Pulmonary Akc hast. disease 19 İnfeksiyonlar Infections 24 Kanser Cancer 52 KVH CVD 0 10 20 30 40 50 60 The World Health Report 2004 Primary health care : Now more than ever Percentage of the population citing health as their main concern before other issues, such as financial problems, housing or crime. Health is among the top personal concerns ! The world health report 2008 1 of every 3 deaths Total CVD† $368 Heart disease $239 Coronary heart disease $133 Hypertension $56 Stroke $54 Congestive heart failure $29 0 50 100 150 200 250 300 350 400 Billions of dollars CVD=Cardiovascular disease NHLBI. www.nhlbi.nih.gov Coronary Artery Disease (CAD) in Turkey • New CAD: 300.000/year • CAD Mortality: 170.000/year • STEMI: 80.000/year Turkish Adult Risk factor Study A. Onat Atherosclerosis Risk Factors 2001;156,1-10 Think about where you're going to be in Death per 100,000 population 2050 50 40 45,2 Over 60 y Over 80 y 30 20 8,5 10 0 1999 Death per 100,000 population 2050 100 90 80 70 60 50 40 30 20 10 0 97 Over 60 y Over 80 y 30 45,2 8,5 1999 2050 (estimate) • The underling pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms occur, generally in middle age. The major risk factors for CVD are well established, with the principal three modifiable factors being hypertension, dyslipidemia and smoking. Primary prevention can help prevent 80% of coronary heart disease. Two complementary strategies that are usually advocated for primary prevention: The population strategy aims to reduce the burden of disease in the whole community while conferring small benefits to each individual. The high-risk strategy, provides large benefits to the few individuals who are most vulnerable but the benefits to the whole community may be relatively limited because the beneficiaries are few. Risk prediction charts enable the estimation of total cardiovascular risk of people in the first category. Total cardiovascular risk means the likelihood of a person developing an atherosclerotic cardiovascular event over a defined period of time. Both community-based primary prevention and secondary prevention are needed for effective CVD prevention and control ON TARGET 55 yrs Cigarette smoking, Family history (+) BP: 135/80 mmHg, TC: 280 mg/dl, LDL-C: 130 mg/dl, HDL-C:35 mg/dl, Blood glucose: 90 mg/dl, microalbuminuria (-) ECG: Normal Echocardiography: Normal ON TARGET 10-year risk for developing CHD http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof ON TARGET Individual counseling and provision of care may have to be prioritized according to cardiovascular risk. Risk <10% Individuals in this category are at low risk. Conservative management focusing on lifestyle interventions is suggested. Risk 10% to <20% Individuals in this category are at moderate risk of fatal or non-fatal vascular events. Monitor risk profile every 6–12 months. Risk >20% Individuals in this category are at high risk of fatal or non-fatal vascular events. Monitor risk profile every 3–6 months. Risk factor screening Adults should know the levels and significance of risk factors as routinely PRESENTATION NAME assessed by their primary care provider. Company name Prevention in Coronary Artery Disease 2011 Turkish Patient: Is he different? EUROASPIRE : European Action on Secondary and Primary Prevention by Intervention to Reduce Events The EUROASPIRE III survey was conducted in 2006-2007 in 22 countries in Europe to describe risk factors, lifestyle and therapeutic management of patients with coronary heart disease (CHD), compliance with current guidelines, and to document changes over time. 1. Belgium 2. Bulgaria 3. Croatia 4. Cyprus 5. Czech Republic 6. Finland 7. France 8. Germany 9. Greece 10.Hungary 11.Ireland 12.Italy 13.Latvia 14.Lithuania 15.The Netherlands 16.Poland 17.Romania 18.Russian Federation 19.Slovenia 20.Spain 21.Turkey 22.United Kingdom EUROASPIRE : European Action on Secondary and Primary Prevention by Intervention to Reduce Events Eur J Cardiovasc Prev Rehabil. 