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Cvd epidemiology

  1. 1. Epidemiology Of Cardiovascular Diseases Made By : Niteesh Kumar
  2. 2. Introduction Cardiovascular disease (CVD) is now the most common cause of death worldwide. Before 1900, infectious diseases and malnutrition were the most common causes, and CVD was responsible for <10% of all deaths. In 2015, CVD accounted for ~17.9 million deaths worldwide (32%), including nearly 34% of deaths in high-income countries and about 32% in low- and middle-income countries.
  3. 3. Epidemiological Transition The epidemiologic transition, the shift is driven by industrialization, urbanization, and associated lifestyle changes and is taking place in every part of the world among all races, ethnic groups, and cultures. Basic stages of transition are :-  Pestilence and famine,  Receding pandemics,  Degenerative and man-made diseases,  Delayed degenerative diseases  Inactivity and obesity
  4. 4. Proportional mortality in India (% of total deaths, all ages) 2016 Total deaths 9 ,569,000 Diabetes 3% Chronic Respiratory Disease 11% Cancers 9% Cardiovascular Disease 27% Injuries 11% Other NCDs 13% Communicable, maternal, perinatal and nutritional conditions 26%
  5. 5. Key Facts CVDs are most common cause of death globally: more people die annually from CVDs than from any other cause. An estimated 17.9 million people died from CVDs in 2016, representing 31% of all global deaths. Of these deaths, 85% are due to heart attack and stroke. More than 75% of CVD deaths take place in low- and middle-income countries. Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2015, 82% are in low- and middle-income countries, and 37% are caused by CVDs.
  6. 6. Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol using population-wide strategies. People with cardiovascular disease or who are at high cardiovascular risk (due to the presence of one or more risk factors such as hypertension, diabetes, hyperlipidaemia or already established disease) need early detection and management using counselling and medicines, as appropriate.
  7. 7. INDIA 2.59 Million deaths due to CVD in 2016.  India suffers highest loss due to death of patients of productive age (35 – 64 years). Prevalence of CVD is 2-3 times higher in urban population than rural population. Prevalence of IHD among adults was estimated at 96.7/1000 population in urban and 27.1/1000 in rural areas.
  8. 8. Common Risk Factors 1) Inappropriate nutrition – Increased saturated fat ,salt, refined carbohydrates and decreased vegetables and fruits consumption. 2) Lack of physical activity 3) Tobacco consumption 4) High blood pressure 5) Overweight 6) Central obesity 7) Dyslipidaemia 8) Diabetes
  9. 9. Coronary ( Ischaemic ) Heart Disease  It is cause of 25-30 % of deaths in most industrialised countries.  Epidemics of CHD – 1) United State – 1920 2) Britain – 1930  About 7.4 Million deaths due to coronary heart disease in 2016. IHD is the most common, serious, chronic, life-threatening illness in the United States, where 15.5 million persons have IHD, and 3.4 million people aged ≥40 years have angina pectoris.
  10. 10. IHD in India According to studies 1990-2002 on IHD , Prevalence of IHD in urban areas was 6.4% and in rural areas 2.5%. It is estimated that 1,608,700 people died of CHD during2016, of which 1,000,800 were men and 607,800 women. The crude death rate was 121.5/100,000 population.
  11. 11. Risk Factors Non Modifiable Modifiable Age Sex Family History Genetic Factors Personality Cigarette smoking High Blood Pressure Elevated serum cholesterol Diabetes mellitus Obesity Sedentary Habits Stress
  12. 12. Hypertension Hypertension - or elevated blood pressure - is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases. An estimated 1.13 billion people worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. In 2015, 1 in 4 men and 1 in 5 women had hypertension.
  13. 13. Fewer than 1 in 5 people with hypertension have the problem 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 25% by 2025 (baseline 2010).
  14. 14. HTN in India The prevalence of hypertension among men aged 15-49 yrs was somewhat higher than among women, 15% men were hypertensive (10% with stage 1, 2% with stage 2 and 1% with stage 3 hypertension) ; 43% men had normal blood pressure and same percentage were prehypertensive. The prevalence of HTN is higher among Sikhs (24% for men and 16% for women), Jains 19% for men and 16% for women and Buddhist/ Neo-Buddhist men 19% than the rest of the religion groups
  15. 15. The prevalence of HTN among women at 15-49 yrs ranges from 8% in Bihar to 18% in Sikkim and Assam. For men, the prevalence ranges from 6% in Delhi to 31% in Sikkim. For both men and women. the North-eastern states (except Meghalaya for men) have a higher prevalence than the national average.
  16. 16. Risk Factors of HTN Non Modifiable Modifiable Age Sex Genetic factors Ethnicity Obesity Salt Intake Saturated fat & dietary fibre intake Alcohol intake Heart rate Physical activity Stress Socio economic status Others
  17. 17. Strokes ( Cerebrovascular Disease ) In 2016 it was estimated that cerebrovascular disease accounted for 5. 78 million deaths worldwide, equivalent to 10.2% of all deaths. Majority of these deaths occurred in people living in developing countries and 33. 72% of the subjects were aged less than 70 yrs. In demographically developed countries, the average age at which stroke occurs is around 73 years reflecting the older age structure of these countries
  18. 18. Strokes in India The prevalence of stroke appears to be comparatively less in India than in developed countries. In India 0.706 million people died of stroke in 2016 of which 0.372 million were men and 0.334 million were women. The crude death rate of stroke was about 54.2/100,000 population .
  19. 19. Risk Factors for Strokes  Age :- >70 yrs  Sex :- Male > Female  Hypertension  Obesity  Left ventricular hypertrophy  Diabetes  Dyslipidaemia  Personal History
  20. 20. Rheumatic Heart Disease During 2008, There are over 15 million cases of RHD with 282,000 new cases. About 220,000 deaths from this disease occurred which is about 0.4% of total deaths. In India, RHD is prevalent in the range of 5- 7/1000 in 5-15 years age group and there are about 1 million RHD cases in India. RHO constitutes 20- 30% of hospital admissions due to CVD in India.
  21. 21.  The African, South-East Asia and the Western Pacific regions are the worst affected, accounting for 84% of all prevalent cases and 80% of all estimated deaths due to rheumatic heart disease in 2015. India in the South-East Asia Region, has the highest global prevalence, with about 27% of all cases globally. The risk of developing rheumatic heart disease is up to 2 times higher for females than males, and females accounted for 2/3rd with rheumatic heart disease admitted to selected hospitals in 12 countries in the African Region, India and Yemen,
  22. 22. Agent Factors Agent : Group A beta haemolytic Streptococcus with rheumatogenic strain. Its causes onset of rheumatic fever preceded by a streptococcal sore throat. Carriers : Convalescent Transient Chronic carriers
  23. 23. Host & Environmental Factors  Age :- 5-15 yrs but also occur in adults.  Sex :- Equal prevalence but poor prognostic in female.  Socio-economic status : More prevalence in poor.  High risk groups : School age children mainly slum dwellers & those living in closed community.  Immunity
  24. 24. References 1) PSM by K Park 25th edition. 2) Harrison Internal Medicine 20th edition 3) www.who.int/health-topics/cardiovascular-diseases
  25. 25. Thank You