2009 Apr;16(2):121-37 1. Belgium 2. Bulgaria 3. Croatia 4. Cyprus 5. Czech Republic 6. Finland 7. France 8. Germany 9. Greece 10.Hungary 11.Ireland 12.Italy 13.Latvia 14.Lithuania 15.The Netherlands 16.Poland 17.Romania 18.Russian Federation 19.Slovenia 20.Spain 21.Turkey 22.United Kingdom Records from Turkish centers: Compared to the EUROASPIRE III data, classical risk factors did not exhibit remarkable differences. Tokgözoğlu L et al. Turk Kardiyol Dern Ars. 2010;38(3):164-72 EUROASPIRE III survey-Turkish Data The most important differences were observed in the higher rates of the following: • Young patients with myocardial infarction (<50 years, 20% vs. 12.7%), • Persistence in smoking (23.1% vs. 17.2%), • İmmobility, • Low HDL-cholesterol • Insufficient follow-up by physicians after the index event (12% vs. 2.2%), and • Insufficient patient education. Tokgözoğlu L et al. Turk Kardiyol Dern Ars. 2010;38(3):164-72 HDL was low in half of pts Europe (n=8966) Turkey (n=338) Obesity 35,3 35,5 High BP 56.0 55.2 High Cholesterol 51.1 48.3 Low HDL 36.7 50.2 Diabetes 34.8 33.6 Risk Factor Tokgözoğlu L et al. Turk Kardiyol Dern Ars. 2010;38(3):164-72 HDL Female:46.0 vs 49.5 mgr/dl Male: 39.4 vs 43.3 mgr/dl 1. Romania 2. South Cyprus 3. Turkey . . . . Tokgözoğlu L et al. Turk Kardiyol Dern Ars. 2010;38(3):164-72 2 Reasons for Low HDL in Turkish Population International Physical Activity Questionnaire Europe (n=8966) Turkey (n=338) Low 54.4 23.1 High 39.4 10.5 Physical Activity PREvention and CONtrol Program for Cardiovascular Diseases in TuRkish POpuLation (PRE-CONTROL) 1) The level and distribution of cardiovascular risk factors in our population, 2) The knowledge and awareness of participants about CVD 3) The evaluation of the effectiveness of prevention education program on awareness of CVD in urban population of Turkey EUROPREVENT 2011 A 24-item questionnaire form was used for detecting cardiovascular risk factors and the awareness of participants about CVD which was concerning personal and family history of disease, education levels, lifestyle factors and heart attack or stroke medications. The Joint British Societies’ cardiovascular disease risk prediction chart was used for investigating cardiovascular risk levels (low risk < 10%; intermediate risk 10-20%; high risk > 20%) of participants. Education programs feed-back data were collected by questionnaires and individual interviews of participants after 2 weeks of education seminars by telephone surveys. Total cardiovascular risk Moderate-High Low 80 70 60 50 76,4 40 30 20 10 0 23,6 Risk Score % ÖMER Kozan, MEHDİ Zoghi, GÜLAY Güven Sain, M Arıcı, ÜLVER Derici, GÖKSEL Bakaç, SEVİM Güllü, OKTAY Ergene on behalf of PRE-CONTROL study investigators, Presented in EUROPREVENT 2011 Although the cardiovascular risk is high (moderate or high risk rate was 74.6%) the knowledge and awareness of the risk factors for cardiovascular disease are low in our community. L RO T ON -C E PR • Only 21% of participants with cardiovascular risk score more than 10% have visited any physician within last year. The awareness of cardiovascular diseases and risk factors was significantly increased following our education programs. Community-based educational L RO T ON -C E PR programs are helpful to increase public awareness, health promotion and management of cardiovascular diseases. ÖMER Kozan, MEHDİ Zoghi, GÜLAY Güven Sain, M Arıcı, ÜLVER Derici, GÖKSEL Bakaç, SEVİM Güllü, OKTAY Ergene on behalf of PRE-CONTROL study investigators, Presented in EUROPREVENT 2011 You can’t change everything Risk Factor 5% 10% Sex: Male Male Age (yrs): 36 50 Smoker: - - Diabetes: - - Blood Pressure: 130/80 130/80 Total Cholestrol 200 200 HDL Cholesterol: 36 36 Brigitte Bardot Marlon Brando Gregory Peck Madonna Ajda Pekkan (Famous Turkish Pop Singer) Demis Roussos Σας ευχαριστώ για την προσοχή σας